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Clinical science
Original article
Vitreoschisis in macular diseases
  1. Priya Gupta1,2,
  2. Kenneth M P Yee1,2,
  3. Patricia Garcia3,
  4. Richard B Rosen3,
  5. Jignesh Parikh4,
  6. Gregory S Hageman5,
  7. Alfredo A Sadun2,
  8. J Sebag1,2
  1. 1VMR Institute, Huntington Beach, California, USA
  2. 2Doheny Eye Institute, USC Keck School of Medicine, Los Angeles, California, USA
  3. 3New York Eye and Ear Infirmary, New York, USA
  4. 4Ophthalmic Pathology, Doheny Eye Institute, Los Angeles, California, USA
  5. 5University of Utah, Salt Lake City, Utah, USA
  1. Correspondence to Dr J Sebag, VMR Institute, 7677 Center Avenue, Suite 400, Huntington Beach, CA 92647, USA; jsebag{at}vmrinstitute.com

Abstract

Objectives Vitreoschisis is a possible pathogenic mechanism in macular diseases. Thus, the vitreoretinal interface was evaluated in monkey eyes and patients with various macular diseases in search of vitreoschisis. It is hypothesised that vitreoschisis is present in macular holes (MH) and macular pucker (MP), but not in other maculopathies.

Methods Histopathology was studied in 14 monkey eyes and a vitrectomy specimen of a patient with macular pucker. Optical coherence tomography/scanning laser ophthalmoscopy (OCT/SLO) was performed in 239 eyes: 45 MH, 45 MP, 51 dry age-related macular degeneration (AMD), 53 non-proliferative diabetic retinopathy (NPDR) and 45 controls.

Results Immunohistochemistry demonstrated lamellae in the posterior vitreous cortex of 12/14 (86%) monkey eyes. With OCT/SLO, vitreoschisis was detected in 24/45 (53%) MH and 19/45 (42%) MP eyes, but in only 7/53 (13%) NPDR, 3/51 (6%) AMD and 3/45 (7%) control eyes (p<0.001 for all comparisons). Rejoining of the inner and outer walls of the split posterior vitreous cortex was visible in 16/45 (36%) MH eyes and 15/45 (33%) MP eyes. Histopathology of the MP specimen confirmed a split with rejoining in the posterior vitreous cortex.

Conclusions Vitreoschisis was detected in half of eyes with MH and MP, but much less frequently in controls, AMD and NPDR patients. These findings suggest that anomalous PVD with vitreoschisis may be pathogenic in MH and MP.

  • Macular pucker
  • macular holes
  • vitreous
  • anomalous PVD
  • vitreoschisis
  • OCT/SLO
  • macula
  • pathology
  • imaging

https://doi.org/10.1136/bjo.2009.175109

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    Footnotes

    • Presented in part at the annual meeting of the American Ophthalmological Society, White Sulphur Springs, West Virginia, May 2007 and in the Transactions of the AOS, December 2007; and as a poster presentation at the American Academy of Ophthalmology, November 2007, New Orleans, Louisiana.

    • Funding RBR has financial affiliations with OPKO Instrumentation, LLC.

    • Competing interests RBR has financial affiliations with OPKO Instrumentation, LLC. The remaining authors have no financial interests.

    • Patient consent Obtained.

    • Ethics approval Ethics approval was provided by the USC IRB.

    • Provenance and peer review Not commissioned; externally peer reviewed.