Incomplete Posterior Vitreous Detachment Research Articles

Risk factors and patterns for progression of fellow-eye myopic traction maculopathy: a 3-year retrospective cohort study

AimsTo investigate the effect of preretinal tractional structures (PTS) and posterior scleral structures (PSS) on myopic traction maculopathy (MTM) progression.MethodsThis retrospective cohort study included 185 fellow highly myopic eyes of...

Tractional Retinal Detachment in Eyes with Vitreous Hemorrhage and Proliferative Diabetic Retinopathy and Posterior Vitreous Detachment in Fellow Eye.

To predict the presence of tractional retinal detachment (TRD) in eyes with dense vitreous hemorrhage (VH) and proliferative diabetic retinopathy (PDR) by evaluating the status of posterior vitreous detachment (PVD) in fellow eyes using optical coherence tomography (OCT). A total of 44 eyes from 22 patients who underwent vitrectomy due to dense VH with PDR were enrolled. Using OCT, the PVD status in the fellow eye was divided into two groups (incomplete and complete PVD). The incomplete PVD group included eyes without PVD and eyes with partial PVD. B-scan ultrasonography was performed on eyes with dense VH to evaluate the presence of TRD. Both OCT and B-scan images were reviewed by four ophthalmologists (two novices and two experienced), and the interobserver agreement was evaluated. There was a difference in the interobserver agreement regarding the presence of TRD in eyes with dense VH evaluated by B scan between novice and experienced ophthalmologists (novice, κ = 0.421 vs. experienced, κ = 0.814), although there was no difference between novice and experienced ophthalmologists in the interobserver agreement regarding the status of PVD in the fellow eye evaluated by OCT (novice, κ = 1.000 vs. experienced, κ = 1.000). All observed TRD during vitrectomy occurred in eyes with incomplete PVD in the fellow eye. Logistic regression analysis revealed a statistically significant relation between TRD and the age of the patient (odds ratio [OR], 0.874; p = 0.047), and between TRD and incomplete PVD in the fellow eye evaluated by OCT (OR, 13.904; p = 0.042). Evaluation of the PVD status in the fellow eye using OCT may be a useful predictor for detecting the presence of TRD in eyes with dense VH and PDR.

Changes in the vitreous body after experimental vitreous hemorrhage in rabbit: An interdisciplinary study.

To explore the changes in vitreous body after vitreous hemorrhage and assess its prognosis from the perspective of vitreoretinal interface. The experiment was performed on 32 New Zealand rabbits (64 eyes), weighing 2500-3000 g for 4 months and unlimited gender, which was injected with 0.2 mL of autologous blood into the center of vitreous cavity-the study group (right eyes), and the control one was treated in the same manner with equal volumes of saline. The rabbits were randomly and equally divided into the following four batches according to the days of observation: Days 3, 7, 14, and 30 after injection. IOP and severity grading were evaluated before rabbits' execution and eyeballs were enucleated. The anterior segment was separated to flow out the vitreous body naturally to detect the liquefaction degree and viscosity. Then, chemical composition of electrolytes, PCT and bFGF were determined by colorimetry and enzyme-linked immunosorbent assay (ELISA). Finally, the incidence of posterior vitreous detachment (PVD) was observed after vitreous sampled. The studies were double-blind. After injection, the extent of vitreous opacity and coagulum size decreased over time. Both the degree of liquefaction and the length of tow differed significantly between two groups at different time points (all p < 0.001). The liquefaction degree in the study group rose obviously from the Day 14, which the viscosity declined significantly on the initial time. Biochemical markers fluctuated temporarily, except for basic fibroblast growth factor (bFGF), which continued to rise and was correlated with the liquefaction degree (r = 0.658, p < 0.001). Besides, the incidence of PVD increased from the 14th day (p < 0.05), and it was highly positively correlated with the number of macrophages (r = 0.934; p < 0.001). After vitreous hemorrhage, the changes of the vitreous body are relatively minor earlier (2-4 weeks), but irreversible later. Specifically, the degree of liquefaction increases with a decrease in viscosity, and the chemotaxis of macrophages and bFGF induce incomplete PVD.

