VITREO-MACULAR TRACTION

A vitreo-macular traction is a condition in which the vitreous body pulls and moves the retinal surface. As the vitreous body degrades overtime, it moves away from the retina and pulls on the strong attachments between the retina and vitreous body. Due to the force of this pull, the retinal surface can curve outward and may even break under the strain. While there is the option of treatment through vitrectomy surgery, it is reserved for patients suffering serious vision loss.

WHAT IS THE DISEASE?

The degeneration of the vitreous body occurs naturally due to aging. Until the vitreous body is fully detached from the retina, this process puts stress on the connections between the retina and vitreous body causing the vitreo-retinal connections to pull on the retinal surface as the vitreous body breaks down. This can lead to structural damage to the retina, the formation of retinal cysts or bumps, and macular holes. Once the vitreous body has pulled free of the retina, however, there is typically a loss of symptoms and the restoration of lost vision.

An OCT image of a vitreo macular traction.

This, though, is not always the case. As previously stated, macular hole formation can occur simultaneously with the detachment of the vitreous body from the retina. Moreover, there is sometimes no improvement in sight after the vitreous body has separated from the retina. Certain patients can even have chronic vitreo-macular traction that causes permanent damage to the underlying layers of the retina. Because this can lead to irreversible vision loss, a vitrectomy surgery is the best option to treat chronic vitreo-macular traction before the condition of the retina worsens.

PREVENTION

Vitreo macular traction is an age-related progression of tractional changes in the central area from the vitreous gel on the retina. Unfortunately, there is no means to prevent this disease. Having said that, in the early stages of the disease, before significant traction has led to cystoid changes in central macular area, it is possible to consider early vitrectomy surgery to relieve the traction on the macula.

As such, early surgical intervention with removal of the vitreous gel can be considered a preventative measure for the development of vitreo macular traction. Unfortunately, due to complications associated with vitrectomy, we generally only recommend this course of action if the patient already has significant visual compromise.

PROGNOSIS

The prognosis for patients who have vitreo-macular traction syndrome can be quite good if the vitreous degenerates further and pulls itself free for the macula. In these patients, symptoms may spontaneously resolve as the macula falls back into a natural position. Unfortunately, in some patients, as the vitreous finally detaches itself fully from the retina, the retina, which may have been substantially deteriorated with cystoid changes, may develop a macular hole. Even though the vitreo-macular traction may finally be relieved, some patients with spontaneous posterior vitreous detachment may show no improvement of sight if the chronic vitreo-macular traction has caused permanent damage to the underlying layers of the retina.

Accordingly, earlier surgical intervention in patients who show any evidence of progressive damage to the retina is warranted. The use of early diagnostic test, including Fluorescein Angiography, OCT, and Microperimetry, is an excellent method of looking for evidence of permanent damage to the retina. The Canadian Centre for Advanced Eye Therapeutics is the first site in Canada to have Microperimetry Technology and remains one of the most important sites for functional, structural, and anatomic analysis of the retina.

TREATMENTS

Because all symptoms fade away after the vitreous body detaches from the retina, the only treatment for the majority of patients is to wait until this happens. For those who carry a significant risk of developing a progressive and substantial loss of sight, however, there is the option of a vitrectomy surgery.

By surgically detaching the vitreous body from the retina and replacing it with a clear fluid, vitrectomy surgery effectively stops the retinal condition from becoming worse. In addition, the removal of the internal limiting membrane using an ICG green dye can remove cysts or bumps and regress the development of future cysts in the retina. Vitrectomy surgery can thus lead to the preservation and improvement of sight for the patient, albeit at the risk of causing retinal detachment, retinal distortion, bleeding underneath the retina, and/or retinal hole formation.