Vitreomacular traction and exudative age‐related macular degeneration

Abstract

ABSTRACT. Vitreomacular traction resulting from lacking, incomplete or anomalous posterior vitreous detachment is suspected to play a crucial role in the pathogenesis of different forms of age-related macular degeneration (AMD) along with the known mechanisms. It is probable that the fundamental pathomechanisms of AMD formation have already begun by the time tractional forces lead to a change for the worse. Vitreomacular traction alone is perhaps not able to induce AMD. It would seem sensible to consider vitreous changes when diagnosing and treating AMD patients because of the high coincidence of vitreomacular traction and choroidal neovascularization (CNV) and the often successful treatment of other diseases of the vitreoretinal interface by vitrectomy. The concept of the pathogenesis of AMD should therefore be extended to include the influence of the vitreous, especially where therapeutic concepts such as pharmacological vitreolysis and vitreous separation have been established as causative treatment of late forms of AMD.

Quadruple Therapy Leads to a Sustained Improvement of Vision in Patients with Wet Age-Related Macular Degeneration

“…The presence of vitreous attachment to the macula was suggested to be a possible risk factor for neovascular AMD by perpetuating macular exposure to inflammatory cytokines or free radicals and by interfering with macular oxygenation [11,12,13]. It is likely that vitreous attachment, through the same mechanisms, also contributes to angiogenesis.…”

A study of the vitreoretinal interface in patients with age-related macular degeneration

“…As demonstrated by a few studies, the hyaloid may only act as a poor prognostic factor for improving visual acuity following treatment, particularly when there is a traction in the macular area (24,(26)(27)(28) . In those cases, there is a disruption of the retinal layers that was caused not only by CNVM but also by hyaloid traction, thus leading to a worse visual prognosis.…”

Vitreomacular Traction Post Intravitreal Bevacizumab for Age Related Macular Degeneration

“…Considering that VMT is a well-recognized association of AMD, this observation is worthy of emphasis. This is especially so as VMT on its own may worsen AMD and ultimately result in anti VEGF treatment failure [5] [7].…”

“…VMT adversely worsens AMD possibly due to the tractional forces that are exerted on the macular inducing inflammation or other mechanisms [6]. Lastly, there is a suggestion that tractional forces of the VMT may antagonize the effect of intravitreal anti VEGF therapy and cause pharmacological treatment failure and resistance [7].…”