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Review
, 2015, 809640

A Review of Current Management of Vitreomacular Traction and Macular Hole

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Review

A Review of Current Management of Vitreomacular Traction and Macular Hole

Alfredo García-Layana et al. J Ophthalmol.

Abstract

The paper presents a review of the sequence of events of posterior vitreous detachment (PVD), vitreomacular adhesion (VMA), vitreomacular traction (VMT), and macular hole (MH) from their pathophysiological aspects, clinical features, diagnostic implications, and current management strategies. A treatment algorithm to be used in clinical practice in patients with VMA, VMT, and MH based on the presence of symptoms, visual acuity, associated epiretinal membrane, and width of the vitreous attachment is presented. Observation, pharmacologic vitreolysis with ocriplasmin, and surgical treatment are positioned as treatment options in the different steps of the therapeutic algorithm, with clear indications of the paths to be followed according to the initial presenting manifestations and the patient's clinical course.

Figures

Figure 1
Figure 1
Horizontal image with swept-source OCT at the foveal level showing posterior vitreous detachment, which remains adhered to the fovea and the papillary edge.
Figure 2
Figure 2
Study of the retinal surface with swept-source OCT showing posterior vitreous detachment, which remains attached at the papillary level.
Figure 3
Figure 3
(a) Focal VMT. The arrow points to the ellipsoid zone. (b) Release of VMT after injection of ocriplasmin. A severe disruption in the ellipsoid zone is shown (by courtesy of Dr. Peter K. Kaiser, Cleveland Clinic, Cleveland, OH, USA).
Figure 4
Figure 4
(a) Fundus photography and OCT of a patient who underwent macular hole surgery with ILM peeling and adequate reconstitution of the outer retina (ELM and ellipsoid bands) and visual acuity 20/30. (b) Reopening of the MH after 3 years with cystoid edema surrounding the hole and decreased visual acuity to 20/200. The ERM is not observed.
Figure 5
Figure 5
Fundus photography and OCT after reoperation using platelet-derived growth factors. Successful anatomic hole closure is observed but glial type scar in the inner retina and the absence of a continuous ellipsoid band determined a final visual acuity of 20/60.
Figure 6
Figure 6
Treatment algorithm for VMA, VMT, and MH (VA: visual acuity, ERM: epiretinal membrane).

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