Vitreomacular Interface Diseases

Pathophysiology, Diagnosis and Future Treatment Options

Aniz Girach; Steve Pakola

Disclosures

Expert Rev Ophthalmol. 2012;7(4):311-323. 

In This Article

Pathophysiology of Vitreomacular Traction

In symptomatic VMA, the continuous tangential and antero posterior stretching on the macula can lead to VMT, which, if allowed to progress, can lead to sight-threatening complications, such as the formation of macular edema and macular hole. VMT can also lead to microscopic damage of the retinal surface. When this focal area of damage or irritation occurs in the macular region, the retina initiates a healing response, leading to a thin layer of scar tissue known as macular pucker or epiretinal membrane.[6] A review of the electron microscopic features of the preretinal membrane tissue removed from eyes with VMT showed a high prevalence of fibroglial tissue,[27] including thickened internal limiting membrane, astrocytes and myofibrocytes.[28]

Abnormalities at the vitreomacular interface, such as retinoschisis progressing to macular hole, have also been reported in the setting of high myopia. This may relate to the higher axial length; an axis length of over 31 mm was reported a risk factor. Other risk factors included macular chorioretinal atrophy and vitreoretinal interface disorders, including macular pucker, posterior vitreoschisis and VMT.[29] The clinical presentation of abnormalities at the vitreoretinal interface may differ depending on the size and strength of the remaining vitreomacular attachments, and on the structural integrity of the macula. For instance, macular hole associated with VMT is found to have a narrower diameter VMA compared with macular edema. It seems that the narrower the VMA, the greater the force it exerts upon the macula, which can lead to macular hole.[30]

Macular holes progress from stage 0 to 4, where stage 0 is only noticeable with optical coherence tomography (OCT; see also section below) and stage 4 is a fully developed hole with complete posterior vitreous detachment. VMT has been associated with the development of macular holes in the literature.[30] An anterior–posterior tractional force contributes to a prehole intraretinal split, which is thought to precede the formation of an idiopathic full-thickness macular hole.[31]

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