Relationship Between Paravascular Abnormalities and Choroidal Thickness in Young Highly Myopic Adults.

PurposeThe purpose of this study was to investigate the clinical characteristics of paravascular abnormalities (PVAs) and retinoschisis, and their associations with choroidal thickness (ChT) in young highly myopic (HM) adults.MethodsA total number of 645 eyes were included. Paravascular microfolds (PMs), paravascular cystoid spaces (PCs), paravascular lamellar holes (PLHs), and retinoschisis were detected using swept-source optical coherence tomography. Their associations with macular ChT and risk factors were analyzed.ResultsPMs, PCs, and PLHs were detected in 203 (31.5%), 141 (21.9%), and 30 (4.7%) eyes, respectively. Retinoschisis was found in 50 (7.8%) eyes, 43 (86.0%) of which were located around the retinal vessels surrounding the optic disc. A decreasing trend of macular ChT (P < 0.001) was observed in the eyes with PMs only, with both PCs and PMs, and with PLHs, PCs, and PMs. After adjustments for age, sex, and axial length (AL), the presence of PCs, PLHs, or retinoschisis around the optic disc was negatively associated with macular ChT (all P < 0.05). Eyes with longer AL, incomplete posterior vitreous detachment (PVD), and myopic atrophic maculopathy (MAM) were more likely to have PCs (all P < 0.01) and retinoschisis around the optic disc (all P < 0.05).ConclusionsPVAs were observed in approximately one third of the young HM adults in this study. The presence of PCs, PLHs, or retinoschisis around the optic disc was associated with thinner macular ChT. Eyes with longer AL, incomplete PVD, and MAM may be at risk of developing PVAs and retinoschisis around the optic disc.Translational RelevancePCs, PLHs, and retinoschisis around the optic disc could serve as early indicators for myopia progression.

Vitreoretinal interface anomalies in patients with a history of toxoplasmosis retinochoroiditis.

To evaluate vitreoretinal interface anomalies over time in patients diagnosed with toxoplasmosis retinochoroiditis (TRC) and progression of the chronic disease. Retrospective clinical study. The clinical records of 36 patients with TRC were studied retrospectively. All patients underwent standard ophthalmological examinations and optical coherence tomography (optical coherence tomography: OCT). Vitreoretinal interface changes and retinal layers in the macula and lesion area were evaluated. The fovea was involved in 9 (25%) patients. OCT of the scar region showed retinal layer thinning and disorganization in all cases. Complete posterior vitreous detachment (PVD) was detected in 9 (25%) cases, incomplete PVD in 22 (61%) cases and no PVD in 5 (13.8%) cases. In 23 (63%) of the 36 patients with inactive TRC lesions, an epiretinal membrane (ERM) was detected by follow-up OCT, i.e., in 14 (60%) patients with incomplete PVD, 8 (34.7%) with complete PVD, and 1 (4%) with no PVD. Vitreoschisis was found in 5 of 22 patients with incomplete PVD; an ERM developed in 4 of these 5 patients. No ERM developed only in the macula, i.e., independent of the TRC scar region. Vitreoretinal interface anomalies are common in patients diagnosed with TRC, including those with incomplete PVD. We observed no progression of vitreoretinal interface anomalies during the follow-up of patients diagnosed with TRC.

Relationship Between Posterior Vitreous Detachment and Macular Dimensions in Myopic Eyes.

