An assessment of vitreous degeneration in eyes with macular holes and vitreomacular traction

Abstract

Purpose : To determine the extent of vitreous degeneration in patients with macular holes (MH) and vitreomacular traction (VMT).

Methods : Eyes with MH or VMT were reviewed in this retrospective study. A control group consisting of eyes with a unilateral posterior vitreous detachment (PVD) in their contralateral eye were also reviewed. Swept-source optical coherence tomography and spectral domain optical coherence tomography vitreous scans were used to evaluate grading of vitreous degeneration based on a previously defined¹ assessment of the premacular bursa and its connections to varying degrees of vitreous degeneration as follows:
Grade 0: homogenous vitreous reflectivity surrounding the premacular bursa with or without a distinct central lacunar space
Grade 1: empty cleavage planes bordered by speckled hyperreflectivity without connection to the premacular bursa
Grade 2: connection of cleavage planes to the premacular bursa
Grade 3: merging of the premacular bursa and the central lacunar space.
Patients with a history of vitreous surgery, lamellar holes, pathologic myopia, or neovascular disease were excluded.

Results : Twenty-four eyes of 20 patients (mean age 66.3 ± 9.2) with MH (9 eyes) or VMT (15 eyes) were reviewed. Eighteen eyes of 18 patients (mean age 59.7 ± 5.6) with a unilateral PVD in the contralateral eye were also reviewed as a control group. Table 1 displays the number of eyes correlating to each grade of vitreous degeneration for each group. A Fisher exact test demonstrated a statistically significant difference between the VMT/MH group and the control group (p=0.0003, two-tailed).

Conclusions : Eyes with MH and VMT demonstrated earlier grades of vitreous degeneration when compared to a control group of eyes with a contralateral PVD. This suggests that a relatively formed posterior vitreous may play a role in the pathogenesis of MH and VMT, possibly by unbuffered translation of rotational forces from the more interior vitreous to the posterior hyaloid. These forces, in turn, may impose stress on the retina.
¹Schaal KB, Pang CE, Pozzoni CM, Engelbert M. The premacular bursa’s shape revealed in vivo by swept-source optical coherence tomography. Ophthalmology. 121(5): 1021-8.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Table 1: Number of eyes by grade of vitreous degeneration