Perifoveal Posterior Vitreous Detachment Research Articles

Vitreous mobility during the posterior vitreous detachment initiation demonstrated by pseudo-motion optical coherence tomography

PurposeTo document the anatomical changes occurring at the vitreoretinal interface during early posterior vitreous detachment (PVD). MethodsWide-angle and pseudo-motion optical coherence tomography (OCT) were obtained on 27 normal eyes during the early stages of age-related PVD. The wide-angle examination in a static phase consisted of montaged conventional OCT images. GIF-formatted pseudo-animation was generated with OCT images acquired initially in a static eye state, followed by scans immediately after ocular excursions. ResultsInitial stages of PVD included peripheral PVD with (stage 1a) or without (stage 1b) interposed material between the posterior vitreous cortex and the retina, and perifoveal PVD expanding to the periphery (stage 2). All stage 1 PVDs presented anterior to the papillomacular vitreous liquefaction. All eyes demonstrated mobility of the vitreous gel at the anterior face of the vitreous liquefaction; however, the adherent cortical vitreous layer comprising the posterior wall of the lacuna showed no mobility. Mobility of the posterior vitreous cortex was not present in eyes with stage 1a PVD and increased with the progression of the stage of PVD (p = 3.60×10−6). ConclusionDuring nonpathological PVD, macula is protected from tractional insults conveyed by mobile vitreous due to overlying vitreous liquefaction. However, the vitreoretinal interface anterior to the lacunae experiences tractional forces until vitreoretinal separation occurs. These observations reinforce the hypothesis that vitreous liquefaction, vitreous mobility, and vitreoschisis formation contribute to PVD initiation and support that premacular lacunae protect the macula during PVD initiation and early progression.

Relationship between Full-Thickness Macular Hole Onset and Posterior Vitreous Detachment: A Temporal Onset Theory

PurposeTo evaluate the relationship between full-thickness macular hole (FTMH) onset and perifoveal posterior vitreous detachment using optical coherence tomography (OCT) data.DesignRetrospective study.ParticipantsA total of 742 patients with FTMH or impending macular hole (MH) in at least one eye, as determined by ophthalmoscopy and OCT.MethodsMHs were staged using OCT results. Patients with the posterior vitreous membrane clearly detected in the OCT images and vitreoretinal adhesion size ≤ 1500 μm—eyes with MH stages 1–3—were included in the study. The contralateral eyes were also included in the analyses if they showed the focal type of vitreomacular adhesion (VMA) (i.e., vitreoretinal adhesion ≤ 1500 μm). The distance between the posterior vitreous membrane and the surface of the retina was defined as the posterior vitreous separation height (PVSH). Using the OCT images, PVSHs of each eye in four directions (nasal, temporal, superior, and inferior) at 1 mm from the center of the MH or fovea were calculated.Main Outcome MeasuresThe main outcome measures were PVSHs according to the MH stage and VMA, the relationship of the foveal inner tear with PVSH, and the likelihood of a foveal inner tear based on the direction.ResultsThe PVSH trends in each of the four directions were as follows: VMA < MH stage 1 = MH stage 2 < MH stage 3. Initial MH stage 2 (onset of FTMH) was defined as the presence of a gap in only one of the four directions from the center of the MH. With increased PVSH, the likelihood of a gap increased (P = 0.002), and a temporal gap was more likely to occur than a nasal gap (P = 0.002).ConclusionsAt FTMH onset, a foveal inner tear likely appears on the temporal side or the side showing a high PVSH value.

An Unusual Cause of Choroidal Excavation

A 43-year-old woman was referred for evaluation of a pigmented fundal lesion in her left eye. Her visual acuity was 20/40. Examination revealed a flat, pigmented lesion at the level of the retinal pigment epithelium (RPE) with lacunae, which involved the inferonasal parafoveal and perifoveal macular areas (Fig A). Diagnosis was consistent with central congenital hypertrophy of the RPE. OCT revealed a conforming choroidal excavation spanning the whole lesion, thickened irregular RPE and outer retinal atrophy in the excavated area, transmission hyper-reflectivity corresponding to lacuna, localized subretinal fluid at foveal edge of excavation, and perifoveal posterior vitreous detachment (Fig B) (Magnified version of Fig A-B is available online at www.aaojournal.org).

