Vitreomacular Hyaloid Attachment: A Normal Optical Coherence Tomography Finding
We would like to comment on the excellent article by Sahni, Stanga, Wong, and Harding . In their paper, a number of descriptive terms for optical coherence tomography (OCT) analysis are defined in age-related macular degeneration (AMD) patients with subfoveal choroidal neovascularization undergoing treatment with photodynamic therapy. One term, “vitreomacular hyaloid attachment (VMHA),” was used to refer to incomplete separation of the posterior hyaloid with attachment at the macula. Twenty of 56 patients (35.7%) included in the study had VMHA on OCT. We would like to point out that this vitreomacular configuration is identical to that described in a previous report of normal eyes .
A study by Uchino, Uemura, and Ohba reported OCT findings at the vitreoretinal interface in 209 normal eyes. In their study, they defined five individual stages of posterior vitreous detachment (PVD). Two stages represented partial PVD with persistent macular attachment, identical to VMHA as defined by Sahni et al. Stage 1 was defined as focal perifoveal PVD in 1 to 3 quadrants with persistent vitreofoveal attachment, and stage 2 was defined as perifoveal PVD in all four quadrants with persistent vitreofoveal attachment. Of the 209 normal eyes, 47.8% had stage 1 PVD and 12.6% had stage 2 PVD. Mean age of the patients in the study was 52.3 years (range 31-74 years) .
We find it interesting that the percentage of AMD patients with VMHA in the Sahni study is less than the percentage of normal eyes with stage 1 or 2 PVD in the Uchino study [1, 2]. This suggests that the vitreomacular configuration defined as VMHA by Sahni et al is not likely a finding specific to the AMD patients included in the study.
Andre J. Witkin, BS, Jay S. Duker, MD
New England Eye Center
Tufts-New England Medical Center
1. Sahni J, Stanga P, Wong D, Harding S. Optical coherence tomography in photodynamic therapy for subfoveal choroidal neovascularisation secondary to age related macular degeneration: a cross sectional study. Br J Ophthalmol. 2005; 89(3):316-320.
2. Uchino E., A. Uemura, N. Ohba. Initial stages of posterior vitreous detachment in healthy eyes of older persons evaluated by optical coherence tomography. Arch Ophthalmol. 2001; 119:1475-1479.