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


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

VMA = focal or broad (> 1500 micrometers).


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.

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.

Location Birmingham Midlands Eye Centre 76 Dudley Road Birmingham B18 7QH UK Phone 0121 554 3801 Hours Mr Ch'ng | Vitreoretinal Clinic Sessions: Monday: 8.30am - 12.30pm Wednesday (alternate): 8.30am - 5.00pm Thursday: 8.30am - 12.30pm Friday: 8.30am - 12.30pm | Vitreoretinal Theatre Sessions: Wednesday (alternate): 8.30am - 5.00pm & Friday (emergency cases): 1.30pm - 5.00pm | Eye Casualty Session: Monday 1.00pm - 4.30pm |
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