Posterior vitreous detachment after cataract surgery in eyes with high myopia: an optical coherence tomography study.

To compare the progression of posterior vitreous detachment (PVD) after cataract surgery in eyes with high myopia with that in eyes without high myopia. Prospective observational study. Eighty eyes of 80 patients with high myopia and 160 eyes of 160 patients without high myopia scheduled for phacoemulsification were recruited. PVD status was examined using swept-source optical coherence tomography at 2days postoperatively (baseline) and at 3, 6, and 12months postbaseline and classified into 5 stages: 0 (no PVD), 1 (paramacular PVD), 2 (perifoveal PVD), 3 (peripapillary PVD), and 4 (complete PVD). The PVD stage and incidence of progression to complete PVD of the 2 groups were compared. The mean PVD stage did not differ significantly between the groups at baseline or at 3months postbaseline but was significantly more progressed in the high myopia group than in the nonhigh myopia group at 6months and 12months postbaseline (P ≤ 0.0201). The Kaplan-Meier survival rate for complete PVD was significantly lower in the high myopia group (P = 0.0129). After adjusting for age, sex, and baseline PVD stage, the hazard ratio for complete PVD was 1.68-fold higher in the high myopia group than in the nonhigh myopia group (P = 0.0326, 95% CI 1.04-2.70). After cataract surgery, PVD progressed significantly faster in eyes with high myopia than in eyes without high myopia, and the relative risk for complete PVD was 1.68-fold higher in eyes with high myopia, suggesting that highly myopic eyes are at considerably high risk for retinal disease postoperatively.

Clinical characteristics of full thickness macular holes that closed without surgery

PurposeTo ascertain the anatomic factors that help achieve non-surgical sealing in full thickness macular hole (FTMH).MethodsRetrospective collaborative study of FTMH that closed without surgical intervention.ResultsA total of 78 patients (mean...

Foveal configurations with disappearance of the foveal pit in eyes with macular pucker: Presumed role of Müller cells in the formation of foveal herniation

Many eyes with macular pucker are characterized by a centripetal displacement of the inner foveal layers which may result in a disappearance of the foveal pit. In this retrospective case series of 90 eyes with macular pucker of 90 patients, we describe using spectral-domain optical coherence tomography different foveal configurations with ectopic inner foveal layers, document the relationship between posterior vitreous detachment (PVD) and idiopathic epiretinal membrane (ERM) formation and spontaneous and postoperative morphological alterations of the fovea, and propose an active role of Müller cells in the development of foveal herniation. We found that ERM were formed during or after partial perifoveal PVD, or after foveal deformations caused by tissue edema. The ERM-mediated centripetal displacement of the inner foveal layers and in various eyes anterior hyaloidal traction caused a disappearance of the foveal pit and an anterior stretching of the foveola with a thickening of the central outer nuclear layer (ONL). After the edges of the thickened inner layers of the foveal walls moved together, continuous centripetal displacement of the inner foveal layers generated a bulge of the fovea towards the vitreous (foveal herniation). Macular pseudoholes with a herniation of the inner foveal layers show that the outer layer of the protruding foveal walls is the outer plexiform layer (OPL). If the ERM covered the foveal walls and parafova, but not the foveola, the inner layers of the foveal walls were not fully centripetally displaced and the foveal pit was present. The visual acuity of eyes with ectopic inner foveal layers was inversely correlated with the thickness of the foveal center. Spontaneous morphological alterations after disappearance of the foveal pit may include the development of cystoid macular edema or additional thickening of the foveal tissue and foveal herniation. The foveal configuration with ectopic inner layers of the foveal walls and a thick central ONL persisted over longer postoperative time periods. The data show that the centripetal displacement of the inner foveal layers in eyes with macular pucker, which results in a disappearance of the foveal pit, may also generate foveal herniation which is suggested to be caused by contraction of Müller cell processes in the OPL. The centripetal displacement of the inner foveal layers and the formation of foveal herniation are suggested to reverse the foveal pit formation during development.

