Vitreomacular Adhesion and Vitreomacular Traction

Published on 09/05/2015 by admin

Filed under Opthalmology

Last modified 22/04/2025

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Vitreomacular Adhesion and Vitreomacular Traction

Introduction:

Vitreomacular adhesion (VMA) is an OCT finding. It represents a perifoveolar detachment of the cortical vitreous from the underlying retina with part of the vitreous remaining attached at the macula and elsewhere in the eye. The underlying macular retina is normal. It is almost always a normal finding, representing the initial evolution of a normal posterior vitreous detachment. Vitreomacular traction (VMT) is present when perifoveolar vitreous detachment is accompanied by retinal morphological changes arising from traction of the vitreous on the retina. There is no known racial predilection for VMT. VMT is more common in women (about 65%), with most patients in their sixth or seventh decade of life

Clinical Features:

Patients may complain of decreased central vision with metamorphopsia. On examination, there may be preretinal fibrosis, epiretinal membrane formation and blunting or alteration of the foveal reflex with a pseudo-hole appearance.

OCT Diagnosis:

OCT is the diagnostic modality of choice for both of these entities. In fact, VMA can only be reliably diagnosed via OCT. In VMA, OCT shows vitreous separating from around the macula with persisting adhesion at the macular center, often in a concentric fashion (Fig. 10.1.1). VMT is accompanied by changes in the retina including cystic changes, macular schisis, defined as a separation between the outer nuclear and the outer plexiform layer, epiretinal membrane formation and tractional retinal detachment (Figs 10.1.2 to 10.1.4) Often the posterior hyaloid appears abnormally thickened in VMT.

Figure 10.1.1 Vitreomacular adhesion. Note the dense posterior hyaloid face (arrows). The retina appears to be normal.

Figure 10.1.2 Early vitreomacular traction/stage 1 macular hole. The OCT shows an adherent vitreoretinal interface with retinal changes.

Figure 10.1.3 Vitreomacular traction with macular schisis and outer retinal cystic changes.

Figure 10.1.4 Vitreomacular traction post-treatment with ocriplasmin showing detachment of the vitreous over the macula (arrow) and improvement of the macular schisis.

Ancillary Testing:

A diagnosis of VMT is best made via OCT. Fluorescein angiography may show leakage in a cystic pattern. B-scan ultrasound may demonstrate peripheral detached vitreous, but with attachment still noted over the posterior pole.

Treatment:

VMA should be observed. The term ‘symptomatic VMA’ will always appear as VMT on OCT. Mild VMT is typically observed. Surgery via vitrectomy or pharmacologic intervention can be considered for eyes with poor or worsening vision.

Related

Handbook of Retinal OCT Optical Coherence Tomography