Vitreomacular Traction

Dr Ben Wild

Overview

The retina is located at the back surface of the inside of the eye. Its main function is to detect and transmit the sensation of light to the brain for interpretation. Clinically, the macula refers to the part of the retina that represents the finely detailed central vision. For light to focus on the macula, it must pass through the cornea (front of the eye), pupil, lens and finally, vitreous humor gel.

A frontal view of a healthy eye fundus (back of the eye) where the macula represents the darker circle.

Vitreomacular traction (VMT) occurs during an impending posterior vitreous detachment (PVD). Briefly, a PVD occurs due to the liquification and shrinkage of the vitreous gel that inflates the eye. This process is a normal part of ageing. Eventually, the gel shrinks enough that it separates from the retina. VMT occurs when the gel is still attached to the retina but is in the process of pulling away.

A frontal view of an eye with a lamellar hole caused by vitreomacular traction.

Signs and Symptoms

Signs

Pseudo-cyst formation only visible on specialized imaging, lamellar macular holes (holes comprising of only a few retinal layers), and blood vessel leakage.

Symptoms

Often asymptomatic (no symptoms), sometimes decreased vision, light flashes, distorted vision.

Causes and Risk Factors

Causes

Vitreous gel pulling on the macula.

Risk Factors

Impending PVD.

Prevention and Treatment

Prevention

There are no known preventative measures.

Treatments

· Majority of cases do not need treatment as they often do not affect vision or only affect vision minimally and resolve on their own.

· Vitreolysis (inject an enzyme that separates the vitreous gel from the retina).

· Vitrectomy (removal of the vitreous gel).

Prognosis

In most cases, VMT resolves on its own after the completion of the PVD. If an epiretinal membrane has formed on the retina, surgery may be required to manually separate the retina from the vitreous gel although this is very rare. Overall, this condition is unlikely to affect vision long-term.