Vitreomacular Traction and Epiretinal Membranes

Abstract

Optical coherence tomography (OCT) has transformed the understanding of the anatomy of the vitreomacular interface (VMI) and pathologic processes that occur there. Since the first description of macular diseases with OCT in 1995, progressive advances in technology have made OCT the gold standard for the diagnosis and management of VMI diseases (Puliafito et al. 1995; Stalmans et al. 2013). Clinical biomicroscopic examination and other imaging modalities are limited in their capabilities to fully diagnose and document diseases of the VMI as vitreous membranes are often clinically invisible. Spectral domain OCT (SD-OCT) provides high-resolution images of the VMI with noninvasive capture and fast acquisition. SD-OCT enables the clinician to more accurately diagnose diseases of the VMI, informs treatment, and guides postoperative care (Folgar et al. 2012). The approval of ocriplasmin (Jetrea, ThromboGenics, Iselin, New Jersey) for pharmacologic vitreolysis of “symptomatic vitreomacular adhesion” has further stimulated interest in understanding the pathophysiology of the VMI (FDA 2012). These developments led to the formation of the International Vitreomacular Traction Study (IVTS) Group to create a strictly anatomic OCT-based classification system for the VMI and more specifically the vitreomacular interface (VMI) (Duker et al. 2013). The panel of vitreoretinal disease experts provided anatomic definitions and classification of vitreomacular adhesion (VMA), vitreomacular traction (VMT), and full-thickness macular hole (FTMH). This classification system and the science upon which it is based inform the current diagnosis and management of diseases of the VMI.