BackgroundPosterior vitreous detachment (PVD) can result in serious pathologic events at the vitreoretinal interface. This study aims to assess the relationship between PVD, macular thickness (MT), and the foveal avascular zone (FAZ) in myopic eyes.MethodsThis retrospective study evaluated 63 myopic subjects’ data who were examined between January 1 and June 30, 2019. The myopes were grouped on a severity scale, namely mild, moderate, high, and very high using their spherical equivalent (SE). The PVD classification was based on OCT images. The status of the PVD and MT were evaluated with the Macular Cube 200×200 images, the FAZ with an OCTA Angioplex, and the dimensions were calculated using a customized algorithm.ResultsThe study population (114 eyes) had a median (range) age was 26.00 (22.00–28.00) years and the females constituted 62.3% of the dataset. In this population, 10 eyes had no PVD in any quadrant, and 73 eyes had incomplete PVD in all four quadrants. The inferior quadrant had the maximum rate of PVD occurrences and the nasal quadrant had the least number of occurrences. High myopic eyes exhibited significantly increased low foveal volume (p = <0.01). The inferior part of the para- and perimacular area showed a significant thinning in very high myopic eyes (p = <0.050). The very high myopic eyes showed a significant alteration of FAZ’s circularity index (p = 0.002).ConclusionIn high and very high myopic eyes, an increasing trend of partial PVD is seen, most commonly in the inferior quadrant. A significant alteration in foveal volume and circularity index of the FAZ is seen in high and very high myopic eyes.

Vitrectomy With Peeling the Internal Limiting Membrane for the Treatment of Macular Hole Following Ruptured Retinal Arterial Macroaneurysm: A Case Report

Background: This study aimed to report a case of vitrectomy with peeling the internal limiting membrane for the treatment of macular hole (MH) following ruptured retinal arterial macroaneurysm (RAMA).Case Presentation: A 65-year-old woman noticed a sudden decrease in vision in the left eye. She had no other ocular problems apart from a mild cataract in both eyes before. Her best-corrected visual acuity (BCVA) was 20/33 in the right eye, and 6/100 in the left eye. Fluorescein angiography (FFA) showed a retinal arterial macroaneurysm with telangiectatic retinal vascular changes in the inferior temporal macular region. Optical coherence tomography (OCT) examination demonstrated the presence of subretinal hemorrhage extending into the foveal area and incomplete posterior vitreous detachment. Because of the presence of submacular hemorrhage, some medicine was administrated and the patient was followed up. Then, 5 months later, the hemorrhage was absorbed. OCT examination exhibited a full-thickness MH with a macular epiretinal membrane. The size of the MH was 722 μm in diameter. She was then given a standard three-port pars plana vitrectomy (PPV), along with peeling of the internal limiting membrane (ILM) and filling the vitreous cavity with air. Anatomic closure of the MH was achieved after 4 weeks of the surgery by the examination of OCT. The BCVA was improved to 15/100.Conclusions: This case expanded our knowledge of the association of MH secondary to ruptured RAMA. We reported a case with successful surgical closure of the MH and improvement of BCVA.

Is pseudoexfoliation syndrome associated with vitreoretinal interface abnormalities?

To evaluate vitreoretinal interface abnormalities in patients with pseudoexfoliation (PEX) syndrome. This case-control study was performed in 136 patients diagnosed with unilateral PEX (PEX group) and 139 age- and sex-matched healthy volunteers (Control group). Both the affected and contralateral eyes were evaluated in the PEX group and the right eye was evaluated in the Control group. Vitreoretinal interface abnormalities and posterior vitreous detachment (PVD) were evaluated on optical coherence tomography (OCT) examination. The incidences of incomplete and complete PVD were significantly higher in the affected than contralateral eye in the PEX group and in the right eye in the Control group (P = 0.009, P = 0.012 and P = 0.004, P = 0.017, respectively). The rates of 'no PVD' were significantly higher in the contralateral eye in the PEX group and the Control group compared to the affected eye in the PEX group (P = 0.003 and P = 0.001, respectively). The odds ratio for incomplete PVD was 3.1 in PEX eyes compared to the contralateral eye in the PEX group and 3.9 compared to the Control group. The rate of epiretinal membranes (ERMs) in the affected eye was significantly different from the contralateral eye in the PEX and Control groups (P < 0.001 and P < 0.001, respectively). The odds ratio for ERM in PEX eyes was 3.51 compared to the contralateral eye in the PEX group and 4.23 compared to the Control group. In the presence of incomplete PVD, the odds ratio for ERM development was 3.81 in PEX eyes. We detected high rates of ERMs and incomplete PVD in patients with PEX. It is important to evaluate and follow up PEX cases in terms of vitreoretinal interface abnormalities.

