Vitreomacular Traction Syndrome Research Articles

Natural course of vitreomacular traction syndrome observed by spectral-domain optical coherence tomography

ObjectiveOur study aimed to characterize the natural course of vitreomacular traction (VMT) syndrome, on which discrepancies have been reported in previous publications, by spectral-domain optical coherence tomography (SD-OCT). DesignRetrospective chart review. ParticipantsA total of 23 eyes of 23 patients with idiopathic symptomatic VMT syndrome diagnosed and followed up in Peking Union Medical College Hospital from 2008 to 2013. MethodsClinical records of all patients who underwent SD-OCT examination and were diagnosed and followed up as idiopathic VMT syndrome were reviewed. Those who had at least 2 visits were included. The median observation period of the patients was 8.2 ± 7.9 months. ResultsThe 23 eyes were categorized into 3 groups based on the follow-up results of SD-OCT: the posterior vitreous detachment (PVD) group comprised 4 eyes that developed complete PVD, the full-thickness macular hole (FMH) group included 4 eyes that formed FMH, and the persisted VMT (PVMT) group comprised the other 15 eyes with PVMT. Epiretinal membrane (ERM) persisted in all 5 eyes in the PVMT group. FMH occurred in 3 of 7 eyes with outer lamellar macular hole (LMH) at the first visit. ConclusionsSpontaneous development of complete PVD in VMT syndrome during follow-up appeared to be more common in our study than in previous reports without SD-OCT. Persistence of ERM might be an unfavourable prognostic factor in the natural course of VMT syndrome. The outer LMH might be a risk factor for FMH formation.

Suprachoroidal layer and suprachoroidal space delineating the outer margin of the choroid in swept-source optical coherence tomography.

To define the morphology of outer choroidal margins in swept-source optical coherence tomography. This is a prospective observational study of 180 eyes: 20 eyes of healthy volunteers, 20 eyes of myopic patients, and 20 eyes from each of the following groups: macular hole, lamellar macular hole, epiretinal membranes, drusen, dry age-related macular degeneration (AMD), neovascular AMD, and vitreomacular traction. A single 12-mm wide swept-source optical coherence tomography image for each of the examined eyes consisting of 1,024 A-scans has been created. The main outcome measure selected was to estimate the presence of suprachoroidal layer, as well as to estimate the ability to delineate the outer choroidoscleral boundary using the software available (DRI-OCT) and to determine its shape. Suprachoroidal layer was observed in 5% of healthy emmetropic eyes, in 50% of eyes with full-thickness macular holes, and in 60% of eyes with vitreomacular traction syndrome. It was also present in 50% of eyes with dry AMD and in 20% of eyes with neovascular AMD. The outer margin of the choroid in all eyes of the healthy volunteers and in eyes with macular diseases has been delineated correctly. In all healthy and myopic eyes, we recognized the outer choroidoscleral boundary as having a regular shape following the natural oval contour of the globe. In eyes with epiretinal membranes, macular hole, vitreomacular traction, and AMD, the outer choroidoscleral boundary was irregular; the choroid varied in thickness from point to point. Swept-source optical coherence tomography enables exact visualization of the outer choroidoscleral boundary. Suprachoroidal layer consisting of two bands has been recognized, the upper of which is hyperreflective and the lower of which is hyporeflective. It may be supposed that the lower hyporeflective band corresponds to suprachoroidal space, which was not earlier visualized in vivo in eyes without choroidal effusion. Suprachoroidal layer in myopic and emmetropic healthy subjects has been rarely observed. We observed it more frequently in different macular diseases.

Vitreomacular traction syndrome: postoperative functional and anatomic outcomes.