Posterior vitreous detachment in patients with diabetes mellitus.

To compare the progression of posterior vitreous detachment (PVD) during aging among eyes of diabetics with diabetic retinopathy (DR), eyes of diabetics without DR, and eyes of nondiabetics. Prospective cross-sectional study. One-hundred thirty-three diabetic eyes with DR (DR group), 254 diabetic eyes without DR (non-DR group), and 577 nondiabetic eyes (nondiabetic group) were divided into four age categories: 1) 40-49 years, 2) 50-59 years, 3) 60-69 years, and 4) 70-79 years. The PVD state was examined using swept source-optical coherence tomography and classified into five stages: 0 (non PVD), 1 (paramacular PVD), 2 (perifoveal PVD), 3 (vitreofoveal separation), and 4 (complete PVD). The PVD stage significantly progressed in the DR, non-DR, and nondiabetic groups (p <0.0001). At 40-49 and 50-59 years, the PVD stage did not differ significantly among the three groups. At 60-69 and 70-79 years, the PVD stage was significantly less progressed in the DR than the non-DR and nondiabetic groups (p ≤0.0027), and did not differ significantly between the non-DR and nondiabetic groups. At 70-79 years, complete PVD was detected in 40.6% of eyes in the DR group, 69.6% in the non-DR group, and 73.5% of eyes in the nondiabetic group. PVD progresses later in diabetic eyes with DR than in diabetic eyes without DR and nondiabetics eyes at 60 and 70 years of age, suggesting a stronger vitreomacular adhesion in diabetics with DR.

CHANGES IN THE POSTERIOR VITREOUS AFTER CATARACT SURGERY ASSESSED BY SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY.

To assess changes in the posterior vitreous caused directly by phacoemulsification with implantation of an intraocular lens, using the enhanced vitreous swept-source optical coherence tomography system (Topcon, Tokyo, Japan). Consecutive patients with cataract without posterior vitreous detachment were enrolled. Swept-source optical coherence tomography examinations were performed 1 day before and several days after surgery, using enhanced vitreous visualization. We compared preoperative and postoperative posterior vitreous status and measured the distance between the internal limiting membrane and the posterior vitreous membrane at 26 locations at the posterior pole. Images of 33 eyes (21 patients) could be analyzed. The perifoveal posterior vitreous detachment was not extended in any eyes, and the internal limiting membrane to posterior vitreous membrane distance before and after surgery did not differ at any location measured (P = 0.071-1.000). The posterior precortical vitreous pocket was dilated in three eyes. Age, gender, axial length, preoperative visual activity, nuclear sclerosis, duration of surgery, and duration between surgery and swept-source optical coherence tomography did not differ between the dilated vitreous pocket group (n = 3) and the unchanged group (n = 30). The height of the posterior vitreous membrane remained unchanged after surgery, although the posterior precortical vitreous pocket was dilated in three patients. Cataract surgery procedures seem to have little influence on the posterior vitreous membrane.

Sex-Related Differences in the Progression of Posterior Vitreous Detachment with Age

To compare the difference in the progression of posterior vitreous detachment (PVD) between men and women in relation to age. Observational cross-sectional study. One hundred eyes of 100 male patients and 100 eyes of 100 female patients in 4 age groups: 40 to 49 years of age, 50 to 59 years of age, 60 to 69 years of age, and 70 years of age or older. Using swept-source (SS) OCT, PVD was classified into 5 stages: 0, no PVD; 1, paramacular PVD; 2, perifoveal PVD; 3, vitreofoveal separation; and 4, complete PVD. The PVD stage distribution was compared between men and women in the 4 age groups and among the age groups. Stage of PVD determined using SS OCT. In both male and female eyes, the stage of PVD progressed significantly in association with the age group (P < 0.0001). The distribution of the PVD stage did not differ significantly between men and women in the 40- to 49- and the 50- to 59-year age groups. The distribution of the PVD stage was significantly more progressed in women than in men, however, in those 60 to 69 years of age and those 70 years of age and older (P ≤ 0.0292). At 40 to 49 years of age, no PVD (stage 0) and paramacular PVD (stage 1) were detected in 92 (92.0%) female eyes and 93 (93.0%) male eyes. At 70 years of age or older, vitreofoveal separation (stage 3) and complete PVD (stage 4) were detected in 93 (93.0%) female eyes and 78 (78.0%) male eyes. Posterior vitreous detachment significantly progresses with age in both genders, specifically between 40 years of age and 70 years of age or older. Posterior vitreous detachment progression occurs significantly faster in female eyes than in male eyes at 60 years of age or older, suggesting that the macular pathologic features associated with PVD occur at a younger age in women.

