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N. A. Hindoyan, M. Y. Wang, J. Chang, D. Nguyen, A. A. Sadun, J. Sebag; Vitreo-Papillary Attachment in Macular Hole and Macular Pucker. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4683.
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While it is known that vitreous plays an important role in the pathogenesis of macular holes (MH) and macular pucker (MP), it is not clear how tractional forces are mediated differently in these two diseases to result in the disparate clinical presentations. One theory is that in MH, persistent vitreo-papillary attachment anchors the posterior vitreous cortex, exerting centrifugal (outward from the fovea) tangential forces on the macula. It is thus hypothesized that vitreous is attached to the optic disc in MH, but not in MP.
Subjects with a history of diabetes, retinal tears or detachments, retino-vascular diseases, any other co-existing maculopathies and prior vitreo-retinal surgery for any reason were excluded. Combined OCT-SLO (OPKO, Inc.) was performed in 15 eyes of 15 subjects with MH (stages III and IV; n=8) and MP (grade 3; n=7). Four radial scans were performed through each optic disc, which was centered.
Posterior vitreous cortex attachment to the optic disc was identified by combined OCT-SLO in 6/8 (75%) of eyes with MH, and 1/7 (14%) of eyes with MP (P = 0.02; Student's T-test).
Vitreo-papillary attachment is far more common in MH than MP. In MH eyes, this attachment could provide an anchor point for the transmission of tractional forces upon the macula, resulting in tangential contraction in a centrifugal (outward from the macula) direction, opening a central dehiscence. In MP, the absence of vitreo-papillary attachment allows tangential contraction to result in centripetal (inward towards the center of the macula) tractional forces, inducing pucker.
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