Vitreopapillary adhesion in macular diseases

Abstract

Purpose: The effect of vitreopapillary adhesion (VPA) in macular diseases is not understood. Spectral-domain optical coherence tomography/scanning laser ophthalmoscopy (SD-OCT/SLO) was used to identify VPA in macular holes, lamellar holes, macular pucker, and dry age-related macular degeneration (AMD).

Methods: Ultrasonography and SD-OCT/SLO were performed in 99 subjects: 17 with macular holes, 11 with lamellar holes, 28 with macular pucker, 15 with dry AMD, and 28 age-matched controls. Outcome measures were the presence of total posterior vitreous detachment (PVD) by ultrasound and the presence or absence of VPA and intraretinal cystoid spaces by SD-OCT/SLO.

Results: PVD was detected by ultrasound in 26 (92.9%) of 28 eyes with macular pucker, 6 (54.5%) of 11 eyes with lamellar holes (P = .01), and 4 (23.5%) of 17 eyes with macular holes (P = .000003). SD-OCT/SLO detected VPA in 15 (88.2%) of 17 eyes with macular holes, 11 (39.3%) of 28 age-matched controls (P = .002), 4 (36.4%) of 11 eyes with lamellar holes (P = .01), 4 (26.7%) of 15 eyes with dry AMD (P = .0008), and 5 (17.9%) of 28 eyes with macular pucker (P = .000005). Intraretinal cystoid spaces were present in 15 (100%) of 15 eyes with macular holes with VPA. In eyes with macular pucker, 4 (80%) of 5 with VPA had intraretinal cystoid spaces, but only 1 (4.3%) of 23 without VPA had intraretinal cystoid spaces (P = .001).

Conclusions: VPA was significantly more common in eyes with macular holes than in controls or eyes with dry AMD, lamellar holes, or macular pucker. Intraretinal cystoid spaces were found in all eyes with macular holes with VPA. When present in macular pucker, VPA was frequently associated with intraretinal cystoid spaces. Although these investigations do not study causation directly, VPA may have an important influence on the vectors of force at the vitreoretinal interface inducing cystoid spaces and holes.

FIGURE 1

Longitudinal OCT/SLO scan (SLO image in lower righthand corner) illustrating the measurement of a stage 4 macular hole, determined by the distance between the vertical lines.

FIGURE 2

Longitudinal OCT/SLO image demonstrating a macular hole with the detachment of posterior vitreous cortex (A). The posterior vitreous cortex is attached to the optic disc (B).

FIGURE 3

Longitudinal OCT-SLO imaging demonstrates a lamellar hole with intraretinal cysts (A). Vitreous adhesion is evident at the margins of the optic disc (B).

FIGURE 4

Longitudinal OCT-SLO imaging demonstrates a macular pucker with intraretinal cystoid spaces (A) and vitreopapillary adhesion to both sides of the optic disc (B).

FIGURE 5

Vitreopapillary adhesion (VPA) was found most prevalent in macular hole (MH) (88.2%) compared to age-matched controls (39.3%; P = .002), lamellar hole (LH) (36.4%, P = .01), dry age-related macular degeneration (AMD) (26.7%, P = .0008), and macular pucker (MP) (17.9%, P = .000005), suggesting that VPA may be causally associated with MH..

FIGURE 6

Intraretinal cystoid spaces are more prevalent in eyes with vitreopapillary adhesion (VPA). In macular holes (MH) with VPA, 100% of eyes had cysts. In macular pucker (MP) with VPA, 80% of eyes had intraretinal cystoid spaces. Lamellar holes (LH) with VPA had cysts in 75% of eyes, whereas cysts were present in only 42.9% of LH without VPA. MP without VPA had cysts in only 1 of 23 eyes (4.3%).