Posterior Vitreous Detachment as Observed by Wide-Angle OCT Imaging

Posterior vitreous detachment (PVD) plays an important role in vitreoretinal interface disorders. Historically, observations of PVD using OCT have been limited to the macular region. The purpose of this study is to image the wide-angle vitreoretinal interface after PVD in normal subjects using montaged OCT images. An observational cross-sectional study. A total of 144 healthy eyes of 98 normal subjects aged 21 to 95 years (51.4±22.0 [mean ± standard deviation]). Montaged images of horizontal and vertical OCT scans through the fovea were obtained in each subject. Montaged OCT images. By using wide-angle OCT, we imaged the vitreoretinal interface from the macula to the periphery. PVD was classified into 5 stages: stage 0, no PVD (2 eyes, both aged 21 years); stage 1, peripheral PVD limited to paramacular to peripheral zones (88 eyes, mean age 38.9±16.2 years, mean ± standard deviation); stage 2, perifoveal PVD extending to the periphery (12 eyes, mean age 67.9±8.4 years); stage 3, peripapillary PVD with persistent vitreopapillary adhesion alone (7eyes, mean age 70.9±11.9 years); stage 4, complete PVD (35 eyes, mean age 75.1±10.1 years). All stage 1 PVDs (100%) were observed in the paramacular to peripheral region where the vitreous gel adheres directly to the cortical vitreous and retinal surface. After progression to stage 2 PVD, the area of PVD extends posteriorly to the perifovea and anteriorly to the periphery. Vitreoschisis was observed in 41.2% at PVD initiation (stage 1a). Whereas prior work suggests that PVD originates in the perifoveal region and after the sixth decade, our observations demonstrate that (1) PVD first appears even in the third decade of life and gradually appears more extensively throughout life; (2) more than 40% of eyes without fundus diseases at their PVD initiation are associated with vitreoschisis; and (3) PVD is first noted primarily in the paramacular-peripheral region where vitreous gel adheres to the retinal surface and is noted to be more extensive in older ages to ultimately involve the fovea.

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.

VITREOMACULAR INTERFACE AND OUTER FOVEAL MICROSTRUCTURE IN FELLOW EYES OF PATIENTS WITH UNILATERAL MACULAR HOLES

To investigate the relationship between the vitreomacular interface and the integrity of the photoreceptor microstructures in the normal fellow eyes of patients with unilateral macular holes. Retrospective observational case series. Fifty-five normal fellow eyes of 55 patients with unilateral macular holes were enrolled in the study. All patients underwent complete ophthalmologic examination including best-corrected visual acuity, slit-lamp biomicroscopy, fundus photography, and spectral domain optical coherence tomography at initial and follow-up visits. The features of the vitreomacular interface were graded based on spectral domain optical coherence tomography findings. At the initial visit, 28 of 55 eyes (51%) had vitreomacular attachments with or without perifoveal posterior vitreous detachment. On their initial visit, a triangular elevation of the cone outer segment tips line was identified in 11 of 18 eyes (61%) with perifoveal posterior vitreous detachment across all quadrants with persistent attachment to the fovea. Conversely, none of the remaining 37 eyes with the other stages of posterior vitreous detachment showed any abnormalities. Over a mean follow-up period of 18 months (range, 12-24 months), the elevation of the cone outer segment tips line resolved after spontaneous vitreomacular separation without macular holes in 3 eyes, remained unchanged in 6 eyes, and showed progression to a full-thickness macular hole in 2 eyes. These findings suggest that an elevation of the cone outer segment tips line in the normal fellow eyes of patients with macular holes is caused by the focal traction of the vitreous at the foveal center. This is considered to be an important primary change observed in the macular tissue in full-thickness macular hole formation.

