The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole.

doi:10.1016/J.OPHTHA.2013.07.042

Journal Article•DOI•

The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole.

Jay S. Duker¹, Peter K. Kaiser², Susanne Binder, Marc D. de Smet, Alain Gaudric, Elias Reichel¹, Srinivas R. Sadda³, Jerry Sebag³, Richard F. Spaide, Peter Stalmans⁴ - Show less +6 more•Institutions (4)

Tufts University¹, Cleveland Clinic², University of Southern California³, Katholieke Universiteit Leuven⁴

01 Dec 2013-Ophthalmology (Elsevier)-Vol. 120, Iss: 12, pp 2611-2619

TL;DR: This classification system will support systematic diagnosis and management by creating a clinically applicable system that is predictive of therapeutic outcomes and is useful for the execution and analysis of clinical studies.

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About: This article is published in Ophthalmology.The article was published on 2013-12-01. It has received 822 citations till now. The article focuses on the topics: Vitreomacular traction & Full-thickness macular hole.

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Journal Article•DOI•

Idiopathic senile macular hole. Its early stages and pathogenesis.

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J. D. M. Gass¹•Institutions (1)

University of Miami¹

01 May 1988-Archives of Ophthalmology

TL;DR: Evidence is presented that idiopathic senile macular hole is caused by focal shrinkage of the vitreous cortex in the foveal area and the clinical value of surgical peeling in eyes with stage 1 changes as a means of preventing hole formation is tested.

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Abstract: Evidence is presented that idiopathic senile macular hole is caused by focal shrinkage of the vitreous cortex in the foveal area. The most reliable biomicroscopic signs of impending hole formation (stage 1) are the development of a yellow spot or ring in the center of the fovea, loss of the foveal depression, and no evidence of separation of the vitreous from the foveal retina. Although in a majority of eyes with stage 1 changes there is a progression to hole formation, spontaneous separation of the vitreous without hole formation may occur in some cases (44%) and cause characteristic biomicroscopic changes, including foveal reattachment, disappearance of the yellow spot or ring, and, in some cases, a pseudo-operculum, with one or more lamellar holes or facets. A prospective collaborative study is recommended to confirm these findings and to test the clinical value of surgical peeling of the vitreous cortex in eyes with stage 1 changes as a means of preventing hole formation.

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937 citations

"The International Vitreomacular Tra..." refers methods in this paper

...The Gass classification was based on careful clinical examination and divided macular holes into 4 stages.(24,25) Although the original Gass classification is still quoted widely and adaptations of it are in clinical use, OCT-based anatomic data have added much to our understanding of the pathogenesis and progression of macular hole over the past 2 decades (Table 2)....
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Journal Article•DOI•

Reappraisal of biomicroscopic classification of stages of development of a macular hole

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J. Donald M. Gass¹•Institutions (1)

Bascom Palmer Eye Institute¹

01 Jun 1995-American Journal of Ophthalmology

TL;DR: In this paper, the change from a yellow spot to a yellow ring (stage 1-A) during the early stages of foveal detachment is unique to patients at risk of age-related macular hole and provides explanations for the remarkable recovery of visual acuity that occurs in some patients after vitreous surgery.

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671 citations

Journal Article•DOI•

Enzymatic Vitreolysis with Ocriplasmin for Vitreomacular Traction and Macular Holes

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Peter Stalmans¹, Matthew S. Benz, Arnd Gandorfer, Anselm Kampik, Aniz Girach, Stephen Pakola, Julia A. Haller - Show less +3 more•Institutions (1)

Universitaire Ziekenhuizen Leuven¹

15 Aug 2012-The New England Journal of Medicine

TL;DR: Intravitreal injection of the vitreolytic agent ocriplasmin resolved vitreomacular traction and closed macular holes in significantly more patients than did injection of placebo and was associated with a higher incidence of ocular adverse events, which were mainly transient.

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Abstract: BACKGROUND Vitreomacular adhesion can lead to pathologic traction and macular hole. The standard treatment for severe, symptomatic vitreomacular adhesion is vitrectomy. Ocriplasmin is a recombinant protease with activity against fibronectin and laminin, components of the vitreoretinal interface. METHODS We conducted two multicenter, randomized, double-blind, phase 3 clinical trials to compare a single intravitreal injection of ocriplasmin (125 μg) with a placebo injec tion in patients with symptomatic vitreomacular adhesion. The primary end point was resolution of vitreomacular adhesion at day 28. Secondary end points were total posterior vitreous detachment and nonsurgical closure of a macular hole at 28 days, avoidance of vitrectomy, and change in best-corrected visual acuity. RESULTS Overall, 652 eyes were treated: 464 with ocriplasmin and 188 with placebo. Vitreo macular adhesion resolved in 26.5% of ocriplasmin-injected eyes and in 10.1% of placebo-injected eyes (P<0.001). Total posterior vitreous detachment was more prev alent among the eyes treated with ocriplasmin than among those injected with placebo (13.4% vs. 3.7%, P<0.001). Nonsurgical closure of macular holes was achieved in 40.6% of ocriplasmin-injected eyes, as compared with 10.6% of placeboinjected eyes (P<0.001). The best-corrected visual acuity was more likely to improve by a gain of at least three lines on the eye chart with ocriplasmin than with placebo. Ocular adverse events (e.g., vitreous floaters, photopsia, or injection-related eye pain — all self-reported — or conjunctival hemorrhage) occurred in 68.4% of ocriplasmininjected eyes and in 53.5% of placebo-injected eyes (P<0.001), and the incidence of serious ocular adverse events was similar in the two groups (P = 0.26). CONCLUSIONS Intravitreal injection of the vitreolytic agent ocriplasmin resolved vitreomacular traction and closed macular holes in significantly more patients than did injection of placebo and was associated with a higher incidence of ocular adverse events, which were mainly transient. (Funded by ThromboGenics; ClinicalTrials.gov num bers, NCT00781859 and NCT00798317.)