To analyze a variety of vitreomacular traction (VMT) morphologies to establish a major classification that better reflects the preoperative predictive factors of postoperative visual and anatomic outcomes. Thirty-six eyes submitted to vitrectomy surgery were categorized with a VMT pattern (V- or J-shaped) and diameter (focal < 1,500 µm or broad > 1,500 µm) based on optical coherence tomography. The researchers compared different classifications of VMT. Despite similar postoperative best corrected visual acuity (BCVA) values (P = .393), cases with focal VMT had greater visual improvement (P = .027) because the preoperative BCVA was significantly lower in the focal group (P = .007). However, the BCVA improvements did not differ between the groups regarding the classic VMT morphologic patterns (P = .235). Postoperative outcomes and macular disorders are closely related to VMT size. The adhesion diameter (focal or broad VMT) and not the classic VMT morphologic pattern (V- or J-shaped) may better predict the postoperative anatomic and functional outcomes.

Incidence of Late-onset Ocular Hypertension Following Uncomplicated Pars Plana Vitrectomy in Pseudophakic Eyes

To determine the incidence of late-onset ocular hypertension following uncomplicated vitrectomy in pseudophakic eyes with an open angle. A retrospective observational case series. Seven hundred and sixty-seven eyes of 767 patients that underwent vitrectomy combined with cataract surgery in 1 eye were studied. There were 383 men and 384 women. The indications for vitrectomy were: 308 eyes with rhegmatogenous retinal detachment, 202 eyes with epiretinal membrane, 169 eyes with macular hole, 44 eyes with vitreous hemorrhage, 16 eyes with subretinal hemorrhage, 15 eyes with vitreomacular traction syndrome, 12 eyes with vitreous opacity, and 1 eye with retinoschisis. Of these, 176 eyes underwent vitrectomy alone because of previous cataract surgery. Late-onset ocular hypertension was defined as an intraocular pressure (IOP) >21mm Hg that developed more than 2months postoperatively in at least 2 postoperative visits. An increase in the IOP >4mm Hg over the preoperative IOP was necessary. Eyes with ocular hypertension, glaucoma (suspect), or a possibility of IOP elevation were excluded. The mean age was 63 ± 11 years. The mean follow-up duration after vitrectomy was 47.8 ± 25.3months. Thirty-two eyes (4.2%) developed late-onset ocular hypertension. The mean age was 60 ± 10 years. The mean interval between vitrectomy and development of ocular hypertension was 31.1 ± 26.0months. There were no significant differences in the incidence of late-onset ocular hypertension and the vitreoretinal disease for vitrectomy, sex, or gauge of instruments for vitrectomy. Long-term IOP monitoring is necessary after vitrectomy.

