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Tractional Maculopathies in Age-related Macular Degeneration

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

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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

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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.

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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

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