Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment
Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment
Posterior vitreous detachment (PVD) is a common phenomenon in the aging eye. However, this may be complicated by persistent symptomatic vitreomacular adhesions that exert tractional forces on the macula (vitreomacular traction; VMT). VMT itself may be associated with epiretinal membrane formation and the development of idiopathic macular holes (IMH). Such pathologies may cause visual disturbances, including metamorphopsia, photopsia, blurred vision, and decreased visual acuity, which impact an individual's quality of life. Technologies such as optical coherence tomography allow an increasingly more accurate visualisation of the macular anatomy, including quantification of macular hole characteristics, and this facilitates treatment decision-making. Pars plana vitrectomy remains the primary treatment option for many patients with VMT or IMH; for the latter, peeling of the inner limiting membrane (ILM) of the retina has shown improved outcomes when compared with no ILM peeling. The development of narrow-gauge transconjunctival vitrectomy systems has improved the rate of visual recovery following surgery. Ocriplasmin, by degrading laminin and fibronectin at the vitreoretinal interface, may allow induction of PVD in a non-invasive manner. Indeed, clinical studies have supported its use as an alternative to surgery in certain patient populations. However, further research is still needed with respect to greater understanding of the pathophysiology underlying the development of VMT and IMH.
vitreomacular traction, macular hole, ocriplasmin, posterior vitreous detachment, vitrectomy
S1-S21
Steel, D.H.W.
835637c7-a54b-4346-a46b-c3adbff602cc
Lotery, A.J.
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514
October 2013
Steel, D.H.W.
835637c7-a54b-4346-a46b-c3adbff602cc
Lotery, A.J.
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514
Steel, D.H.W. and Lotery, A.J.
(2013)
Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment.
Eye, 27, .
(doi:10.1038/eye.2013.212).
(PMID:24108069)
Abstract
Posterior vitreous detachment (PVD) is a common phenomenon in the aging eye. However, this may be complicated by persistent symptomatic vitreomacular adhesions that exert tractional forces on the macula (vitreomacular traction; VMT). VMT itself may be associated with epiretinal membrane formation and the development of idiopathic macular holes (IMH). Such pathologies may cause visual disturbances, including metamorphopsia, photopsia, blurred vision, and decreased visual acuity, which impact an individual's quality of life. Technologies such as optical coherence tomography allow an increasingly more accurate visualisation of the macular anatomy, including quantification of macular hole characteristics, and this facilitates treatment decision-making. Pars plana vitrectomy remains the primary treatment option for many patients with VMT or IMH; for the latter, peeling of the inner limiting membrane (ILM) of the retina has shown improved outcomes when compared with no ILM peeling. The development of narrow-gauge transconjunctival vitrectomy systems has improved the rate of visual recovery following surgery. Ocriplasmin, by degrading laminin and fibronectin at the vitreoretinal interface, may allow induction of PVD in a non-invasive manner. Indeed, clinical studies have supported its use as an alternative to surgery in certain patient populations. However, further research is still needed with respect to greater understanding of the pathophysiology underlying the development of VMT and IMH.
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Published date: October 2013
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
Keywords:
vitreomacular traction, macular hole, ocriplasmin, posterior vitreous detachment, vitrectomy
Organisations:
Clinical & Experimental Sciences
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Local EPrints ID: 359158
URI: http://eprints.soton.ac.uk/id/eprint/359158
ISSN: 0950-222X
PURE UUID: 5a2d8efa-e724-4b7d-b9e5-d59c9dc35bff
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Date deposited: 23 Oct 2013 11:06
Last modified: 15 Mar 2024 03:15
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D.H.W. Steel
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