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500 citations

"The International Vitreomacular Tra..." refers background in this paper

...Paper presented at: ARVO Annual Meeting, May 6, 2012; Fort Lauderdale, FL).(27) Amedium FTMH is defined by aperture size from 250 to 400 mm (Fig 2C)....
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...In the few eyes with large FTMH that have undergone pharmacologic vitreolysis, no anatomic success has been recorded.(27)...
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Journal Article•DOI•

Structural macromolecules and supramolecular organisation of the vitreous gel.

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Paul N. Bishop¹•Institutions (1)

Wellcome Trust Centre for Cell-Matrix Research¹

01 May 2000-Progress in Retinal and Eye Research

TL;DR: The molecular basis of normal vitreous gel structure and how this is altered during ageing is understood to open up new therapeutic opportunities as it will allow the development of therapeutic reagents that can be used to modulate Vitreous Gel structure and thus treat a number of common, potentially blinding, ocular conditions.

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477 citations

"The International Vitreomacular Tra..." refers background in this paper

...The vitreous consists of approximately 98% water and 2% structural macromolecules.(5,6) These molecular constituents form a clear, gel-like structure during early embryonic development, which ultimately attains an average volume of 4 ml in adults....
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Journal Article•DOI•

Macular hole formation: new data provided by optical coherence tomography.

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Alain Gaudric¹, Belkacem Haouchine, Pascale Massin, Michel Paques, Pierre Blain, Ali Erginay - Show less +2 more•Institutions (1)

University of Paris¹

01 Jun 1999-Archives of Ophthalmology

TL;DR: In fellow eyes of eyes with macular holes posterior hyaloid detachment begins around the macula, but the hyaloids remains adherent to the foveolar center, indicating the action of anteroposterior forces.

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Abstract: Objective To establish the sequence of events leading from vitreofoveal traction to full-thickness macular hole formation. Methods Both eyes of 76 patients with a full-thickness macular hole in at least 1 eye were examined by biomicroscopy and optical coherence tomography. Results Sixty-one fellow eyes had a normal macula. Optical coherence tomograms showed central detachment of the posterior hyaloid over the posterior pole in 19 cases (31%) and a perifoveal hyaloid detachment not detected on biomicroscopy in 26 cases (42%). In the 4 impending macular holes, optical coherence tomography disclosed various degrees of intrafoveal split or cyst, with adherence of the posterior hyaloid to the foveal center and convex perifoveal detachment. In the 14 stage 2 holes, eccentric opening of the roof of the hole was observed, and in the 24 stage 3 holes, the posterior hyaloid was detached from the entire posterior pole. Conclusions In fellow eyes of eyes with macular holes posterior hyaloid detachment begins around the macula, but the hyaloid remains adherent to the foveolar center, indicating the action of anteroposterior forces. This results in an intraretinal split evolving into a cystic space, and then to the disruption of the outer retinal layer and the opening of the foveal floor, thus constituting a full-thickness macular hole.

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438 citations

"The International Vitreomacular Tra..." refers background in this paper

...Autopsy studies reveal that residual vitreous remains on the surface of the retina in nearly half of all eyes with PVD.21 This condition is called vitreoschisis.22 This residual vitreous may proliferate to form an epiretinal membrane (ERM) at any stage of vitreous separation....
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...However, in cases where liquefaction or gel contraction outpaces detachment of the vitreous cortex, an abnormal adhesion of the vitreous cortex to the ILM is present, or a combination of both is present, a range of anomalous macular conditions can ensue that vary according to the strength and position of the remaining attachments.13,14 The result of this mismatch is an anomalous PVD....
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...People with VMA generally experience no visual impairment, and the finding is normal in the natural course of PVD....
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...Typically, concurrent vitreoretinal separation initiates at multiple sites throughout the peripheral fundus as well, and the process proceeds for years to decades before coalescing into a final separation of the vitreous from the macula and optic nerve, resulting in a complete PVD....
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...In Uchino’s, Gaudric’s, and Johnson’s classification schemes, VMA is the equivalent of a stage 1 PVD.(1,2,13,15) Most eyes have complete vitreoretinal adhesion at birth, so the concept of vitreoretinal adhesion and VMA is a normal state....
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The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole.

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"The International Vitreomacular Tra..." refers background in this paper

"The International Vitreomacular Tra..." refers background in this paper

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