OCT proves that vitreomacular adhesion is significantly more likely to develop vision-threatening retinal complications than vitreomacular separation

Abstract

Background: SD-OCT is becoming commonplace in everyday practice. Vitreomacular adhesions (VMAs) are being more routinely diagnosed. Predictive studies to the natural course of VMA are thus clinically significant. Spectral domain-optical coherence tomography (SD-OCT) was presently utilized to analyze the incidence of floaters, the complete vitreomacular separation or VMA, the VMA complication, the vitreomacular angle (VMAng), and the complication mechanism. Methods: Monthly SD-OCT was performed on patients with/without symptomatic floaters. OCT allowed VMA and vitreomacular separation to be compared. The incidence was assessed applying one-tailed Fisher's exact tests. The VMAngs between the inner retina and posterior hyaloid were measured, and the complication mechanism was studied using OCT image. For macular hole (MH), pre-and/or post-operative best corrected visual acuities (BCVAs; LogMAR), refractions and photoreceptor conditions were also evaluated. Results: Totally, 124 eyes were included; there were 116 eyes with VMA and 8 eyes with vitreomacular separation. Considering the percentages over 124 eyes, floaters were present in 14.5% of enrolled eyes (=18/124), consisting of 12.9% of eyes with VMA (16/124) and 1.6% of eyes with vitreomacular separation (2/124). Moreover, there were twelve eyes (9.7%) with VMA-associated vision-threatening complications, including MH (n = 8; 6.5%), retinal detachment (RD; n = 2; 1.6%), vitreomacular traction (VMT; n = 1; 0.8%) and macular pucker (MP; n = 1; 0.8%). Eyes with initial VMA had a significantly greater possibility of complications than eyes with initial vitreomacular separation (p = 0.03). Among these eyes with MH (n = 8), the pre-operative BCVA (LogMAR) was 1.1 ± 0.5, which was insignificantly (p = 0.35) improved to 0.8 ± 0.7 post-operatively. The VMAng of VMA eyes with MHs was 24.2 ± 24.9°( n = 8). The critical VMAng was 13.3°. (Continued on next page)Conclusions: A minority of eyes with VMA or vitreomacular separation had floaters. Moreover, the use of SD-OCT could identify vision-threatening sequelae, namely MH, RD, MP and VMT, and this was significantly more frequent in eyes with VMA than in eyes with complete vitreomacular separation. Therefore, SD-OCT might be a useful way of identifying either identity, and evaluating VMA-associated complications. Whether VMA eyes with MH (n = 8) that have a VMAng greater than critical VMAng have a greater likelihood of tangential traction and subsequent MH needs further investigation.

Multimodal Imaging-Based Phenotyping of a Singaporean Hospital-Based Cohort of High Myopia Patients

“…Myopic tilted disc and PS have also been reported to be progressive in nature in eyes with severe myopia ( 17 , 59 , 60 ). Axial length was identified as a risk factor for the presence of ERM ( 61 ), and similarly, DSM and VMA are conditions that are commonly seen in patients with HM ( 26 , 27 ), and although these conditions alone might not affect visual function, they may increase the risk of developing further sight-threatening complications ( 26 , 27 ). We found that the prevalence of PPA, myopic tilted disc, PS, DSM, ERM, and VMA was significantly higher in eyes with longer AL even among HM eyes.…”

“…In addition to PM, HM eyes are more likely to develop associated myopic pathologies, such as peripapillary atrophy (PPA) ( 23 ), myopic tilted disc ( 24 ), posterior staphyloma (PS) ( 25 ), dome-shaped macula (DSM) ( 26 ), vitreomacular adhesion (VMA) ( 27 ), and the epiretinal membrane (ERM) ( 28 ). Determining the characteristics of patients with HM at high risk of developing these pathologic changes is critical in guiding the optimal monitoring of patients with HM, so as to administer timely interventions to mitigate or prevent permanent visual loss ( 29 ).…”

Outer Plexiform Layer Angle: A Prognostic Factor for Idiopathic Macular Pucker Surgery

“…e researchers of other publications regarding pucker correlated macular conditions such as vitreomacular traction and vitreomacular adhesion [29][30][31] carried out investigations into predictive visual outcome factors including optical coherence tomography pattern (e.g., vitreomacular adhesion ≤1500 μm), shorter symptom duration, and younger age. In the future study, these prognostic factors might also need further investigation.…”

Human menstrual blood-derived mesenchymal stem cells regulation of the EGF/Ras p21 pathway as a potential therapeutic target for thin endometrium

“…The thin endometrium is a critical factor that limits embryo implantation and the success in vitro fertilization-embryo transfer (8,12,13). The therapeutic options for thin endometrium mainly include drug treatments and stem cell therapy, among others, but these options currently remain ineffective (9,(14)(15)(16)(17). Recent studies have shown that stem cells can migrate to the endometrium, increase endometrial thickness, and improve endometrial receptivity, which provides new avenues for developing treatments for thin endometrium (18)(19)(20).…”