Proprietary or commercial disclosure may be found after the references. This classification system will support systematic diagnosis and management by creating a clinically applicable system that is predictive of therapeutic outcomes and is useful for the execution and analysis of clinical studies. Full-thickness macular hole is subclassified by size of the hole as determined by OCT and the presence or absence of VMT. Full-thickness macular hole is primary if caused by vitreous traction or secondary if directly the result of pathologic characteristics other than VMT. Full-thickness macular hole (FTMH) is defined as a foveal lesion with interruption of all retinal layers from the internal limiting membrane to the retinal pigment epithelium.
When associated with other macular disease, VMT is classified as concurrent. Vitreomacular traction can be subclassified by the diameter of vitreous attachment to the macular surface as measured by OCT, with attachment of 1500 μm or less defined as focal and attachment of more than 1500 μm as broad. Vitreomacular traction is characterized by anomalous posterior vitreous detachment accompanied by anatomic distortion of the fovea, which may include pseudocysts, macular schisis, cystoid macular edema, and subretinal fluid. It is an OCT finding that is almost always the result of normal vitreous aging, which may lead to pathologic conditions. Vitreomacular adhesion is defined as perifoveal vitreous separation with remaining vitreomacular attachment and unperturbed foveal morphologic features. Optical coherence tomography-based anatomic definitions and classification of vitreomacular adhesion, vitreomacular traction (VMT), and macular hole. Responses to questionnaires and the group's opinions on definitions specified in the literature were used to guide the discussion. The articles were preselected based on searches for comprehensive reviews covering diseases of the VMI. The IVTS applied their clinical experience, after reviewing the relevant literature, to support the development of a strictly anatomic OCT-based classification system.Ī panel of vitreoretinal disease experts was the foundation of the International Classification System.īefore the meeting, panel participants were asked to review 11 articles and to complete 3 questionnaires. If you require surgery for VMT, I operate at the Nuffield Health Bristol Hospital.The International Vitreomacular Traction Study (IVTS) Group was convened to develop an optical coherence tomography (OCT)-based anatomic classification system for diseases of the vitreomacular interface (VMI). In certain patients, VMT may be treated with a simple injection of a bubble of gas into the eye. If the VMT is causing you problems, then the standard surgical treatment is a vitrectomy. However, there is a small chance that the VMT may cause a macular hole if left untreated. If the VMT is not affecting your quality of life, it can be monitored as it may remain stable or improve by itself. However, some people may have normal vision despite significant VMT. What are the symptoms of vitreomacular traction?Īs the macula is the part of the retina that you use for central vision, VMT may affect tasks such as reading by causing your vision to become blurred and distorted. Instead the vitreous pulls on the retina and distorts the underlying macula. In VMT, there is a strong attachment between the vitreous and the macula that prevents the vitreous from pulling away cleanly. It collapses and pulls away from the retina.
The critical point in this weakening process is when the vitreous gel can no longer support itself. It serves no purpose following birth and breaks down and weakens as we get older. The vitreous is a ball of transparent gel that acts as a scaffold for the retina and the wall of the eye to grow around as we develop in the womb. A PVD is a natural process within the eye that occurs at some point in everyone’s life. Vitreomacular traction (or VMT) occurs with an abnormal posterior vitreous detachment (or PVD).