Intravitreal application of epidermal growth factor in non-exudative age-related macular degeneration

PurposeTo assess the safety of intravitreally applied epidermal growth factor (EGF).MethodsThe clinical interventional, prospective, single-centre, case series study included patients with age-related macular degeneration-related geographic atrophy (GA), in whom the...

Spontaneous resolution of vitreomacular traction

Vitreomacular traction (VMT) is an ocular condition which involves the vitreoretinal interface, and is characterised as an incomplete posterior vitreous detachment with residual adhesions of the vi...

Structural Retinal Assessment Using Optical Coherence Tomography and Fundus Fluorescein Angiography in Systemic Lupus Erythematosus Patients.

Ocular manifestations in systemic lupus erythematosus (SLE) can be the presenting symptom of the disease or a sight-threatening complication. To detect different structural retinal changes in patients with SLE who had no ophthalmological symptoms and investigate the relationship between different retinal changes and the disease activity assessed by the Systemic Lupus Erythromatosus Disease Activity Index score. A descriptive pilot study from January 2016 to January 2017. Fifty-two eyes of 26 patients diagnosed to have SLE were examined using visual acuity assessment, fundus examination, optical coherence tomography (OCT), and fundus fluorescein angiography (FFA). Fundus fluorescein angiography showed different changes in the form of venular occlusion and optic nerve leakage. There were also degenerative changes in the form of alternating hyperfluorescent and hypofluorescent areas outside the arcades as well as peripapillary areas and capillary dropout. Optical coherence tomography detected signs of degenerative thinning, incomplete posterior vitreous detachment, and epiretinal membrane. A significant correlation was found between SLE activity and the changes detected by FFA (p = 0.017). However, there was no significant correlation between disease activity and changes detected by OCT. Optical coherence tomography changes were significantly correlated with the duration of hydroxychloroquine use of more than 5 years (p = 0.032). There was no correlation between FFA or OCT changes and proteinuria or antiphospholipid antibodies. Fundus fluorescein angiography is more sensitive in detecting early subclinical retinal changes in patients with SLE, which correlates with disease activity, whereas OCT is more sensitive in detecting changes resulting from hydroxychloroquine use.

Vitreomacular Traction and Outer Retinal Structural Changes

In this case report we aimed to present the outer retinal structural changes secondary to vitreomacular traction (VMT). Outer retinal structural changes occurring secondary to VMT due to incomplete posterior vitreous detachment were described retrospectively with spectral-domain optical coherence tomography in 3 eyes of 3 patients. The patients ranged in age from 58 to 65 years and best corrected visual acuity in the 3 eyes was 4/10, 8/10, and 9/10. All of the patients were symptomatic and exhibited outer retinal microholes at the fovea extending from the retinal pigment epithelium to outer limiting membrane, with an overlying operculum on the detached posterior hyaloid membrane over the macula following spontaneous resolution of VMT. In the mean follow-up period of 32 months, the outer retinal microholes decreased in size but did not completely resolve. As demonstrated in these cases, VMT can cause small outer retinal layer defects without signs of full-thickness macular hole. These lesions can cause symptoms and affect visual function, and may be permanent structural changes.

Pharmacotherapy of Vitreomacular Traction.

Vitreomacular traction occurs due to incomplete or anomalous posterior vitreous detachment. Over time, the vitreous pulls anteriorly and causes retinal distortion and eventually reduced vision. Traditionally, vitreomacular traction was treated with vitrectomy surgery. In the past few years, there is a paradigm shift towards pharmacologic vitreolysis, which involves the intravitreal injection of enzymatic and non-enzymatic agents that facilitate posterior vitreous detachment. Many agents have been investigated and trialled including plasmin, microplasmin (Ocriplasmin), hyaluronidase, nattokinase, chondroitinase and dispase. This review will focus on the progress and current status in this research.

