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Mayuka Tsukahara, Keiko Mori, Peter L Gehlbach, Keisuke Mori; Evolution of vitreoretinal separation in normal subjects as described by wide-angle montage imaging of optical coherence tomography. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5445.
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© ARVO (1962-2015); The Authors (2016-present)
Posterior vitreous detachment (PVD) plays an important role in several vitreoretinal interface disorders. Historically, observations of PVD using optical coherence tomography (OCT) were limited to the macular region. The purpose of this study is to describe the morphology of the vitreoretinal interface, from the macula to the periphery, in normal subjects, using montaged OCT images.
The design of this study is a prospective, consecutive interventional case series. All investigations adhered to the tenets of the Declaration of Helsinki. Recruited were 70 healthy eyes of 50 normal subjects, ranging from 21 to 75 years (48.9 ± 18.3 [mean ± SD]). Montaged images of horizontal and vertical OCT scans through the fovea, were obtained in each subject as previously described.
Based on the montaged OCT images, the PVD was classified into the following 5 stages: stage 0, no PVD (0 eye); stage 1, focal PVD limited to paramacular, peripheral or from paramacular to peripheral zones (48 eyes, 45.2 ± 18.5 years [mean ± SD]); stage 2, perifoveal PVD expanding to the periphery (8 eyes, 53.7 ± 14.6 years); stage 3, near-complete PVD with persistent vitreopapillary adhesion alone (2 eyes, 59.5 ± 0.5 years); stage 4, complete PVD (12 eyes, 66.7 ± 8.5 years). Initiation of vitreous separation often occurred in a superior quadrant in 94% of stage one PVDs.
Using wide-angle montage OCT we have successfully imaged the vitreoretinal interface from the macula to the periphery and documented the longitudinal development of age-related PVD. Whereas prior work suggests that PVD originates in the perifoveal region, our observations clearly demonstrate more peripheral points of initiation. Our findings also show that PVD is usually initiated superiorly but that other quadrants may also be involved. Initiation of PVD is observable even in the second decade of life, much younger than previously appreciated. Following initiation, PVDs generally progress slowly and move posteriorly to the perifoveal region and anteriorly to the periphery.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
A vertical montage OCT image of 32 years old female with stage 1 PVD. Focal PVD is limited to the paramacular region (arrows).
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