Oct-based interpretation of the vitreomacular interface and indications for pharmacologic vitreolysis

Retina. Nov-Dec 2013;33(10):2003-11. doi: 10.1097/IAE.0b013e3182993ef8.

Abstract

Purpose: To review the role of optical coherence tomography (OCT) in diagnosis and management of vitreomacular disease and the impact of OCT on potential uses of ocriplasmin, a new pharmacologic vitreolysis agent recently approved by the U.S. Food and Drug Administration for the treatment of symptomatic vitreomacular adhesion.

Methods: Analysis of current literature regarding OCT in diagnosis and management of vitreomacular interface disease.

Results: Posterior vitreous detachment is typically a nonpathologic age-related event. Anomalous posterior vitreous detachment emerges when the vitreous cortex fails to cleanly detach from the macula, optic nerve, or other adherent sites. Focal vitreomacular adhesion is a nonpathologic anatomical designation associated with perifoveal posterior vitreous detachment but normal retinal morphology on OCT. Vitreomacular traction is a pathologic consequence of persistent vitreous attachment with structural disturbance of the macular retina visible on OCT. Full-thickness macular holes are foveal defects continuous through all retinal layers to the retinal pigment epithelium. Vitreomacular traction and macular hole with focal vitreomacular adhesion are indications for pharmacologic vitreolysis.

Conclusion: Noninvasive high-resolution OCT imaging has transformed the understanding of vitreomacular interface disease. Careful evaluation of the vitreomacular interface with OCT has increased in importance with the introduction of ocriplasmin for vitreomacular adhesion associated with symptomatic anatomical retinal changes.

Publication types

  • Review

MeSH terms

  • Eye Diseases / diagnosis*
  • Fibrinolysin / therapeutic use*
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Intravitreal Injections
  • Peptide Fragments / therapeutic use*
  • Retinal Diseases / diagnosis*
  • Retinal Perforations / diagnosis
  • Retinal Perforations / drug therapy*
  • Tissue Adhesions / diagnosis
  • Tomography, Optical Coherence*
  • Vitreous Body / pathology*
  • Vitreous Detachment / diagnosis
  • Vitreous Detachment / drug therapy*

Substances

  • Fibrinolytic Agents
  • Peptide Fragments
  • microplasmin
  • Fibrinolysin