A new approach for sutureless 20-G vitrectomy

Aim of the work To assess the safety and the effectiveness of a new approach for sutureless 20-G pars plana vitrectomy using N -butyl-2-cyanoacrylate 'Histoacryl' glue, aiming for the conversion of the conventional 20-G vitrectomy to a sutureless technique. Design An interventional study. Patients and methods About 40 eyes of 40 patients attending the surgical retina clinics of the Research Institute of Ophthalmology were subjected to the new technique. The selection criterion included patients with diabetic and nondiabetic vitreous hemorrhage, rhegmatogenous retinal detachment (RD), recurrent RD, pseudophakic RD, giant retinal breaks, macular hole, proliferative diabetic retinopathy, complications of anterior segment surgery, posterior dislocated IOL, vitreomacular traction syndrome, macular pucker, idiopathic epiretinal membrane, and dropped nucleus. Patients were selected randomly. There was no age limitation, sex choice, or race preference. All the patients underwent a modified 20-G sutureless vitrectomy surgery. Periotomy was performed in the upper part of the eye, and the sclera was exposed, three 1/2-thickness scleral flaps were fashioned using a crescent knife for a length of 2 mm, and a 20-G self-retaining infusion cannula was introduced at the 12 O'clock position. At the end of the surgery, Histoacryl tissue glue was applied to close the scleral flaps and the conjunctiva. Different vitreal substitutes and tamponades were used according to the case. All the patients had undergone ultrasonic biomicroscopy at the sclerotomy sites 6 weeks postoperatively. Our main concern was to assess the success and the effectiveness of the procedure, wound integrity, intraoperative and postoperative complications, the efficacy of the N -butyl-2-cyanoacrylate to hold the tissues, tissue reaction related to cyanoacrylate, patients' satisfaction, and the final surgical outcome. The postoperative intraocular pressure (IOP) and the Snellen visual acuity relative to the preoperative values were recorded. Patients were evaluated postoperatively on the first day, the first week, and then weekly for 1 month and monthly for 6 months or till the time of removal of silicone oil, which was also removed by the same aforementioned technique. Results The proportion of male patients was 47.5% (19 patients) and that of female patients 52.5% (21 patients). The mean age of the male patients was 49 ΁ 12.5 years, whereas the mean age of the female patients was 44 ΁ 15.5 years. Different vitreous substitutes/tamponades were used, including air, SF6, ringer lactate, and silicon oil 5000 cSt. The mean operative time was 61.75 ΁ 13.8 min and the mean time fashioning and closing the sclerotomies and the conjunctiva was 7 ΁ 1.8 min. No sclerotomy-related intraoperative difficulties or complications were seen and none of the patients required stitching of the sclerotomies at the end of the surgery. All patients were discharged from the hospital immediately after the surgery. Ultrasonic biomicroscopy (UBM) revealed complete wound closure in 36 patients (90%), partial internal wound dehiscence in four patients (7.5%), and three patients (10%) showed microcyst formation under the conjunctiva. Postoperative hypotony was not seen in any of the patients.There was no single case of endophthalmitis or chemical uveitis. The visual acuity was improving along the follow-up period, except for one uncontrolled diabetic patient, who developed rubeosis iridis and the condition deteriorated. Most patients presented with an initial increase in the IOP followed by stabilization of the IOP thereafter. Conclusion The new approach of 20-G sutureless vitrectomy utilizing N -butyl-2-cyanoacrylate is a safe and effective technique for the surgical treatment of a variety of vitreoretinal pathologies. Conversion to this technique is very simple. A very short learning curve is required, with no need for new expensive instrumentation. It combines all the advantages of 20-G vitrectomy, adding to it the sutureless advantage of the technique.

The vitreoretinal interface and its role in the pathogenesis of vitreomaculopathies

The vitreoretinal interface consists of the inner limiting membrane of the retina, the posterior vitreous cortex, and an intervening extracellular matrix. Hyalocytes are mononuclear phagocytes embedded in the posterior vitreous cortex, in a single layer of sparse density. At the macula, anomalous posterior vitreous detachment (PVD) results in either full-thickness vitreous cortex adhesion with vitreomacular traction syndrome, or partial-thickness adhesion due to vitreoschisis, a split in the posterior vitreous cortex. Anomalous PVD with vitreoschisis splitting behind the level of the monolayer of hyalocytes leaves a relatively thin hypocellular membrane attached to the macula. Vitreoschisis anterior to the level of the hyalocytes leaves a thicker cellular membrane. Persistent vitreopapillary adhesion promotes outward (from the fovea) tangential traction and is therefore associated with macular holes. Inward (centripetal) tangential traction results in macular pucker, almost always in the absence of persistent vitreopapillary adhesion. The English full-text version of this article is available at SpringerLink (under supplemental).

The Prevalence and Distribution of Vitreoretinal Interface Abnormalities among Urban Community Population in China.

The aim of this research was to identify the prevalence and distribution of vitreoretinal interface abnormalities (VIAs) among urban community population in Shenyang, China. According to the WHO criteria, a cross-sectional study was carried out among 304 Type 2 diabetes (T2D) patients and 304 people without diabetes as control over 45 years old. The presence of VIAs was determined by standardized grading of macular optical coherence tomography (Optovue OCT; Optovue, Inc., Fremont, CA) scans and two-field fundus photographs in at least one eye. For both men and women, high prevalence of VIAs (70.79%) was observed among over 65-years-old T2D patients. Prevalence of VIAs was observed to be high among T2D patients in all age groups compared to normal subjects. Prevalence of VIAs increased with age in all subjects. Prevalence of components of VIAs was epiretinal membrane (ERM) 11.43%, posterior vitreous detachment (PVD) 17.76%, vitreomacular traction syndrome (VMT) 5.67%, macular cysts/macular edema (MC/ME) 4.61%, full-thickness macular hole (FTMH) 0.82%, and partial thickness macular hole (PTMH) 0.74% in any eye, respectively. ERM and MC/ME were more prevalent in T2D in both males and females. The results highlight the need for early detection using OCT and approaches for the prevention of VIAs of diabetes in urban community.

