References 167
Fig. 14.14 Posterior vitreous adhesion in VMTS. Vitreomacular traction syndrome (VMTS) results from peripheral PVD with persistent (anomalous) vitreous adhesion to the macula. There is full-thickness (i.e., no vitreoschisis) posterior vitreous adhesion to the macula inducing such significant traction that the result is a tractional retinal detachment
leaving the outer layer of the vitreous cortex (partial thickness) still attached to the macula.
There is a broad, full-thickness posterior vitreous adhesion in VMTS, while a more focal adhesion is found in the vitreo-foveal traction syndrome (VFTS). In both instances, there is peripheral vitreo-retinal separation but persistent adhesion at the macula. The tractional forces are primarily antero-posterior, inducing retinal thickening with edema in the VMTS and a central cyst in the VFTS. There is most likely no role for vitreoschisis or VPA in VMTS or VFTS, although VPA has not been studied in this group of individuals.
Summary for the Clinician
■Owing to its intended transparency, vitreous has been difficult to image and thus overlooked as important in retinal disease. Recent advances in the understanding of vitreous biochemistry, structure, and aging have forged the unifying concept of anomalous PVD. Combined SD-OCT/SLO has enabled imaging of the vitreo-retinal interface and elucidated the pathogenic mechanisms of vitreomacular disorders, including vitreoschisis. This enhanced understanding will improve current surgical therapeutics and in the future replace surgery with pharmacologic vitreolysis.
14.7 Conclusion
Anomalous PVD is a unifying concept of vitreo-retinal diseases that brings together conditions that were previously considered disparate in origin. This perspective not only contributes to our understanding of the pathogenic mechanisms in vitreo-retinal disorders, but could also influence therapeutic approaches. The advent of SD-OCT/ SLO has enabled in vivo visualization of various diseases, and thus our understanding of pathophysiology is increasingly elucidated, and better treatments are being developed. One of the most exciting of these new modalities is pharmacologic vitreolysis [39–41, 43]. To date, this approach has been largely used as a surgical adjunct, but the future will see more preventative applications in high-risk individuals. For example, pharmacologic vitreolysis may be an effective way to lower the risk of exudative changes by inducing innocuous liquefaction of the gel and concurrent dehiscence at the vitreo-macular interface. Future studies using SD-OCT/SLO and other advanced imaging technologies will hopefully identify individuals at risk of other vitreo-retinopathies as candidates for prophylactic PVD with pharmacologic vitreolysis.
References
1. Bishop PN (2000) Structural macromolecules and supramolecular organization of the vitreous gel. Prog Retin Eye Res 19:323–344
2. Scott JE, Chen Y, Brass A (1992) Secondary and tertiary structures involving chondroitin and chondroitin sulphate in solution, investigated by rotary shadowing electron microscopy and computer simulation. Eur J Biochem 209:675–680
3. Sebag J (2004) Anomalous posterior vitreous detachment: a unifying concept in vitreo-retinal disease. Graefes Arch Clin Exp Ophthalmol 242:690–698
4. Sebag J (1992) The vitreous. In: Hart WM Jr (ed) Adler’s physiology of the eye. Mosby, St. Louis, pp 268–347
5. Sebag J, Yee KM (2009) Vitreous – from biochemistry to clinical relevance. In: Tasman W, Jaeger EA (eds) Duane’s ophthalmology.LippincottWilliams&Wilkins,Philadelphia, Chapter 16
6. Sebag J (2008) Vitreoschisis. Graefes Arch Clin Exp Ophthalmol 246:329–332
7. Sebag J (1989) The vitreous – structure, function and pathobiology. Springer, New York
8. Nishitsuka K, Kashiwagi Y, Tojo N et al (2007) Hyaluronan production regulation from porcine hyalocyte cell line by cytokines. Exp Eye Res 85:539–545
9. Sebag J, Hageman GS (2000) Vitreo-retinal interface. In: Sebag J, Hageman GS (ed) Interfaces. Fondazione G.B. Bietti, Rome, pp 41–58
168 |
14 Combined Spectral-Domain Optical Coherence Tomography |
10.Green WR, Sebag J (2001) Vitreous and the vitreo-retinal interface. In: Ryan SJ (ed) Retina. Mosby, St. Louis, pp 1882–1960
11.Sebag J, Gupta P, Rosen RR et al (2007) Macular holes and
14 |
macular pucker: the role of vitreoschisis as imaged by opti- |
|
cal coherence tomography/scanning laser ophthalmos- |
copy. Trans Am Ophthalmol Soc 105:121–129
12.Sebag J (1991) Age-related differences in the human vitreoretinal interface. Arch Ophthalmol 109:966–971.
