Correlation of vitreous attachment and foveal deformation in early macular hole states¹

Abstract 

PURPOSE : To report the foveal anatomy in patients with perifoveal posterior vitreous detachments (PPVD) using optical coherence tomography.

DESIGN : Retrospective observational case series.

METHODS : A retrospective study of fellow eyes of patients of patients with macular holes and those with early macular hole states were examined with optical coherence tomography, biomicroscopy, and contact b-scan ultrasonography. Twenty-three eyes of 23 patients were discovered to have PPVD, which was defined as persistent attachment of the vitreous to the central macula with a limited detachment of the posterior vitreous in the perifoveal region.

RESULTS : The mean diameter of persistent vitreous attachment in eyes with no foveal deformation was 1829 μm, flattening of the foveal depression 840 μm, and with foveal cavitation 281 μm (P < .001, Spearman rank correlation). The difference in the mean diameters was significant (P = .001, Kruskal-Wallis test, all pairwise comparisons showing significant difference using the Mann-Whitney test).

CONCLUSIONS : This study found that the diameter of the vitreous attachment in eyes with PPVD correlated with induced changes in foveal anatomy. The diameters of vitreous attachment were consistent with known regions of robust attachment of the vitreous determined histologically. Although the actual force loading on the central macula cannot be determined in patients with perifoveal posterior vitreous detachments, the stress, which is force / unit area may well increase with smaller areas of attachment leading to mechanical failure of the macula.

• 1 From the Vitreous Retina Macula Consultants of New York, LuEsther T. Mertz Retina Research Laboratory, Manhattan Eye, Ear, and Throat Hospital, New York, NY. (Dr. Wong is currently at the Singapore National Eye Centre, Singapore.) The authors have no financial interest in any instrument mentioned in this paper.