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Vitreomacular Traction

Anomalous PVD = Abnormal PVD + premature vitreous liquefaction + insufficient weakened VR adhesion.

Anomalous PVD (consequences)

–> partial thickness (vitreoschisis) –> macular hole or pucker

OR

–> full thickness but partial PVD –> peripheral separation (posterior traction) which leads to VMT OR posterior separation (peripheral traction) which leads to retinal tears / RD

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Vitreomacular adhesion (VMA) = perifoveal vitreous detachment + persistent vitreous attachment + no change in retina contour.

VMA = focal or broad (> 1500 micrometers).

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Symptoms: Asymptomatic (most) or gradual reduced vision with metamorphopsia.


Investigations: OCT


Management:

  1. Observation with Amsler grid

  2. Pars plana vitrectomy + ERM/ILM peeling +/- air/gas

  3. Ocriplasmin intravitreal (MIVI-TRUST trial)

  4. Pneumatic vitreolysis – C3F8 with dipping bird maneuver procedure repeatedly to induce PVD.

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Myopic foveoschisis:

  • Around 10% high myopes with posterior staphyloma.

  • 70% worsen vision vs. 30% stable vision over 3 years.

  • Related to increased degenerative changes in the retina from mechanical stretching and thinning of choroid and RPE secondary to elongation of the eye.

  • Fundus autofluorescence – differentiate it from RD (hypoautofluorescence appearance).

  • Treatment – PPV +/- ILM peel (fovea sparing) +/- gas tamponade.

  • ILM peel – risk iatrogenic MH formation.

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