13.Sebag J, Balazs EA (1989) Morphology and ultrastructure of human vitreous fibers. Invest Ophthalmol Vis Sci 30: 1867–1871
14.Sebag J (1987) Ageing of the vitreous. Eye 1:254–262
15.Sebag J (1987) Age-related changes in human vitreous structure. Graefes Arch Clin Exp Ophthalmol 225:89–93
16.Nguyen N, Sebag J (2005) Myopic vitreopathy – significance in anomalous PVD and vitreo-retinal disorders. In: Midena E (ed) Myopia and related diseases. Ophthalmic Communications Society, New York, pp 137–145
17.Wang MY, Nguyen D, Hindoyan N, Sadun AA (2009) Vitreo-papillary adhesion in macular hole and macular pucker. Retina 29:644–650
18.Sebag J (2004) Seeing the invisible: the challenge of imaging vitreous. J Biomed Opt 9:38–46
19.Sebag J (2008) To see the invisible: the quest of imaging vitreous. Dev Ophthalmol 42:5–28
20.Gupta P, Sadun AA, Sebag J (2008) Multifocal retinal contraction in macular pucker analyzed by combined optical coherence tomography/scanning laser ophthalmoscopy. Retina 28:447–452
21.Miyazaki M, Nakamura H, Kubo M et al (2003) Prevalence and risk factors for epiretinal membranes in a Japanese population: the Hisayama Study. Graefes Arch Clin Exp Ophthalmol 241:642–646
22.Roth AM, Foos RY (1971) Surface wrinkling retinopathy in eyes enucleated at autopsy. Trans Am Acad Ophthalmol Otolaryngol 75:1047–1058
23.Wise GN (1975) Clinical features of idiopathic preretinal macular fibrosis. Am J Ophthalmol 79:349–357
24.Kita T, Hata Y, Kano K et al (2007) Transforming growth factor-beta2 and connective tissue growth factor in proliferative vitreoretinal diseases: possible involvement of hyalocytes and therapeutic potential of Rho kinase inhibitor. Diabetes 56:231–238
25.Hirayama K, Hata Y, Noda Y et al (2004) The involvement of the rho-kinase pathway and its regulation in cytokineinduced collagen gel contraction by hyalocytes. Invest Ophthalmol Vis Sci 45:3896–3903
26.Ezra E (2001) Idiopathic full thickness macular hole: natural history and pathogenesis. Br J Ophthalmol 85:102–108
27.Tashimo A, Mitamura Y, Ohtsuka K et al (2003) Macular hole formation following ruptured retinal arterial macroaneurysm. Am J Ophthalmol 135:487–492
28.Gass JD (1988) Idiopathic senile macular hole: its early stages and pathogenesis. Arch Ophthalmol 106:629–639
29.Gass JD (1995) Reappraisal of biomicroscopic classification of stage of development of a macular hole. Arch Ophthalmol 119:752–759
30.Johnson RN, Gass JD (1988) Idiopathic macular holes: observations, stages of formation, and implications for surgical intervention. Ophthalmology 95:917–924
31.Kokame GT (1995) Clinical correlation of ultrasonographic findings in macular holes. Am J Ophthalmol 119:441–451
32.Johnson MW, Van Newkirk MR, Meyer KA (2001) Perifoveal vitreous detachment is the primary pathogenic event in idiopathic macular hole formation. Arch Ophthalmol 119:215–222
33.DaMata AP, Burk SE, Foster RE et al (2004) Long-term followup of indocyanine green assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for idiopathic macular hole repair. Ophthalmology 111:2246–2253
34.Smiddy WE, Feuer W, Cordahi G (2001) Internal limiting membrane peeling in macular hole surgery. Ophthalmology 108:1471–1478
35.Sebag J, Wang MY, Nguyen D et al (2009) Vitreo-papillary adhesion in macular diseases. Trans Am Ophthalmol Soc 107 (in press)
36.Krebs I, Brannath W, Glittenberg C et al (2007) Posterior vitreomacular adhesion: a potential risk factor for exudative age-related macular degeneration? Am J Ophthalmol 144:741–746
37.Robison CD, Krebs I, Binder S et al (2009) Vitreomacular adhesion in active and end-stage age-related macular degeneration. Am J Ophthalmol 148:79–82
38.Smiddy WE (2009) Vitreomacular traction syndrome. In: Yanoff M, Duker JS (eds) Ophthalmology. Mosby, Philadelphia, pp 691–695
39.Sebag J (1998) Pharmacologic vitreolysis. Retina 18:1–3
40.Sebag J (2002) Is pharmacologic vitreolysis brewing? Retina 22:1–3
41.Sebag J (2005) Molecular biology of pharmacologic vitreolysis. Trans Am Ophthalmol Soc 103:473–494
42.Lee SJ, Lee CS, Koh HJ (2009) Posterior vitreomacular adhesion and risk of exudative age-related macular degeneration: paired eye study. Am J Ophthalmol 147:621–626
43.Sebag J (2009) Pharmacologic vitreolysis – premise and promise of the first decade. Retina 29:871–874