Classification of posterior vitreous detachment

Diagnosing a posterior vitreous detachment (PVD) is important for predicting the prognosis and determining the indication for vitreoretinal surgery in many vitreoretinal diseases. This article presents both classifications of a PVD by slit-lamp biomicroscopy and of a shallow PVD by optical coherence tomography (OCT). By biomicroscopy, the vitreous condition is determined based on the presence or absence of a PVD. The PVD then is classified as either a complete posterior vitreous detachment (C-PVD) or a partial posterior vitreous detachment (P-PVD). A C-PVD is further divided into a C-PVD with collapse and a C-PVD without collapse, while a P-PVD is divided into a P-PVD with shrinkage of the posterior hyaloid membrane (P-PVD with shrinkage) and a P-PVD without shrinkage of the posterior hyaloid membrane (P-PVD without shrinkage). A P-PVD without shrinkage has a subtype characterized by vitreous gel attachment through the premacular hole in a posterior hyaloid membrane to the macula (P-PVD without shrinkage [M]). By OCT, a shallow PVD is classified as the absence of a shallow PVD or as a shallow PVD. A shallow PVD is then subclassified as a shallow PVD without shrinkage of the posterior vitreous cortex, a shallow PVD with shrinkage of the posterior vitreous cortex, and a peripheral shallow PVD. A shallow PVD without shrinkage of the posterior vitreous cortex has two subtypes: an age-related shallow PVD and a perifoveal PVD associated with a macular hole.

Spectral-Domain Optical Coherence Tomography Features in Fellow Eyes of Patients with Idiopathic Macular Hole

To describe the vitreomacular interface and foveal structural changes in fellow eyes of patients with idiopathic macular holes using spectral-domain optical coherence tomography (SD-OCT). Retrospective analysis of consecutive medical records and SD-OCT images of the fellow eyes of patients with macular hole was done. Changes of the vitreoretinal interface and foveal structures on SD-OCT scan of the 101 fellow eyes of 101 subjects with full-thickness macular hole were studied and compared with 101 eyes of 101 age-matched healthy subjects. Sixty-four patients (57.65%) were female. Mean age at presentation was 60.44 ± 12.17 years. The best-corrected visual acuity (BCVA) in eyes with macular hole was 0.86 logMAR units and in fellow eyes was 0.41 logMAR units. Seven eyes had macular hole in the fellow eye at the time of presentation. The majority of the fellow eyes (87/101, 78.37%) were phakic. The average base diameter of macular hole was 1105 ± 451.63 µm. Incidence of vitreomacular traction, epiretinal membrane, lamellar hole, and inner foveal split was more common (<0.05) in fellow eyes in comparison to healthy eyes. In contrast, posterior vitreous detachment (PVD) and perifoveal PVD was more common in age-matched control eyes. There was no statistically significant correlation between foveal abnormalities of fellow eyes with base diameter of eyes with macular hole, BCVA, and duration of symptoms. Fellow eyes of patients with idiopathic macular hole have a high frequency of abnormal vitreoretinal interface and foveal abnormalities, which predisposes to formation of macular hole.

OCT-BASED INTERPRETATION OF THE VITREOMACULAR INTERFACE AND INDICATIONS FOR PHARMACOLOGIC VITREOLYSIS

To review the role of optical coherence tomography (OCT) in diagnosis and management of vitreomacular disease and the impact of OCT on potential uses of ocriplasmin, a new pharmacologic vitreolysis agent recently approved by the U.S. Food and Drug Administration for the treatment of symptomatic vitreomacular adhesion. Analysis of current literature regarding OCT in diagnosis and management of vitreomacular interface disease. Posterior vitreous detachment is typically a nonpathologic age-related event. Anomalous posterior vitreous detachment emerges when the vitreous cortex fails to cleanly detach from the macula, optic nerve, or other adherent sites. Focal vitreomacular adhesion is a nonpathologic anatomical designation associated with perifoveal posterior vitreous detachment but normal retinal morphology on OCT. Vitreomacular traction is a pathologic consequence of persistent vitreous attachment with structural disturbance of the macular retina visible on OCT. Full-thickness macular holes are foveal defects continuous through all retinal layers to the retinal pigment epithelium. Vitreomacular traction and macular hole with focal vitreomacular adhesion are indications for pharmacologic vitreolysis. Noninvasive high-resolution OCT imaging has transformed the understanding of vitreomacular interface disease. Careful evaluation of the vitreomacular interface with OCT has increased in importance with the introduction of ocriplasmin for vitreomacular adhesion associated with symptomatic anatomical retinal changes.

