Macular Degeneration, Retina/Vitreous
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Tractional Maculopathies in Age-related Macular Degeneration

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Published Online: Jun 21st 2012 US Ophthalmic Review, 2012;5(2):119–25 DOI:
Authors: Cynthia X Qian, William J Foster, Flavio A Rezende
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Age-related macular degeneration (AMD) is the leading cause of blindness among the elderly in developed countries. Much progress has been and continues to be made in search of better visual outcomes for dry and exudative AMD. Over the past decade, the importance of vitreomacular attachments has been recognized in AMD. In this article, we better characterize and describe vitreomacular and photoreceptor-retinal pigment epithelium interface relationships in AMD among treated and untreated patients and describe the surgical options available as well as their outcomes and possible complications.


Age-related macular degeneration, tractional maculopathy, posterior vitreous detachment, macular hole, epiretinal membrane, Müller cells, reactive gliosis, vitreoretinal adhesion, vitreomacular traction syndrome


Age-related macular degeneration (AMD) is an insidious progressive loss of visual function that occurs with aging, and is the leading cause of visual loss in the Western Hemisphere in the elderly.1,2 Although common, the pathways mediating its onset and progression are complex and multifactorial. While many studies have looked at the pathogenesis and physiological changes that occur at the outer retina during AMD, research on inner retinal changes is less common. More specifically, when AMD is compounded by degenerative tractional changes at the vitreomacular interface and inner retina, the problem becomes greater than the sum of its parts. In this article, we address the different etiologies of vitreomacular interface pathologies found in association with both dry and exudative AMD, their pathogenesis, and how their pharmacological and surgical treatment responses differ from the presentation and treatment of either condition alone.

Vitreomacular Adhesions
Vitreomacular adhesion (VMA) defines a condition in which the vitreous gel and posterior hyaloid are abnormally adherent to the retina. When a posterior vitreous detachment (PVD) is incomplete and does not undergo a normal synchronous sequence of synchisis and syneresis, a taut anterior/posterior traction on the underlying macula can be created.3,4 This leads to vitreomacular traction (VMT) and subsequent visual degradation, now identifiable and characterizable on a more regular basis through advances in time- and spectral-domain optical coherence tomography (OCT) imaging.5,6 More commonly, traction can lead to a spectrum of retinal architectural distortions, ranging fromcystoid macular edema, epiretinal membrane (ERM), and macular holes up to macular and retinal pigment epithelium (RPE) detachments.7

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This work did not receive funding from any source. None of the authors have any proprietary or financial interest in the products discussed in this article.


Flavio A Rezende, MD, PhD, Department of Ophthalmology, University of Montreal, Montreal, QC, Canada. E:




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