К вопросу о создании современной единой классификации хирургической патологии витреомакулярного интерфейса

Abstract

The progress of modern methods the vitreomacular interface (VMI) visualization, clinical and histopathological studies are constantly expanding our understanding of the course of the macular pathological process. At the same time, the diagnostic and classification schemes we use may lose their relevance without reflecting the pathogenesis of the disease, complicating the choice of treatment tactics, and also complicating professional communication when we using various classification approaches. Aim. To offer our views on the possibility of creating a unified clinical classification of primary surgical pathology of VMI. Material and methods. Research papers related to the surgical pathology of VMI were analyzed. Results. The main role in the development of VMI pathology belongs to the vitreous body and the changes that occur in it, leading to posterior vitreous detachment (PVD). Pathological PVD is a variant of vitreomacular adhesion: vitreoschisis or separation of the entire thickness of the posterior cortex with the presence of local vitreoretinal fixation. In the first case, an epiretinal membrane (ERM) develops, which can progress to an ERM with macular pseudohole or to an ERM with foveoschisis. In the second case, pathological PVD is realized in vitreomacular traction (VMT). Depending on various factors, VMT can resolve both asymptomatically and with the formation of a defect in the retinal tissue, leading to outer lamellar macular hole (outer LMH) and the subsequent formation of a full-thickness macular hole (FTMH). If the traction does not cause strong changes, then it, disrupting the architectonics of the retina, triggers the processes leading to the LMH (which was previously called degenerative LMH), and it, in turn, in rare cases, can also become FTMH. Conclusions. We proposed the combined clinical classification scheme of VMI primary surgical pathology, which more fully reflects modern ideas about pathogenesis and allows, based on OCT data, to more clearly differentiate macular changes requiring a various surgical approach. Key words: PPV, vitreomacular interface, classification, VMT, epiretinal membrane, ERM, pseudohole, macular hole.