DEVELOPMENT AND PROGRESSION OF A LAMELLAR MACULAR HOLE WITH LAMELLAR HOLE–ASSOCIATED EPIRETINAL PROLIFERATION

To describe evolution and progression of a lamellar macular hole (LMH) with "lamellar hole-associated epiretinal proliferation (LHEP)" using spectral-domain optical coherence tomography and fundus autofluorescence. Observational case report. We report on a 63-year-old male patient demonstrating a complete history of LMH development with LHEP occurring during a follow-up period of 8 years. Presenting with a normal foveal contour and attached posterior vitreous at first visit, an LMH developed shortly after incomplete posterior vitreous detachment with vitreopapillary adhesion. On spectral-domain optical coherence tomography images, progression of the LMH including enlargement of the intraretinal cavitation and decrease in the retinal thickness were documented. An increase of LHEP was first documented 6 months after LMH evolution. One month after cataract surgery and 6 years after the first visit, a full-thickness macular hole developed that closed spontaneously after 4 weeks. Localization of LHEP had moved into the foveal defect toward the outer retinal layers. Thereafter, the LMH was stable, and the patient presented with a visual acuity of 20/25. Proper follow-up time is important for studying eyes with an LMH. Epimacular cell proliferation shows progression over time that appears to be associated with morphologic changes of the LMH including shape of the lamellar defect, amount of LHEP, and contractive properties of epiretinal tissue. The presence of LHEP was documented shortly after posterior vitreous detachment.

Vitreomacular Adhesion, Vitreomacular Traction, and Concurrent Diseases

The introduction of the optic coherence tomography in ophthalmology has been enabled us to understand the relationship between vitreomacular interface pathologies and concurrent retinal diseases. It is known that vitreomacular adhesion (VMA) and traction (VMT) develops as a result of an incomplete posterior vitreous detachment. VMA/VMT usually coincidence with age-related macular degeneration, diabetic macular edema, and retinal vascular occlusions. Some studies suggested that the complete posterior vitreous detachment is protective against these kinds of retinal diseases. It is proclaimed that VMA/VMT may have a role in the etiology and progression of these retinal diseases. And also, in the majority of the studies, it is proposed that VMA/VMT may interfere with the treatment and even worsen the result of the anti-vascular endothelial growth factor (Anti-VEGF) therapy which is used within the treatment regime of these retinal diseases. It is obvious that further studies are needed to clarify the cause-result relationship and the effectiveness of the treatment for the concurrent retinal diseases.

Vitreomacular Traction Following Anti-VEGF Therapy - Two Cases

Vitreomacular traction syndrome (VMTS) is defined as an incomplete or anomalous posterior vitreous detachment resulting in tractional forces at the macular region. In the context of anti-VEGF therapy, the formation of vitreoretinal traction has mainly been reported as a potential complication of VEGF inhibition in ischemic proliferative retinal disease, such as proliferative diabetic retinopathy. In this report, we present two patients who developed VMTS during anti-VEGF therapy for exudative age-related macular degeneration and diabetic macular edema. VMTS following anti-VEGF therapy of exudative macular diseases is rare. The exact pathomechanism remains unclear. However, there is a hypothesis that in eyes with adherent vitreous cortex, the induction of fibrosis as a result of the VEGF inhibition may lead to vitreomacular traction.

Spectral domain optical coherence tomography and B-scan ultrasonography in the evaluation of retinal tears in acute, incomplete posterior vitreous detachment.

BackgroundThe purpose of this study was to evaluate the extension and traction effects of posterior vitreous detachment (PVD) complicated with retinal tears using spectral domain optical coherence tomography (OCT) and B-scan ultrasonography.MethodsComplete ophthalmological examination, B-scan ultrasonography and spectral domain OCT were performed in patients with acute PVD and retinal tears. Vitreous detachment was classified as complete or incomplete, based on extent of posterior pole or peripheral vitreous detachment. Retinal tear location and persistent traction on the retinal flap was evaluated with B-scan ultrasonography and OCT. Categorical data were evaluated with Fisher’s exact test. Statistical significance was considered as P < 0.05.ResultsTwenty-six eyes of 25 patients were assessed. Four eyes (15 %) presented complete PVD with detachment at the posterior pole and periphery. 22 eyes (85 %) presented incomplete PVD with detachment in the periphery. Twenty eyes presented retinal tears in the superior quadrants with respect to only 6 in the inferior quadrants (p = 0.006). There was a higher incidence of retinal tears in the pre with respect to post-equatorial areas (19 vs 7 eyes, p = 0.019). B-scan ultrasonography and OCT revealed persistent traction on the retinal tear flap in 19 and 15 eyes, respectively.ConclusionsIn acute PVD, retinal tears are prevalently associated with peripheral vitreous detachment. The impact of complete or incomplete PVD can be of clinical value when evaluating patients with retinal tears.

