Diseases of the vitreo-macular interface

Abstract

A pathological vitreomacular adhesion is a common pathogenetic mechanism of various clinical entities such as idiopathic epimacular membrane, vitreomacular traction syndrome, and macular hole. Vitrectomy is recommended for these disorders. Anatomical and functional results in 207 operated eyes are discussed. The results of a vitrectomy in 3 groups of patients were compared: idiopathic epimacular membrane (group 1, n = 52), vitreomacular traction syndrome (group 2, n = 48); macular hole (group 3, n = 107; 33 eyes without and 74 eyes with retinal detachment). After excision of the vitreous gel, a thin layer of epimacular vitreous cortex was identified and excised by gentle aspiration under continuous air infusion. In 50 of the 107 eyes of group 3, the vitrectomy was combined with the application of a drop of autologous blood to the macular hole. A vitreomacular adhesion existed in 56% of group 1, 74% of group 2, and 84% of group 3. The visual acuity improved in 54%, 62% and 50% of eyes of the 3 groups, respectively. More eyes with an initial visual acuity of at least 40/200 achieved final vision of 80/200 or better (57%, 65% and 48% of group 1 to 3, respectively) than eyes with acuities of less than 80/200. A postoperative cataract was the main reason for reduced visual results in all cases. In group 3-eyes with retinal detachment and/or myopia, a significant postoperative visual improvement was achieved only after application of autologous blood to the macular hole. A pathological vitreomacular adhesion was identified in the majority of patients with idiopathic epimacular membranes, vitreomacular traction syndrome, and macular hole, respectively. Vitreoretinal surgery for syndromes with vitreomacular traction is indicated as it warrants a significant improvement of visual function and relief of metamorphopsia.