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Vitreomacular Traction

Background

Vitreomacular traction is a condition in which the vitreous gel has an abnormally strong adhesion to the retina. Over time, the gel tends to pull forward and can cause vessel and retinal distortion causing retinal swelling and decreased vision.

Clinical Features

There is a wide spectrum of severity and, hence, clinical findings. Some patients have minimal symptoms, while others are bothered by decreased or distorted central vision. With the advent of a test called optical coherence tomography (OCT), this diagnosis has been much easier to make, and is rarely confused with other similar-appearing conditions.

The clinical course is variable. Typically this will either remain stable or it may progress if additional traction occurs. In the past, it had been reported that as many as 50% of patients will spontaneously improve, but this was well before OCT was available to confirm the diagnosis. In our experience, a minority of patients will have the vitreous spontaneously separate and visual improvement.

Management

Often early stages are observed for any progression. Vitrectomy with separation of the vitreous is the only treatment option for patients who develop significant visual symptoms. Depending on the amount of a patient's vision interferes with their activities of daily living (ADL's), surgery is generally considered for vision around 20/40 or worse.

Typical Vitreomacular Traction

Preoperative OCT [above] showing significant macular edema due to traction from the posterior vitreous. Postoperative OCT [below] one month later showing restoration of macular anatomy.

Atypical Vitreomacular Traction

Preoperative OCT showing a significant amount of macular distortion but not a full-thickness macular hole.
Postoperative OCT one year later showing restoration of macular anatomy.

Visual recovery after vitrectomy for vitreomacular traction is variable and is difficult to predict. If traction is relieved, the macula can return to more normal anatomy and more normal function. The length of postoperative recovery is also variable and usually depends on the duration of the problem before surgery. Patients generally should expect visual improvement to occur over weeks to months. Normal activities can generally be resumed in 2-4 weeks even if visual recovery is not complete.