Ranibizumab Versus Bevacizumab for Neovascular Age-Related Macular Degeneration With an Incomplete Posterior Vitreous Detachment.

The aim of this study was to compare the effects of ranibizumab to those of bevacizumab during the treatment of neovascular age-related macular degeneration (AMD) with an incomplete posterior vitreous detachment. A retrospective chart review. A retrospective chart review was performed on treatment-naive neovascular AMD subjects with an incomplete posterior vitreous detachment treated with either ranibizumab or bevacizumab over a 12-month period. One hundred thirty subjects were analyzed. There were 49 subjects determined to have vitreous attachment to the fovea. Subjects with vitreous attachment to the fovea required a significantly greater number of injections during the study interval compared with those without (10.2 ± 0.75 vs 7.8 ± 0.62) (P < 0.0001). In subjects with vitreous attachment to the fovea, the ranibizumab cohort had a greater improvement in visual acuity (0.18 ± 0.1 vs 0.04 ± 0.11 logMAR) (P = 0.0176) and a greater reduction in macular thickness (93.4 ± 32.2 μm vs 30.3 ± 28.3 μm) (P = 0.0064) compared with the bevacizumab cohort. Neovascular AMD patients with vitreous attachment to the fovea may have better visual and anatomic outcomes when treated with ranibizumab compared with bevacizumab.

Incidence, Progression, and Associated Risk Factors of Posterior Vitreous Detachment in Type 2 Diabetes Mellitus: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS II, Report No. 7)

ABSTRACTPurpose: To report the incidence and progression of posterior vitreous detachment (PVD) and factors influencing the same in a cohort of patients with type 2 diabetes in a South Indian population. Methods: A subset of 615 subjects from Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study II were included in this study. All of the subjects underwent detailed ophthalmic evaluation including stereo fundus photography. The status of PVD was assessed using B-scan ultrasonography. A p value of <0.05 was considered statistically significant. Results: The incidence of either incomplete PVD (IPVD) or complete PVD (CPVD) from no PVD at baseline visit was 80.8%. Of them, 32.63% converted to CPVD from IPVD at baseline. High prevalence of emmetropia was observed in subjects with stable No PVD. Risk factors associated with the conversion of CPVD from no PVD and IPVD at baseline were age (OR: 1.04, p = 0.002), myopia (OR: 2.14, p = 0.009), and increase in axial length (OR: 1.35, p = 0.004). Subjects undergoing cataract surgery were at 2.32 times higher risk of converting to CPVD (p = 0.038). Conclusion: Independent risk factors for the progression of PVD were increase in age, myopia, increased axial length, and cataract surgery.

Clinical evaluation of ocriplasmin as a vitreolytic agent

Incomplete perifoveal posterior vitreous detachment (PVD) associated with abnormal vitreomacular adhesion (VMA) can cause vitreomacular traction (VMT) and macular hole (MH) formation, which require vitrectomy treatment. Pharmacologic vitreolysis, which is intravitreal injection with vitreolytic enzymes to resolve VMA, may be used as an alternative therapy.Ocriplasmin, formerly known as microplasmin, is a recombinant truncated form of plasmin with proteolytic activity against fibronectin and laminin.It was recently approved for VMA treatment in the European Union and USA. Phase III studies indicated that ocriplasmin injection was a safe and effective treatment for selected cases of symptomatic VMA and MH. VMA release was achieved in 26.5% of ocriplasmin-injected eyes versus 10.1% of the placebo group. MH closure was achieved in 40.6% as compared with 10.6% of the placebo group.In comparison with the outcome after vitrectomy, the success rate of ocriplasmin was still far below expectation. Ocular adverse events included vitreous floaters, photopsia and profound visual decline. Its efficacy and safety need to be further evaluated in more clinical trials.