Vitreomacular traction syndrome

 

 The vitreous is a transparent, gelatinous material that fills the space inside the eye between the lens and the retina. 

 As the eye matures or in certain pathological conditions, the vitreous can pull away from the retina, leading to a condition known as posterior vitreous detachment (PVD). This detachment usually occurs as part of the normal aging process.

There are cases where the posterior vitreous detachment is incomplete, leaving the vitreous partially attached to the retina and causing traction forces that can cause anatomical damage. The resulting condition is called vitreomacular traction syndrome (VMT).

 Vitreoretinal traction syndrome can lead to various disorders in the macular area (in the center of the retina), such as full- or partial-thickness macular holes, epiretinal membranes, and macular edema. These disorders are often accompanied by reduced visual acuity.

 

Symptoms

 The most common symptoms that occur in patients with vitreoretinal traction syndrome are: 

• Reduced vision
• Light flashes
• Micropsia- Images appear smaller than they are
• Metamorphopsia, when vision becomes distorted and straight lines appear wavy or with gaps

 Some of these symptoms may be mild and develop slowly. However, chronic tractions can lead to ongoing vision loss if left untreated. In some cases, distortion of a visual image may be observed without necessarily reducing visual acuity.

 

Causes

 Age-related vitreous degeneration leads to the formation of fluid pockets within the vitreous, causing shrinkage and volume loss. Vitreous detachment occurs as a result of the vitreous becoming liquefied. 

 Weakening of the vitreous-retinal internal limiting membrane (ILM) attachments can also lead to partial detachment of the posterior vitreous surface, leading to vitreous detachment and possibly vitreoretinal traction syndrome.

 

Risk factors

Vitreoretinal traction syndrome is more common in older adults and women due to age-related vitreous changes and vitreous liquefaction associated with postmenopausal estrogen decline, respectively.

Other risk factors include: 

• High myopia
• Age related macular degeneration
• Diabetic macular edema
• Vein occlusion
• Diabetic retinopathy

 

Diagnosis

Optical coherence tomography (OCT) is a common and recommended method for noninvasive detection and monitoring of vitreoretinal traction syndrome. This technology captures cross-sectional images of the retinal layers, including the surface, and allows physicians to assess the extent to which vitreous traction forces are distorting the retinal structure.

Treatment and outcome

 There are currently 3 main options for treating vitreoretinal traction syndrome.

 Watchful waiting and regular monitoring with OCT is often used for patients whose symptoms do not warrant active intervention. Some cases of vitreoretinal traction may resolve without intervention.

 For patients whose symptoms are severe enough to require intervention, vitrectomy surgery is a treatment option. The procedure involves surgically releasing the vitreous adhesion, but it is invasive and carries a corresponding risk of complications. Therefore, vitrectomy is reserved for patients at risk of severe visual impairment. Some studies have shown that shorter duration of symptoms leads to a better prognosis when surgical treatment is used.

Ocriplasmin (Jetrea®), a recombinant form of human plasmin, is a pharmacological option for the treatment of vitreoretinal traction syndrome. Clinical trials have demonstrated the efficacy and safety of a single intravitreal injection of ocriplasmin for the treatment of patients with symptomatic vitreoretinal traction. Therefore, Ocriplasmin is a treatment option for some patients who have vitreoretinal adhesion but are not candidates for surgery.

Most patients with vitreoretinal traction maintain good visual acuity in the affected eye, even if treatment is required.