In Vivo Imaging of Cortical Vitreous Using 1050-nm Swept-Source Deep Range Imaging Optical Coherence Tomography

To image the cortical vitreous, determine the prevalence of the bursa premacularis and space of Martegiani, and measure the dimensions of the bursa using the new 1050-nm swept-source deep range imaging optical coherence tomography (DRI OCT-1 Atlantis). Retrospective cross-sectional study. One hundred and nineteen consecutive patients (5-100 years) underwent an OCT scan using 1050-nm swept-source deep range imaging optical coherence tomography. Prevalence of the bursa premacularis and space of Martegiani and the stage of posterior vitreous detachment (PVD) were determined. The horizontal (width) and anteroposterior (depth) dimensions of the bursa were recorded along with the patient's age. A bursa was detected in 57.1% (136/238) of eyes. The bursa and space of Martegiani coexisted in 97.8% of eyes. Prevalence of detected bursa was 84.5% in eyes with either no PVD or perifoveal PVD only; the prevalence fell with further increases in the extent of PVD. Prevalence of detected bursa was 75.4% in patient group aged 0-60 years and 38% in the group aged 60-100 years. Mean width was 7001 μm (range: 3354-10 316 μm, SD: 1412 μm). Mean depth was 416 μm (range: 31-1189 μm, SD: 187 μm). Width and depth of the bursa did not correlate with age (R(2) width = 0.0316; R(2) depth = 0.0108). Bilateral bursa tended to be symmetrical in width but less so in depth (R(2) width = 0.63, P < .001; R(2) depth = 0.33, P < .001). Swept-source OCT has allowed us to demonstrate the almost invariable coexistence of the bursa premacularis and space of Martegiani. Swept-source OCT can image both in patients from as early as the first to as late as the tenth decade of life.

Evolution of Vitreomacular Detachment in Healthy Subjects

Development of posterior vitreous detachment (PVD) plays an important role in vitreomacular diseases. Spectral-domain optical coherence tomography (SD-OCT) with noise reduction can visualize a posterior precortical vitreous pocket (PPVP) and classify PVD stages according to the state of the posterior wall of the PPVP. To describe the role of the PPVP in early-stage PVDs in healthy individuals. We performed biomicroscopy and SD-OCT in the right eyes of 368 healthy volunteers (188 males and 180 females; mean [SD] age, 57.1 [19.4] years; range, 12-89 years). The condition of the posterior wall of the PPVP was classified into stages according to the biomicroscopic findings and SD-OCT images: stage 0, no PVD with PPVP (134 eyes; mean [SD] subject age, 38.7 [16.5] years; range, 12-76 years); stage 1, paramacular PVD with PPVP (47 eyes; mean age, 55.2 [10.3] years; range, 36-77 years); stage 2, perifoveal PVD with PPVP (27 eyes; mean age, 62.0 [8.7] years; range, 46-81 years); stage 3, vitreofoveal separation with persistent attachment to the optic disc (19 eyes; mean age, 65.8 [6.2] years; range, 55-80 years; stage 3a, vitreofoveal separation with an intact posterior wall of the PPVP in 12 eyes; stage 3b, vitreofoveal separation with a defect in the posterior wall of the PPVP in 7 eyes; and stage 4, complete PVD (141 eyes; mean age, 73.2 [8.3] years; range, 48-89 years). Ages in each PVD stage. The posterior wall of the PPVP initially detaches at the paramacular area and extends to the perifoveal area, which results in a perifoveal PVD. A vitreofoveal detachment may develop with or without a defect in the PPVP. When the vitreous detaches from the optic disc, a complete PVD develops. An anatomical feature of the PPVP may play a role in the development of a perifoveal PVD.