Tug of war

A 74-year-old man had reproducible superior and inferior arcuate visual field defects in the left eye only that were initially believed to be caused by primary open-angle glaucoma. Diagnostic evaluation with the aid of optical coherence tomography revealed extrafoveal vitreomacular traction (VMT) with secondary retinal thickening and schisis. We discuss the evaluation of non-glaucomatous visual field defects and review the literature on the pathogenesis, clinical manifestations, and treatment of VMT syndrome.

Comparative analysis of vitreofoveolar traction syndrome surgical treatment

This article focuses on the surgical treatment of the vitreomacular traction ( VMT) syndrome comparing vitrectomy with and without internal limiting membrane (ILM) removal. Patients were randomly divided into 2 groups. In the 1st group, the procedure was performed without the ILM removal. In the 2nd group, the surgery was performed with perifoveolar ILM removal. A comparative analysis revealed that an anatomical result was reached in both groups, but in the 1st group, the development of epiretinal fibrosis was observed in 35 % of the cases in the late postoperative period; and this was not observed in the 2nd group. Visual function recovery was faster in the 1st group, but at 1 year visit, data from both groups were comparable. Thus, the treatment method with surgical ILM removal is preferable, due to more stable anatomical result.

What's new for the surgical management of vitreoretinal interface disorders?

AbstractThe main vitreomacular interface disorders include epiretinal membranes, macular holes, vitreomacular traction syndrome, and less commonly myopic foveoschisis. They are characterized by abnormal mechanical and biochemical interactions between the posterior hyaloid and retinal surface. Based on patient visual impairment and on OCT findings, surgical approach may be considered. Depending on pathophyisiological process, ILM peeling may be discussed. Latest developments of surgical technology for the management of vitreomacular interface disorders will be detailled based on most recent data.

Assessment and novel classification of vitreoretinal interface disorders

AbstractOptical coherence tomography has nowdays become essential investigation device in patient evaluation. It has changed our understanding of vitreomacular interface disorders. Principal pathologies include epiretinal membrane, vitreomacular traction syndrome, macular holes, and less commonly myopic foveoschisis. They characteristics will be detailled. Recently, new international classification of vitreomacular adhesion, traction, and macular hole has been proposed considering anatomical oct considerations. According to panel consensus definitions, this classification may help clinician in predicting therapeutical outcomes.

Pathophysiology of vitreoretinal interface disorders

AbstractPathologic changes at the vitreoretinal interface and vitreomacular tractions lead to phenotypic lesions such as epiretinal membranes (ERMs), idiopathic macular holes, vitreomacular traction syndrome (VMTS) and myopic foveoschisis. In the presence of clinically evident posterior vitreous (PVD), remnants of vitreous collagen fibers and/or cellular proliferations of fibrous astrocytes or glial cells, migrate outward from the retina. Migration occuring on the inner vitreo‐retinal interface through the internal limiting membrane(ILM), in the presence of growth factors such as laminin or fibronectin, may contribute to the fibrocellular proliferation at the retinal surface. Most studies regarding idiopathic or diabetic epiretinal membranes or late stages of macular holes, described the presence of fibrocytes or myofibroblasts. More recent studies confirmed those observations by using antibodies against alpha smooth muscle actine (a‐SMA). Based on the mechanistic association between a‐SMA expression and a tractional force generation, there is little doubt that these cells represented the source of traction during the evolution of those pathologies.

Retinal breaks due to intravitreal ocriplasmin.

