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Dx Vitreomacular Adhesion Treatment: Read more...


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Observation:
Vitremacular Adhesion Disease

The Merck Manual Home Edition


states:
"Vitreomacular adhesion as a part of natural aging, the process of posterior vitreous detachment can become pathological when vitreous liquefaction occurs without concomitant vitreoretinal interface weakening. Under these circumstances, the volume displacement from the central vitreous to the preretinal space is only able to achieve partial vitreous separation from the retina. This condition is referred to as anomalous posterior vitreous detachment (also referred to as incomplete or partial posterior vitreous detachment). It may result from disorders that cause premature vitreous liquefaction, such as high myopia, vitreous hemorrhage, uveitis, hereditary vitreoretinal syndromes, trauma, retinal vascular diseases and aphakia.[1] When the area of remaining attachment is in the macula (the area of the retina responsible for central vision), this attachment is known as vitreomacular adhesion (VMA).

Vitreomacular adhesion.
(A) Complete posterior detachment.
(B) Incomplete posterior detachment with VMA.
(C) Spectral domain optical coherence tomography image showing VMA and VMT.VMA: Vitreomacular adhesion; VMT: Vitreomacular traction.

VMA has emerged as a distinct clinical entity, evidenced by the recent assignment of an International Classification of Diseases – Clinical Manifestations code. This persistent adhesion can lead to symptoms (i.e., symptomatic VMA), including metamorphopsia (distorted vision), decreased visual acuity and central visual field defect. These symptoms are as a direct result of traction caused by the persistent VMA at the vitreomacular interface, often referred to as VMT. VMT can sometimes lead to the formation of a full-thickness macular hole. Hence, the term symptomatic VMA encompasses symptomatology due to VMT and its consequences, such as macular hole.

The vitreous gel is a transparent extracellular matrix that fills the cavity behind the lens of the eye. It occupies an average volume of 4.4 ml in adulthood. It is surrounded by and attached to the retina and lens of the eye.

Starting in the fourth decade of life, the vitreous body witnesses a significant decrease in gel volume with a concomitant increase in the liquid volume. Derangement of the normal association between hyaluronan and collagen results in the formation of large pockets of liquid vitreous recognized clinically as 'lacunae'. By 80–90 years of age, more than half of the vitreous is liquid. VMT was noted in 8% of patients with ophthalmoscopy alone, compared with 30% of the same patients evaluated with OCT. OCT was also a valuable method for characterizing the morphological retinal changes after vitrectomy for VMT. VMA/VMT is visualized on OCT imaging as a low reflective band above the retina, detached nasal and temporal to the macula, with remaining adherence to the central fovea. Recently, the use of high-resolution coronal-plane OCT scanning combined with simultaneous scanning laser ophthalmoscope imaging was reported to identify VMA/VMT that would be missed by conventional OCT.

OCT was also a valuable method for characterizing the morphological retinal changes after vitrectomy for VMT. VMA/VMT is visualized on OCT imaging as a low reflective band above the retina, detached nasal and temporal to the macula, with remaining adherence to the central region.

Medications Used in Treatment:
1.

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