Vitreomacular traction syndrome symptoms and treatment. While the risk of progression to more severe disruption of foveal function or progression to a macular hole exist, it is low. Vitreomacular traction syndrome is described as a maculopathy in which incomplete vitreous detachment associated with macular traction and visual acuity decrease occurs. Sometimes, there is an epiretinal membrane associated with this and it, too, may be removed. Myofibroblasts were also identified as the predominant cell type in vitreomacular traction syndrome 5. What you should know about vitreomacular traction syndrome. Visual outcome after vitrectomy for vmt is correlated with preoperative vitreomacular structure, duration of symptoms, and preoperative central. This is followed by the peeling of the inner limiting membrane ilm, with the entire procedure performed using small 25 or 27 gauge implements to ensure no stitches are necessary. D, an example of a broad adhesion subtype of the international vitreomacular traction study group subtypes. The prevalence of vitreomacular traction vmt associated with ocular disease has been estimated to range from 0. Vitreomacular traction vmt syndrome is a potentially visually significant disorder of the vitreoretinal interface characterized by an incomplete posterior vitreous detachment with the persistently adherent vitreous exerting tractional pull on the macula and resulting in morphologic alterations and consequent decline of visual function. Introduction vitreomacular traction vmt syndrome was described for the first time in 1967 as partial peripheral detachment of the vitreous with preserved posterior attachment to the macula 1. The vitreous humor is the gellike substance located between the retina and the lens. An interesting case of spontaneous resolution of vitreomacular traction syndrome vmts in which, fortuitously, pars plana vitrectomy was deferred and the patient resolved over a period of 2 weeks.
What can you expect from tests for vitreomacular adhesion. Vitreomacular traction vmt syndrome is an eye condition involving the vitreous, the clear gel that fills the inside of the eyeball. Chapter vitreomacular traction syndrome william e. Vitreomacular traction occurs when the adherent vitreous tugs and distorts the macula. Vitreomacular traction syndrome pubmed central pmc. The degree of vision loss that remains after treatment for vitreomacular traction syndrome depends on the severity of the traction and how long it was in place before treatment. Complications can include cystoid macula oedema, macular pucker, tractional macular detachment and ftmh kamur et al 2010. The pathogenesis and risk factors for vitreomacular traction syndrome are not well established. Most patients who have vmt syndrome experience some difficulty doing daily tasks. Spontaneous resolution of vitreomacular traction syndrome.
One is the vitreous, or the jelly part that fills the eyeball. As the eye ages, it is common for the vitreous to separate from the retina. Oct scan top of normal macula compared to an eye with vitreomacular traction bottom what are the symptoms of vitreomacular traction. Vitreomacular traction syndrome vmts is a disorder that causes foveal depression via anterior traction of the foveal retina when posterior vitreous detachment pvd occurs. This causes central visual impairment, either in the form of a generalised blurring or distortion. The presence of traction on themacula was confirmed through the use of histologic studies,and the term vitreomacular traction vmt syndrome wascoined. The predominance of myofibroblasts may help to explain the high prevalence of cystoid macular edema and progressive vitreomacular traction characteristic of this disorder. The expanding spectrum of vitreomacular traction pdf. Vitreomacular traction vitreomacular traction surgery. Abnormalities of the vitreoretinal interface as imaged by oct are described including vitreomacular traction syndrome, cystoid macular edema diabetic macular edema, epiretinal membranes, full.
If you have symptoms of vitreomacular adhesion vma, your doctor can do tests to figure out whats going on with your eyes. A study of the natural history of vitreomacular traction. Your retina specialist mahi muqit will assess your symptoms to help you decide whether to proceed with surgery. Vitrectomy for macular pucker and vitreomacular traction. Clinical features of vitreomacular traction syndrome with. Sometimes, the adherent vitreous will free itself and the macula will return to its normal position.
It is the macula that gives us the vision we use to read and to do detailed visual tasks. Spontaneous resolution of vitreomacular traction in a. Proposed mechanism of erm proliferation in vitreomacular traction syndrome, according to johnson 4 and chang et al. Browning, md, phd the eye is filled by a vitreous gel that is attached to the neural lining of the back.
Vitreomacular traction vmt syndrome is an idiopathic retinal disease caused by incomplete posterior vitreous detachment pvd. Vitreomacular traction syndrome decisionmaker plus. Vitreomacular traction syndrome the vitreous humor is a transparent, gellike material that fills the space within the eye between the lens and the retina. What you should know about vitreomacular traction syndrome vmt and vitreopapillary traction syndrome vpt by david j. The eye is filled by a vitreous gel that is attached to the neural lining of the back of the eye, the retina, and to the optic disk. Vitreomacular traction syndrome europe pmc article.
