Classifications of vitreomacular traction syndrome: diameter vs morphology

Abstract

Purpose: The aim of this study is to analyze the agreement between the classifications based on morphology and diameter of vitreomacular traction (VMT) syndrome, as well as to correlate the morphological findings of VMT with specific maculopathies.

Methods: Fifty-three eyes with VMT syndrome were categorized into two classifications based on optical coherence tomography images: the VMT morphology (V- or J-shaped) and the diameter of adhesion (focal ≤ 1500 μm or broad>1500 μm).

Results: High correlation was seen between V-shaped and focal-VMT and between J-shaped and broad-VMT (kappa=0.850; P<0.001), except in four cases with broad adhesion despite the presence of a V-shaped pattern. These four cases had common characteristics to those with broad vitreal attachment regarding associated maculopathies and visual function. V-shaped VMT (n=29) and focal-VMT (n=25) led to tractional cystoid macular edema (CME; 79.31% and 84%, respectively) and macular hole (MH; 37.93% and 44%); J-shaped VMT (n=24) and broad-VMT (n=28) were associated with epiretinal membranes (ERMs; 91.66% and 92.85%, respectively) and diffuse retinal thickening (62.50% and 64.28%). The best-corrected visual acuity (BCVA) was not significantly different between the groups (BCVA logarithm of the minimum angle of resolution: V-shaped, 0.45; J-shaped, 0.46; P=0.816; and focal, 0.50; broad, 0.42; P=0.198).

Conclusions: Although highly concordant, the classification based on the diameter of the adhesion and not on the classical adhesion morphology seemed to better reflect the specific macular changes. V-shaped and focal VMT led to tractional CME and MH, while J-shaped and broad VMT were associated with ERM and diffuse retinal thickening.

Figure 1

High-definition optical coherence tomography (OCT) images of vitreomacular traction (VMT) syndrome based on the pattern of vitreomacular adhesion: (a) V-shaped VMT and (b) J-shaped VMT. OCT images of the VMT syndrome classification based on the diameter of the vitreomacular adhesion: (c) focal VMT and (d) broad VMT.

Figure 2

High-definition optical coherence tomography images of patients classified as broad type, based on diameter of the vitreomacular adhesion, and V-shaped, based on the pattern of the vitreomacular adhesion (a–d).