Anomalous PVD = Abnormal PVD + premature vitreous liquefaction + insufficient weakened VR adhesion.
Anomalous PVD (consequences)
–> partial thickness (vitreoschisis) –> macular hole or pucker
–> 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.
- Observation with Amsler grid
- Pars plana vitrectomy + ERM/ILM peeling +/- air/gas
- Ocriplasmin intravitreal (MIVI-TRUST trial)
- Pneumatic vitreolysis – C3F8 with dipping bird maneuver procedure repeatedly to induce PVD.
- 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.