Vitreomacular traction vmt syndrome is an eye condition involving the vitreous, the clear gel that fills the within the eyeball. The usual treatment for vitreomacular traction is vitrectomy. The macula is the most sensitive part of the retina. Immediately after your combined vitreomacular traction syndrome surgery, and for several days following, you will not be able to see the bottom part of your visual field with the eye that was operated on. The surgery for vitreomacular traction syndrome involves a vitrectomy the removal of vitreous gel, which releases the area of traction upon the macular. During the course of a socalled posterior vitreous detachment, a thin layer of the posterior vitreous cortex often remains adherent to the underlying retina. Predictors of vitreomacular traction release retina today. The same process appears to underlie the development of true epimacular. While these complications may be present, the idiopathic form occurs in. Vitreomacular traction vmt syndrome represents a wide spectrum of vitreoretinal anatomical configuration, and vitrectomy is effective in resolving the traction in vmt with slight complications. Vitreomacular traction typically has an asymmetric presentation with the fellow eye rarely showing clinical changes. The vitreous is encapsulated in a thin shell called the vitreous cortex, and the cortex in young. Vitrectomy for vitreomacular traction syndrome retina doctor.
Often, many doctors try a short period of observation along with some eye drops. Incomplete separation of the vitreous at the macular area may cause macular traction that leads to cystoid changes in the neurosensory retina. Current concepts in vitreomacular traction syndrome. This will cleave the connection between the vitreous and the retina specifically in the area of the macula. Vitreomacular adhesion vma can be serious, but its treatable. The mechanical tugging on the macula causes the central vision to be blurred or distorted. The vitreous is encapsulated in a thin shell called the vitreous cortex, and the cortex in young, healthy eyes is usually sealed to the retina. In the classic form of vmt syndrome, as initially described 1, the vitreous is separated from the retina throughout the peripheral fundus but remains adherent posteriorly, engendering anteroposterior traction on a broad. The macula is the small area at the center of the retina, which is the thin tissue that lines the inside of the back of the eye. What is the longterm impact of vitreomacular traction syndrome on my vision. Published april 16, 2010 when to monitor or treat vmt cases of vitreomacular traction progress very differently, so keep a close eye on your patient. Combined surgery for vitreomacular traction syndrome. It is a visionthreatening condition and can cause symptoms ranging from blurry vision to distorted and blackedout central vision. Tangential stretch of this vitreous pseudomembrane may cause vitreomacular traction syndrome, edema, and macular hole formation.
It is a visionthreatening condition and can cause symptoms varying from lowered and blurred vision to distorted and blackedout main vision. It is encapsulated in a thin shell vitreous cortex and typically remains attached. Vitreomacular adhesion vma is a human medical condition where the vitreous gel or simply vitreous, aka vitreous humour of the human eye adheres to the retina in an abnormally strong manner. Design retrospective, interventional, single centre, case series. Epiretinal membrane, macular hole and vitreomacular. Vitreomacular traction treatment for vitreomacular traction can include medication, surgery, or observation by your ophthalmologist in mild cases. Clinical features of vitreomacular traction syndrome with peripheral vitreoretinal adhesion. Both your vision and your eye itself can be affected. Recent findings hdoct has provided unprecedented visualization of the vitreomacular interface, which has led to better comprehension of the vmt syndrome.
In some cases, vitreomacular traction syndrome can progress to a macular hole. Epiretinal pathology of vitreomacular traction syndrome. Vitreomacular traction, pars plana vitrectomy, ocriplasmin, optical coherence tomography. Vmt was assumed to be an uncommon entity and not associated with other macular disorders. After induction of posterior vitreous detachment, epiretinal tissue and the inner limiting membrane ilm of the retina were removed, and. The visual acuity after treatment of vitreomacular traction syndrome depends on how long it has been present and how severely it has impacted the retina. Vitreomacular traction syndrome is a vitreoretinal interface alteration where presence of myofibroblast associated or not to collagen layers prevents the total detachment between posterior vitreous and the retina. Vitreomacular traction syndrome is distinguished from impending macular hole because the vitreomacular traction syndrome is rarely associated with progression to a fullthickness macular hole and eyes with an impending macular hole typically do not have residual macular traction from a partial posterior vitreous detachment 7, 26, 27. Epimacular membranes and vitreomacular traction syndromes. Anatomical and visual outcomes following ocriplasmin. Clinical trials demonstrated the efficacy and safety of a single intravitreal injection of ocriplasmin for the treatment of patients with symptomatic vitreomacular adhesion, andor vitreomacular traction.
Over time, the gel tends to pull forward and can cause vessel and retinal distortion causing retinal swelling and decreased vision. Pars plana vitrectomy for vitreomacular traction syndrome. Smiddy definition incomplete posterior vitreous separation with preretinal tissue proliferation and associated macular traction distributed in the zone of persistent vitreous attachment. Vitreomacular traction is an uncommon condition in which shrinkage of the vitreous jelly within the eye pulls on the central macular area of retina. For most patients, there is less distortion and greater clarity of vision.
Vitreomacular traction syndrome the american society of. The advent of new technologies such as high definition optical coherence tomography oct has not only provided unprecedented imaging capabilities, but also raised the need to define concepts not yet settled and often confusing such as the vitreomacular traction vmt syndrome. Vitreomacular traction typically manifests with decreased visual acuity, metamorphopsia, blurred vision. To investigate the ultrastructure of the vitreoretinal interface in patients with vitreomacular traction syndrome. Vitreomacular traction is a condition in which the vitreous gel has an abnormally strong adhesion to the retina. Key features prominent vitreoretinal attachment at the posterior pole. Retinal oct scans depicting the grading reported by john et al 9 of retinal architecture in vitreomacular traction syndrome.