Ocriplasmin represents a new treatment option for numerous vitreoretinopathies involving an abnormal vitreomacular interface. While the drug may circumvent the traditional risks of surgical treatment, pharmacologic vitreolysis is not devoid of risk itself. This report presents two cases, one of vitreomacular traction syndrome and the other of a full-thickness macular hole, both of which were treated with an intravitreal injection of ocriplasmin. Notably, in both cases, vitreomacular traction of the macula appears to have been alleviated; however, failure to completely relieve vitreoretinal traction from the peripheral retina generated retinal breaks with one patient eventually developing a macula-involving retinal detachment. Thus, even in instances of ‘successful’ pharmacologic treatment of vitreomacular traction, continued follow-up evaluation is essential.

Classifications of vitreomacular traction syndrome: diameter vs morphology.

The aim of this study is to analyze the agreement between the classifications based on morphology and diameter of vitreomacular traction (VMT) syndrome, as well as to correlate the morphological findings of VMT with specific maculopathies. Fifty-three eyes with VMT syndrome were categorized into two classifications based on optical coherence tomography images: the VMT morphology (V- or J-shaped) and the diameter of adhesion (focal ≤ 1500 μm or broad>1500 μm). High correlation was seen between V-shaped and focal-VMT and between J-shaped and broad-VMT (kappa=0.850; P<0.001), except in four cases with broad adhesion despite the presence of a V-shaped pattern. These four cases had common characteristics to those with broad vitreal attachment regarding associated maculopathies and visual function. V-shaped VMT (n=29) and focal-VMT (n=25) led to tractional cystoid macular edema (CME; 79.31% and 84%, respectively) and macular hole (MH; 37.93% and 44%); J-shaped VMT (n=24) and broad-VMT (n=28) were associated with epiretinal membranes (ERMs; 91.66% and 92.85%, respectively) and diffuse retinal thickening (62.50% and 64.28%). The best-corrected visual acuity (BCVA) was not significantly different between the groups (BCVA logarithm of the minimum angle of resolution: V-shaped, 0.45; J-shaped, 0.46; P=0.816; and focal, 0.50; broad, 0.42; P=0.198). Although highly concordant, the classification based on the diameter of the adhesion and not on the classical adhesion morphology seemed to better reflect the specific macular changes. V-shaped and focal VMT led to tractional CME and MH, while J-shaped and broad VMT were associated with ERM and diffuse retinal thickening.

A novel spectral-domain optical coherence tomography model to estimate changes in vitreomacular traction syndrome.

To analyze the course of eyes with vitreomacular traction (VMT), and to find by optical coherence tomography (OCT) possible correlations between vitreomacular interface area changes and the chance of spontaneous VMT resolution. Retrospective analysis of all consecutive patients presenting with VMT over a 24-month period. We introduced a novel OCT evaluation model to assess the vitreomacular interface area. Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were also analyzed throughout follow-up. Twenty-six eyes of 18 symptomatic patients were followed for 12.9 ± 4.8 months. Eyes were subdivided into groups according to their clinical course. Six eyes (23%) had a spontaneous resolution of the VMT (group A), and the interface area before its occurrence (39565 ± 26409 μm(2)) was smaller than at study entry (99434 ± 38819 μm(2); p = 0.03). The interface area did not significantly change throughout follow-up in the group that underwent surgery (group B, 11 eyes) and in the group that remained overall stable (group C, 9 eyes). At baseline, the interface area was smaller in group A compared to groups with non-resolved VMT (mean values of group B and C together) (785095 ± 920721 μm(2); p = 0.002). CFT and BCVA did not significantly change in any of the studied groups. Vitreomacular interface area of 101002 μm(2) was identified as the threshold value separating the spontaneous VMT resolution group from the group with non-resolved VMT (p < 0.001). The more the vitreomacular interface area reduced over time, the higher was the chance of spontaneous VMT resolution. An area below 101002 μm(2) was the threshold value indicating a higher chance of spontaneous release of VMT.

Vitreomacular traction syndrome.

