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SYMPTOMATIC VITREOMACULAR ADHESION

Jackson, Timothy L. PhD, FRCOphth*,†; Nicod, Elena MSc; Simpson, Andrew MBBS, MRCOphth*,†; Angelis, Aris MSc; Grimaccia, Federico MD; Kanavos, Panos PhD

doi: 10.1097/IAE.0b013e31829232fd
Review

Background: Symptomatic vitreomacular adhesion describes symptomatic loss of visual function as a result of vitreous traction at the macula.

Methods: Literature review.

Results: Symptomatic vitreomacular adhesion can occur in isolation as vitreomacular traction, which may lead to the development of a macular hole, or it may occur alongside epiretinal membrane. It is likely to be associated with age-related macular degeneration and possibly diabetic maculopathy, although this is less certain. The treatment depends largely on the cause, but options include observation, vitrectomy, and pharmacologic vitreolysis. Small uncontrolled trials have also explored the use of an intravitreal gas bubble as a means of releasing VMA. If all cases of sVMA are considered together, then the burden of illness is substantial, with a prevalence of ∼0.35 per 100 population (excluding epiretinal membrane). Furthermore, there may be many more cases of undiagnosed sVMA.

Conclusion: The recent introduction of ocriplasmin is likely to increase interest in sVMA. Clinical trials suggest that it has a role in the treatment of vitreomacular traction and Stages 1 to 3 macular holes but not primarily as a treatment of epiretinal membrane. Its role in other diseases associated with VMA remains to be determined.

Symptomatic vitreomacular adhesion describes symptomatic vision loss from vitreous traction at the macula. It can manifest as vitreomacular traction syndrome, macular hole, and may be associated with epiretinal membrane, age-related macular degeneration, and diabetic maculopathy. Prevalence is ∼1.5%. Treatment options include observation, vitrectomy, and, more recently, pharmacologic vitreolysis.

*Department of Ophthalmology, King's College Hospital, London, United Kingdom;

School of Medicine, King's College London, London, United Kingdom; and

London School of Economics, London, United Kingdom.

Reprint requests: Timothy L. Jackson, PhD, FRCOphth, Department of Ophthalmology, King's College Hospital, London SE5 9RS, United Kingdom; e-mail: t.jackson1@nhs.net

This project was supported by an unrestricted grant from Thrombogenics.

T. Jackson is a consultant to Thrombogenics. None of the authors have any financial/conflicting interests to disclose.

© 2013 by Ophthalmic Communications Society, Inc.