Macular Degeneration, Retina/Vitreous
Read Time: < 1 min

Tractional Maculopathies in Age-related Macular Degeneration

Published Online: June 21st 2012 US Ophthalmic Review, 2012;5(2):119–25 DOI: http://doi.org/10.17925/USOR.2012.05.02.119
Authors: Cynthia X Qian, William J Foster, Flavio A Rezende
Quick Links:
Abstract
Article
Article Information
Abstract:
Overview

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.

Keywords

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

Article:

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

To view the full article in PDF or eBook formats, please click on the icons above.

Article Information:
Disclosure

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.

Correspondence

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

Received

2011-11-14T00:00:00

References

  1. Zarbin MA, Current concepts in the pathogenesis of age-related macular degeneration, Arch Ophthalmol, 2004;122(4):598–614.
  2. Penfold PL, Madigan MC, Gillies MC, Provis JM, Immunological and aetiological aspects of macular degeneration, Prog Retin Eye Res, 2001;20(3):385–414.
  3. Bishop PN, Holmes DF, Kadler KE, et al., Age-related changes on the surface of vitreous collagen fibrils, Invest Ophthalmol Vis Sci, 2004;45(4):1041–6.
  4. Sebag J, Anomalous posterior vitreous detachment: a unifying concept in vitreo-retinal disease, Graefes Arch Clin Exp Ophthalmol, 2004;242(8):690–8.
  5. Krebs I, Glittenberg C, Zeiler F, Binder S, Spectral domain optical coherence tomography for higher precision in the evaluation of vitreoretinal adhesions in exudative age-related macular degeneration, Br J Ophthalmol, 2011;95(10):1415–8.
  6. Mirza RG, Johnson MW, Jampol LM, Optical coherence tomography use in evaluation of the vitreoretinal interface: a review, Surv Ophthalmol, 2007;52(4):397–421.
  7. Georgalas I, Heatley C, Ezra E, Retinal pigment epithelium detachment associated with vitreomacular traction syndrome. A case report, Int Ophthalmol, 2009;29(5):431–3.
  8. Krebs I, Brannath W, Glittenberg C, et al., Posterior vitreomacular adhesion: a potential risk factor for exudative age-related macular degeneration? Am J Ophthalmol, 2007;144(5):741–6.
  9. Robison CD, Krebs I, Binder S, et al., Vitreomacular adhesion in active and end-stage age-related macular degeneration, Am J Ophthalmol, 2009;148(1):79–82.
  10. Jun Lee S, Lee CS, Jun Koh H, Posterior vitreomacular adhesion and risk of exudative age-related macular degeneration: paired eye study, Am J Ophthalmol, 2009;147(4):621–6.
  11. Weber-Krause B, Eckardt U, Incidence of posterior vitreous detachment in eyes with and without age-related macular degeneration. An ultrasonic study, Ophthalmologe, 1996;93(6):660–5.
  12. Mojana F, Cheng L, Bartsch D-UG, et al., The role of abnormal vitreomacular adhesion in age-related macular degeneration: spectral optical coherence tomography and surgical results, Am J Ophthalmol, 2008;146(2):218–27.
  13. Ondes F, Yilmaz G, Acar M, et al., Role of the vitreous in age-related macular degeneration, Jpn J Ophthalmol, 2000;44(1):91–3.
  14. Rezende F, Kickinger M, Prado R, Vitreomacular and photoreceptor-retinal pigment epithelium interface relationships in age-related macular degeneration, Invest Ophthalmol Vis Sci, 2010;51(E-abstract 520).
  15. Krebs I, Glittenberg C, Zeiler F, Binder S, Spectral domain optical coherence tomography for higher precision in the evaluation of vitreoretinal adhesions in exudative age-related macular degeneration, Br J Ophthalmol, 2011;95(10):1415–8.
  16. Schulze S, Hoerle S, Mennel S, Kroll P, Vitreomacular traction and exudative age-related macular degeneration, Acta Ophthalmol, 2008;86(5):470–81.
  17. Rotsos T, Sagoo MS, daCruz L, et al., Intravitreal anti-VEGF treatment in eyes with combined choroidal neovascularisation and vitreomacular traction syndrome, Br J Ophthalmol, 2010;94(9):1205–10.
  18. Spaide R, Armstrong D, Browne R, Choroidal neovascularization in age-related macular degeneration – what is the cause?, Retina, 2003;23(5):595–614.
  19. Kimura H, Kuroda S, Nagata M, Premacular cortical vitreous in patients with a rhegmatogenous retinal detachment, Retina, 2004;24(2):329–30.
  20. Sullivan R, Penfold P, Pow DV, Neuronal migration and glial remodeling in degenerating retinas of aged rats and in nonneovascular AMD, Invest Ophthalmol Vis Sci, 2003;44(2):856–65.

Further Resources

Share this Article
Related Content In Retina/Vitreous
  • Copied to clipboard!
    accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-red tick-whiteticktimetranscriptup-arrowwebinar Sponsored Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72