Retinal Conditions

Vitreomacular Adhesion

Vitreomacular adhesion refers to an attachment between the vitreous gel which fills the eyeball and the central part of the retina which lines the back of the eye. If the vitreous gel separates from the retina except for a persistent central attachment, then the gel can physically pull on the retina and cause swelling or deformation which results in blurred or distorted vision.

CAUSES OF VITREOMACULAR ADHESION

At birth, the vitreous gel is clear and firm. The surface of the gel is attached to the retina. With age, the gel begins to liquefy and soften. Eventually, in most eyes, the surface of the gel separates cleanly from the retina, creating a posterior vitreous detachment. However, in some eyes the attachment between the gel and the retina is strong enough that the gel separates only partially, leaving a small area of attachment.This attachment can pull on the retina cause various deformations.

EVALUTION

Your retinal surgeon may order diagnostic tests in the office to identify and characterize the adhesion between the vitreous gel and the retina. Optical coherence tomography (OCT) is a scan of the retina that measures abnormal retinal contours in very high resolution. In some cases of vitreomacular adhesion, fluorescein angiography imaging is helpful in indentifying blood vessel leakage that may be associated with the traction exerted by the vitreous gel on the retinal surface.

TREATMENT

Treatment is usually warranted only if vitreomacular adhesion is resulting in vitreomacular traction affecting the vision. Treatment options include observation, intravitreal ocriplasmin injection, or micro-incisional surgery.

OBSERVATION

Your retinal surgeon may order diagnostic tests in the office to identify and characterize the adhesion between the vitreous gel and the retina. Optical coherence tomography (OCT) is a scan of the retina that measures abnormal retinal contours in very high resolution. In some cases of vitreomacular adhesion, fluorescein angiography imaging is helpful in indentifying blood vessel leakage that may be associated with the traction exerted by the vitreous gel on the retinal surface.

PNEUMATIC RETINOPEXY

Pneumatic retinopexy for vitreomacular adhesion consists of (1) Gas is injected into the back part of the eye (vitreous cavity). When the head is later positioned appropriately, this bubble may disrupt the vitreomacular adhesion and release traction on the macula. (2) Fluid is removed from the eye in order to make place for the gas. This can be done before the gas is injected, after the gas is injected, or both before and after. Positioning by the patient immediately after this procedure is critical. Make sure you understand your doctor's positioning instructions before leaving the office. You will see your doctor frequently in the weeks following the procedure in order to monitor the status of the vitreomacular adhesion and assess the need for further intervention, such as repeating the steps described above or going to the operating room for surgical repair. 

MICRO-INCISIONAL SURGERY

Micro-incisional vitrectomy surgery is performed in the operating room as a same-day procedure. The surgery is able to successfully separate the vitreomacular adhesion more than 90% of the time. In some cases, a gas bubble is placed in the eye and face-down position is required in order to achieve the best visual outcome after surgery.

Visual improvement following treatment depends on several factors. Without physical separation of the adhesion, vision is unlikely to improve. If the adhesion separates (spontaneously or with treatment), the vision is likely but not guaranteed to improve. Visual improvement is less likely if the retinal deformation is very severe or has been present for a long period of time. If the adhesion separates but causes a full thickness macular hole, then vision may actually worsen, and treatment is then required to close the macular hole.

Bay Area Retina Associates has eight offices around the East Bay region of the San Francisco Bay Area.
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