Vitreomacular interface in patients with familial exudative vitreoretinopathy

Familial exudative vitreoretinopathy (FEVR) is a rare hereditary vitreoretinal disease that occurs in young patients and results in an avascular peripheral retina, retinal neovascularization, and tractinal retinal detachment. Patients occasionally have concurrent macular diseases. However, the vitreomacular relationship in FEVR remains unclear. We report two cases, a 22-year-old woman (case 1) and a 14-year-old boy (case 2) with FEVR who have the characteristic findings of the disease in the vitreomacular interface and the macular morphology, observed using spectral-domain optical coherence tomography (SD-OCT). In case 1, the best-corrected visual acuity (BCVA) was 20/20 bilaterally. SD-OCT showed a perifoveal posterior vitreous detachment (PVD) with vitreofoveal adhesion in the left eye. In case 2, SD-OCT showed a perifoveal PVD in the right eye (BCVA, 20/30) with numerous small deposits that appeared as rod-shaped attachments perpendicular to the parafoveal face without intraretinal and subretinal materials beneath the posterior hyaloid face that corresponded to white material on the fundus examination. Fluorescein angiography showed a circumferential peripheral avascular area and peripheral neovascularization in both cases. These SD-OCT findings suggested that a perifoveal PVD and small deposits, which appeared as rod-shaped attachments perpendicular to the parafoveal face in patients with FEVR, may carry the risk of macular disease and decreased visual acuity.

Three-dimensional foveal shape changes after asymptomatic macular posterior vitreous detachment

PurposeTo show a case in which the shape of the fovea changed after an asymptomatic macular posterior vitreous detachment (PVD).MethodsThe foveal shape was determined from the spectral-domain optical coherence tomography (OCT) images before and after a spontaneous macular PVD.ResultsA 66-year-old man with a unilateral macular hole in the right eye presented with a perifoveal PVD in the asymptomatic left eye. One year later, the left eye developed a macular PVD, and OCT measurements showed a 16.7% decrease in the central foveal thickness, and increases in the pit depth by 20.5%, foveola diameter by 14.7%, and pit volume by 19.4%. The thicknesses of the macular subfields of the Early Treatment Diabetic Retinopathy Study were decreased by 13.0% in the central subfield and by 1.4%–6.6% in the other subfields.ConclusionThe deepening and widening of the fovea after a macular PVD indicate that a PVD can alter the shape of the fovea.

Idiopathic Full-Thickness Macular Holes and the Vitreomacular Interface: A High-Resolution Spectral-Domain Optical Coherence Tomography Study

To analyze the vitreomacular interface in idiopathic full-thickness macular holes (MHs) using spectral-domain optical coherence tomography. Prospective cross-sectional case series. Ninety-one eyes of 86 consecutive patients with a MH were examined by spectral-domain optical coherence tomography. The vitreomacular interface was assessed and the presence or absence of an operculum was analyzed. Fifty-two eyes had a stage 2 MH, 12 eyes a stage 3 MH, and 27 eyes a stage 4 MH. No posterior hyaloid membrane was detected in any eyes with a stage 4 MH. In 35 (54.7%) of the 64 eyes with an MH without a complete posterior vitreous detachment (PVD), we saw a perifoveal PVD with vitreofoveal adhesion and partial dehiscence of the raised inner retina with an outer retinal separation in the MHs. In 24 (37.5%) of the 64 eyes without a complete PVD, an operculum, which is a hyperreflective structure of the foveal retina, was in front of the MH. The posterior hyaloid membrane was separated completely but adhered to the optic disc. In 2 (3.1%) of the 64 eyes without a complete PVD, the posterior hyaloid membrane was separated from the macula without an operculum. In 3 (4.7%) of the 64 eyes without a complete PVD, vitreofoveal adhesion on both edges of the hole was connected to the taut posterior hyaloid membrane without an operculum. The vitreomacular interface had 4 configurations in MHs without a complete PVD. Approximately 55% of cases with an open roof in the eyes without a complete PVD may be at risk for progression to operculum formation (loss of retinal tissue).