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R. Margolis, W. Nam, S. Chang; Posterior Vitreous Anatomy: Intraoperative Correlation With Spectral Domain Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2010;51(13):296.
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To determine posterior vitreous anatomy using triamcinolone-assisted vitrectomy, correlated with 3-dimensional (3D) spectral-domain (SD) optical coherence tomography (OCT) imaging to provide insight into the mechanisms for vitreomacular interface disorders.
Twenty eyes of consecutive 19 patients with vitreomacular traction abnormalities were managed by vitrectomy. In all there was no evidence of posterior vitreous separation preoperatively. Triamcinolone was injected after a limited core vitrectomy to identify the posterior cortical vitreous. The staining pattern of the cortical vitreous and its adhesions to the macula and optic disc were identified and compared with preoperative OCT imaging.
In all eye, an intraoperative injection of triamcinolone revealed a premacular vitreous structure that encompassed the optic disc and macula in a bi-lobed configuration. The posterior premacular vitreous cortex stained more densely than the adjacent vitreous cortex located beyond the arcades. The premacular vitreous structure was detected by 3D OCT in 19 of 20 eyes. Four pattern of posterior vitreous anatomy were detected: (1) focal foveolar adhesion (7 eyes); (2) splitting of posterior hyaloid with macular pucker (5 eyes), macular and disc attachment with peripheral hyaloid separation (4 eyes), and posterior vitreoschisis with peripheral hyaloid serparation (4 eyes). Pattern 1 was seen in diabetic retinopathy and macular hole. Pattern 3 was seen in vitremacular traction syndrome. Patterns 2 and 4 were seen in macular pucker and diabetic retinopathy.
A thickened and adherent vitreous structure overlying the macula and optic disc with a distinct staining pattern may be observed during vitrectomy assisted by triamcinolone. Variations in the degree of abnormal vitreomacular adhesions may explain different disorders that ultimately result.
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