In today’s real-world clinical settings, a confirmed diagnosis on spectral-domain OCT (SD-OCT) has made it much easier for clinicians to examine the vitreoretinal interface and identify tractional diseases, often before visual loss becomes irreversible. Įpidemiological data on VMA, VMT, and MH also are limited. However, anatomic improvements do not necessarily correlate with visual function (VA or symptoms), and PPV has been reported to have a relatively modest impact on VA. In some patients, watchful waiting results in favorable outcomes, including spontaneous resolution of VMA. Pars plana vitrectomy (PPV) is typically reserved for more severe or progressive cases. In patients with tractional VMI disease, “watchful waiting” has been the traditional standard of care. There are very limited data on the impact of these symptoms on visual quality in patients with VMT however, metamorphopsia has been associated with decreased vision-related quality of life in other vitreoretinal disorders, and it has been suggested that it may be more important to overall perception of visual function than visual acuity. VMT can also lead to visual disturbances, among them metamorphopsia, photopsia, and micropsia. Visual acuity (VA) is usually preserved in early VMT, but is progressively impacted as a macular hole develops. However, the progression of VMA and VMT is not consistent among all patients, and data on the natural history are limited. Focal VMT can result in macular hole (MH) formation or tractional cystoid macular edema, while broad VMT has been associated with epiretinal membrane (ERM) and diffuse retinal thickening, among others. Other potential anatomic effects include vitreomacular adhesion (VMA) and vitreomacular traction (VMT) syndromes or hemorrhage in the presence of concomitant disease. Forced tractional separation (either surgical or mechanical) between the posterior vitreous and the internal limiting membrane (ILM) has shown pockets of extreme adhesion subsequent methods to break the bond can result in retinal tears and dialyses. Numerous potential anatomic consequences of anomalous PVD exist. When the liquefaction exceeds vitreoretinal dehiscence and traction is exerted at the vitreomacular interface (VMI), an anomalous PVD occurs.

Posterior vitreous detachment (PVD) is a consequence of aging whereby the vitreous liquefies and detaches from the internal limiting lamina of the retina. Spontaneous resolution of VMT and VMA was rare, whereas disease progression resulting in PPV was more common. Conclusionsīetter visual acuity outcomes were found in eyes with spontaneous resolution compared to the other groups.

Of the eyes with VMA, 4.8 % (6/124) had disease progression resulting in patients opting for PPV. Eleven of the 203 eyes with VMT (5.4 %) developed a macular hole 52 of 203 eyes with VMT (25.6 %) had disease progression that resulted in patients opting for pars plana vitrectomy (PPV). During follow-up, 11.3 % (14/124) of eyes with VMA showed disease progression six (4.8 %) developed a macular hole. In the former group, 34.1 % (14 eyes) showed improved visual acuity (P = .001). Spontaneous resolution occurred in 22.7 % (46/203) of eyes with VMT and in 7.3 % (9/124) of eyes with VMA ( P < .001). Patients were followed for a mean of 10.9 months (median 6.9 months). Vision loss and metamorphopsia were the leading causes for referral. The outcomes measured include prevalence of symptoms, rates of disease stabilization, spontaneous resolution, and disease progression necessitating surgical intervention. Retrospective, single-center, observational study of 400 patients (556 eyes) who presented with optical coherence tomography (OCT) findings related to tractional diseases of the vitreomacular interface (187 with bilateral disease). To assess how vitreomacular adhesion (VMA), vitreomacular traction (VMT), and macular holes (MH) evolve, and to assess visual acuity outcomes associated with different management strategies for each subgroup.

Vmt medical