Original article
Correlation of vitreous attachment and foveal deformation in early macular hole states1

https://doi.org/10.1016/S0002-9394(01)01377-0Get rights and content

Abstract

PURPOSE : To report the foveal anatomy in patients with perifoveal posterior vitreous detachments (PPVD) using optical coherence tomography.

DESIGN : Retrospective observational case series.

METHODS : A retrospective study of fellow eyes of patients of patients with macular holes and those with early macular hole states were examined with optical coherence tomography, biomicroscopy, and contact b-scan ultrasonography. Twenty-three eyes of 23 patients were discovered to have PPVD, which was defined as persistent attachment of the vitreous to the central macula with a limited detachment of the posterior vitreous in the perifoveal region.

RESULTS : The mean diameter of persistent vitreous attachment in eyes with no foveal deformation was 1829 μm, flattening of the foveal depression 840 μm, and with foveal cavitation 281 μm (P < .001, Spearman rank correlation). The difference in the mean diameters was significant (P = .001, Kruskal-Wallis test, all pairwise comparisons showing significant difference using the Mann-Whitney test).

CONCLUSIONS : This study found that the diameter of the vitreous attachment in eyes with PPVD correlated with induced changes in foveal anatomy. The diameters of vitreous attachment were consistent with known regions of robust attachment of the vitreous determined histologically. Although the actual force loading on the central macula cannot be determined in patients with perifoveal posterior vitreous detachments, the stress, which is force / unit area may well increase with smaller areas of attachment leading to mechanical failure of the macula.

Section snippets

Design

THIS IS A RETROSPECTIVE OBSERVATIONAL CASE SERIES.

Methods

The oct images of 44 eyes of 44 consecutive patients with macular holes or premacular hole states have been seen in our practice for patients with a PPVD. In patients with a full-thickness macular hole, the fellow eye was imaged for changes in the foveal anatomy including the presence of a perifoveal posterior vitreous detachment. In patients with premacular hole states, the ipsilateral eye was imaged. Only one eye / patient was included in the study. Of the 44 patients, 23 had perifoveal

Results

Of the 23 eyes with ppvd, there were 4 with no ob servable abnormality in the foveal contour and the mean diameter of attachment was 1829 μm (standard deviation 1378 μm). Ten eyes had a flattening of the foveal depression and their mean diameter of attachment was 840 μm (standard deviation 508 μm). Nine eyes had a foveal cyst with a mean diameter of attachment of 281 μm (standard deviation 136 μm) (Figure 3). The correlation between the diameter of attachment and the foveal deformation was

Discussion

This study examined the vitreo-foveal interface in patients with optical coherence tomography after first examining their vitreous with fundus biomicroscopy and contact b-scan ultrasonography. We found that there was a significant correlation of increasing foveal deformation in patients with smaller diameters of vitreous attachment.

While the amount of tractional force on the fovea from the vitreous cannot be measured by optical coherence tomography, the stress (force / unit area) acting on the

References (21)

There are more references available in the full text version of this article.

Cited by (98)

  • Structure and mechanics of the vitreoretinal interface

    2022, Journal of the Mechanical Behavior of Biomedical Materials
    Citation Excerpt :

    The contact area of lingering vitreoretinal adhesions affects the risk for adverse outcomes. Specifically, a smaller area of lingering adhesion in the fovea may result in greater stress and deformation, and increased risk of retinal damage (Spaide et al., 2002). A better understanding of the adhesion mechanisms and mechanics could provide insight into why lingering adhesions occur and lead to novel strategies to prevent adverse outcomes during PVD.

  • The Fovea: Structure, Function, Development, and Tractional Disorders

    2021, The Fovea: Structure, Function, Development, and Tractional Disorders
View all citing articles on Scopus
1

From the Vitreous Retina Macula Consultants of New York, LuEsther T. Mertz Retina Research Laboratory, Manhattan Eye, Ear, and Throat Hospital, New York, NY. (Dr. Wong is currently at the Singapore National Eye Centre, Singapore.) The authors have no financial interest in any instrument mentioned in this paper.

View full text