Focal vitreomacular traction: a prospective study of the evolution to macular hole: the mathematical approach

Abstract

Purporse To determine the associated balance of forces of the vitreofoveal interface in focal vitreomacular traction evolving to full-thickness macular hole (FTMH) and to link/explain the observed changes in the context of mathematical and physics models. Patients and methods This is a multicenter, prospective, and observational case series conducted at the Vitreoretinal Department of three different referral centers. Fellow eyes of patients with unilateral idiopathic FTMH were included. Eighty-nine patients were included in the analysis. The fellow normal eye of the study patients was imaged with spectral-domain optical coherence tomography. The main outcome measure was the optical-coherence-tomography-defined characteristics of the vitreofoveal interface and their analysis with mathematical and physics models at the end of follow-up period. Results Of the included 89 patients (66 women and 23 men; mean age±SD, 68.5 years±9.8), 10 (11.2%) developed FTMH at the fellow eye at the end of the follow-up period. We observed two types of vitreofoveal attachment. A V-shaped (cordlike) configuration and a U-shaped configuration. The eyes with the V-shaped attachment demonstrated initial structural changes in the outer foveal layers and the eyes with the U-shaped attachment showed inner morphological changes. Conclusion We hypothesize that the type (V-or U-shaped) of the vitreofoveal attachment may affect the type and location of the initial structural change leading to the formation of FTMH from the stage of the focal vitreomacular traction.

Size and vitreomacular attachment of primary full-thickness macular holes

“…These tractional forces result in a drawbridge elevation of the inner retina12 and are then transmitted along the oblique parafoveal Müller cells, inducing a centrifugal force on the outer retina 13 14. This pathogenic sequence explains well the mechanism of MH opening but does not predict its size 15.…”

Idiopathic macular holes and direction of vitreomacular traction: structural changes and surgical outcomes

“…Horizontal traction tends to create inner foveal cysts, whereas foveal detachment is likely to be formed because of more anteriorly and posteriorly oriented traction. 17 If this theory is correct, some questions arise regarding traction direction and foveal changes being predisposing factors for FTMHs. The actual vectors acting on the foveal area caused by the PH are complex and difficult to determine.…”

The design and validation of an optical coherence tomography-based classification system for focal vitreomacular traction

“…16,19,31 Observation of cases has shown that inner retinal changes are more common and that outer retinal changes can range from subtle alterations at the level of the outer segments of the photoreceptors to outer retinal dehiscence and FTMHs. 32 Recently, however, Almeida et al 22 noted that eyes with isolated inner retinal distortion but without outer retinal changes have an apparently higher incidence of spontaneous vitreomacular separation than those with outer retinal changes.…”