The authors attributed the VMTR associated with IVIs of expansile gas to the internal massaging action of the bubble over VMT. 13 showed in a meta-analysis that IVIs of expansile gas induced a higher rate of VMTR (87.5%) in comparison with IVIs of ocriplasmin (42.9%) at day 28. 12 showed that 52% of eyes with VMTR received IVIs of anti-VEGF during the observation period (mean of 9.1 ± 8.9 injections during 13.7 ± 11.4 months) versus only 13% of eyes in the group of persistent VMT (mean of 2.8 ± 1.8 IVIs during 10.0 ± 6.6 months). Plus, previous IVIs of anti-VEGF has been associated with a higher incidence of VMTR. Visual improvement and VMTR rate (50% with ocriplasmin versus 100% with PPV) were better with vitrectomy. 11 showed macular structural changes and subretinal fluid in the eyes treated with ocriplasmin, not seen in eyes that had PPV. Although a biological effect is attributed to ocriplasmin the authors admitted some treatment response to placebo injections. 10 showed that IVIs of 0.1 ml of saline resulted in VMTR in 10.1% of eyes compared with 26.5% of VMTR in eyes treated with IVIs of ocriplasmin at day 28. IVIs produces hyperhydration of the vitreous and transient IOP elevation. Otherwise, it is known that internal vitreous manipulation effected through IVIs can induce VMTR. Thus, in the present clinical case VMTR, that occurred 4 days later, seemed rather to be related to mechanical effects of external OM. recently observed that only 20% of 183 eyes with VMT resolved spontaneously in a 17.4-month follow-up period (occurring on average at 15 months with a range between 1 and 48 months). 6 noted that 43% of eyes affected with VMT (20 out of 46 eyes) presented a spontaneous VMTR during a median follow-up period of 594 days (longer than 19 months), most of them after 6–12 months of observation, being the median duration from baseline examination to the VMTR of 375 days. 8 In our case the diameter of VMT was very narrow (114 μm). Focal VMT has also been associated to a better final visual acuity after PPV. They also found that when the horizontal diameter of VMT is narrow (<400 μm), a greater force is exerted upon the fovea, which facilitates the VMTR. 5 demonstrated that 28.5% of VMTs (12 out of 46 eyes) proceeded to spontaneous resolution during a mean follow-up of 8.75 ± 6.06 months. found that only 30.23% of VMTs (13 out of 43 eyes) without intraretinal cysts or clefts and 30.35% (17 out of 56 eyes) with intraretinal cysts or clefts released spontaneously after a median follow-up period of 18 months.

It is very unlikely that VMTR had occurred spontaneously because this possibility has been described to happen many months (but not few days) after the diagnosis and in a moderately low percentage of eyes, according to the results of recent studies concerning the natural course of VMT. 3 All these changes may had helped to achieve VMTR in this patient.

2 Vitreous rehydration and subsequent IOP recovery occurs after some minutes. Besides, a diminution in the volume of the vitreous with a reduction of intraocular pressure (IOP) due to vitreous water loss (dehydration) is observed after OM. OM induces an intermittent vitreous movement and probably a mechanical tension/distension cycle over the VMT. In this case, OM was performed with the aim of solving the disorder.

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