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Justin Nguyen, Kenneth M.P. Yee, Jeannie Nguyen-Cuu, J Sebag; Vitreo-Papillary Adhesion in Lamellar Macular Holes. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5270. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Vitreo-papillary adhesion (VPA) is more prevalent in lamellar macular holes (LMH) than macular pucker (Sebag et al: Trans AOS 107:35-46, 2009), and may thus play a role in the induction of centrifugal tangential traction resulting in LMH. Recent studies (Govetto et al: AJO 164:99-109, 2016) subdivided LMH into tractional (TLMH) and degenerative (DLMH) forms, but it is currently not known whether the prevalence of VPA is the same in both subtypes of LMH. It is hypothesized that VPA is more prevalent in TLMH than DLMH.
To test this hypothesis, SD-OCT imaging of the macula and optic disc was performed in 27 eyes of 27 patients (age = 71 ± 11 years) with tractional (n=15) or degenerative (n=12) LMH. Snellen visual acuity (VA), ultrasound diagnosis of posterior vitreous detachment, and SD-OCT imaging of the optic disc were obtained. Statistical significance was evaluated with Fisher's exact test.
Mean VA was 20/32 in TLMH and 20/50 in DLMH (P < 0.004). There was no difference in ultrasound findings between the two groups. SD-OCT detected VPA in 11/27 (40%) of all eyes with LMH, confirming previous findings (Wang et al: Retina 29:644-50, 2009). However, VPA was present in 9/15 (60%) TLMH eyes, but only 2/12 (16.7%) DLMH eyes (P < 0.05).
Vitreo-papillary adhesion (VPA) is four times more prevalent in tractional LMHs than degenerative LMHs. VPA may thus influence the vectors of force at the vitreo-retinal interface inducing the centrifugal tangential traction that causes the sharp split at the level of the Henle fiber layer characteristic of tractional LMH. If this pilot study is confirmed, then non-surgical intervention to resolve VPA, such as pharmacologic vitreolysis (Sebag: Retina 29:871-4, 2009), might alter the tangential forces at the macula and lessen the negative impact on central retinal structure.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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