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

Abstract

PurposeTo compare the structural changes, clinical course, and treatment outcomes of vertical and horizontal vitreomacular traction (VMT) induced impending macular holes (IMHs) and full-thickness macular holes (FTMHs).MethodsIn this retrospective study, 23 and 32 cases of IMHs and FTMHs, respectively, were analyzed. The IMH cases were divided into two subgroups: IMH with and without foveal detachment. Vitreofoveal traction angles (TAs) between the inner retinal surface and posterior hyaloid were measured from horizontal and vertical optical coherence tomography (OCT) images by using the trigonometric function (the angle equals the arctangent of the height over the base) after adjustments for magnification factors. The largest angle was defined as the vitreomacular TA for the examined case. The critical angle-the TA differentiating cases with (vertical traction) or without (horizontal traction) foveal detachment (vertical traction)-was determined using regression analysis. Pretreatment and posttreatment OCT images, clinical courses, and treatment outcomes were compared between the two groups.ResultsThe critical angle was 27.2°. Cases of vertical traction had higher foveal height in the IMH group and wider bases in the FTMH group (P<0.05 respectively). IMHs with vertical traction had greater VM attachment than those with horizontal traction. In the FTMH group, postoperative visual improvement was lower (P=0.002); in the vertical traction group, inner segment:outer segment defects persisted longer (P=0.02).ConclusionsThe critical angle separating vertical from horizontal traction was 27.2°. Vertical VMT results in greater foveal structural changes in IMHs and possibly less favorable surgical outcomes in FTMHs.

OCT proves that vitreomacular adhesion is significantly more likely to develop vision-threatening retinal complications than vitreomacular separation

“…This agrees with the widely accepted concept that the former have persistently stronger adhesions that pull at the fovea [3,12,[14][15][16][17][18][19][20][21], and induce detrimental complications. By way of contrast, the latter group seems to have lost this strong traction [3,12,17,22]. Thus, accurate diagnosis, long term observation and appropriate management needs to be emphasized when treating patients with VMA associated adverse sequelae.…”

“…As implied by previous reports [3,12,[14][15][16][17][18][19][20][21], VMA can be complicated by a variety of defined visual dysfunction retinal diseases. The present results support the hypothesis that the incidence of defined retinal complications among VMA eyes seems to be significantly greater than that among vitreomacular separation eyes (Tables 1, 2 and 3; Figs.…”

“…The angle between the inner retinal surface and posterior hyaloid was then directly measured using the On-Screen Protractor Program (Minimum Java Runtime Environment version 1.7, Gnu's Not Unix General Public License version 3); the largest angle for VMA, with either V-shaped or J-shaped posterior hyaloids, of an eye that received both vertical and horizontal OCT scans was defined as the vitreomacular angle of the examined eye. The directly measured critical vitreomacular angle was 13.3°, which is considerably lower than that 45.0°of the study of Tsai et al [12]. The above vitreomacular angle was retrieved by utilizing the point on the receiver operating characteristics curve with a minimum value of [(1 − sensitivity) 2 + (1 − specificity) 2 ] for macular hole in all of the selected eyes.…”

“…Thus, accurate diagnosis, long term observation and appropriate management needs to be emphasized when treating patients with VMA associated adverse sequelae. As mentioned earlier, SD-OCT seems to be a clinically useful and an easily accessible approach that is able to detect various specific vitreomacular interface abnormalities that might not be observed by ultrasonography and indirect ophthalmoscopy [3,12,17,22].…”

“…Vitreomacular traction seems to be able to produce tangential (horizontal) [12,22] and anteroposterior (vertical) traction [12,22] that causes foveal conformational changes and subsequent visual dysfunctional symptoms such as blurred vision, floaters/flashes and/or a distorted image. In a twenty-year cross-sectional study, namely the Beaver Dam Eye Study [21], it was found that the incidence of vitreomacular traction was 1.6% among all eyes with maculae scanned by SD-OCT.…”