This study aimed to review the available literature on vitreomacular traction (VMT) syndrome and propose the future study prospect in this field. The data used in this review were mainly obtained from articles listed in Medline and Pubmed (1970-2013). The search terms were "vitreomacular traction", "optical coherence tomography", "vitrectomy", and "ocriplasmin". Articles regarding the pathophysiology, diagnosis, and treatments of VMT were selected and reviewed. VMT syndrome is a persistent attachment of vitreous to the macula in eyes with an incomplete posterior vitreous detachment and considered to be an uncommon status which correlated with some other macular disorders. Optical coherence tomography (OCT) can support a new way to examine and classify VMT. Nonoperative and operative intervenes on this disease have been developed recently, especially the intravitreal medical therapy. VMT syndrome may be associated with various disorders in the macular region, depending in part on the size and strength of the residual vitreomacular adhesion. Regular OCT monitoring is recommended to detect it. Patients with asymptomatic VMT should be observed for at least 2-3 months; nonoperative treatment with ocriplasmin should be considered when disorders persist; surgery is recommended if VMT-related disease is significant.

A retrospective study of a single practice use of ocriplasmin in the treatment of vitreomacular traction

Purpose: To evaluate success with intravitreal injection of ocriplasmin in releasing symptomatic vitreomacular traction (VMT).Methods: A retrospective review of consecutive series of patients in a single vitreoretinal practice. Patients with symptomatic distortion and loss of vision secondary to VMT were included in the study. Patients received a single injection of ocriplasmin (JETREA®) and were followed-up after 1 month with optical coherence tomography.Results: Eight patients (8 eyes) were included (2 males and 6 females) in the study. Five of 8 eyes (62.5%) experienced complete release of the VMT; one of 8 eyes (12.5%) had partial release of VMT and two of 8 eyes (25%) did not have release of VMT. The two patients with no release of their VMT had the same vision. Of the 5 patients with complete release of VMT, 3 patients had a one line worsening of their vision, 1 had a 4 line improvement of vision, and 1 stayed the same. The patient with only partial release of their VMT had a 1 line worsening of vision.Conclusions: Intravitreal ocriplasmin is a promising treatment option for vitreomacular traction syndrome in symptomatic patients.

Macular abnormalities in Italian patients with retinitis pigmentosa

AimTo investigate the prevalence of macular abnormalities in a large Caucasian cohort of patients affected by retinitis pigmentosa (RP).MethodsA retrospective study was performed by reviewing the medical records and optical...

Microincision Vitrectomy Surgery in Vitreomacular Traction Syndrome of Retinitis Pigmentosa Patients

Purpose. To investigate long-term retinal changes after microincision pars plana vitrectomy surgery (MIVS) and internal limiting membrane (ILM) peeling outcome in retinitis pigmentosa (RP) patients affected by vitreomacular traction syndrome (VMT) with higher vitreous surface adhesion or coexisting epiretinal membrane (ERM). Methods. Eight RP patients suffering from VMT were evaluated by means of best corrected visual acuity (BCVA), anterior and posterior binocular examination, spectral-domain optical coherence tomography (SD-OCT), MP-1 microperimetry (MP-1), and full-field electroretinogram (ERG), before MIVS and ILM peeling and during the 36-month follow-up. Patients were hospitalized for two days after the surgery. Surgical procedure was performed following this schedule: surgical removal of crystalline lens (MICS), MIVS with 23-gauge sutureless system trocars, core vitreous body removal, and balanced-sterile-salin-solution- (BSS-) air-gas (SF6) exchange. Results. All patients presented visual acuity (VA) increase after MIVS. None of the patients developed ocular hypertension or vitreomacular adhesions during the 3-year follow-up. MP-1 bivariate contour ellipse area (BCEA) was reduced in its dimensions and improved in all patients demonstrating a better fixation. Conclusions. MIVS could be the gold standard therapy in RP patients with VMT and higher vitreous surface adhesion or coexisting ERM if medical therapy is not applicable or not effective.

Structural and Functional Changes After Macular Hole Surgery

Chin, Eric K. MD; Almeida, David R.P. MD, MBA, PhD; Sohn, Elliott H. MD Author Information