Vitreo-papillary adhesion in macular hole and macular pucker

Vitreo-macular pathology may be influenced by vitreo-papillary adhesion (VPA). Optical coherence tomography/scanning laser ophthalmoscopy (OCT/SLO) was used to identify VPA in full-thickness macular hole, lamellar hole, and macular pucker (MP).

Ultrasonography and OCT/SLO were performed in 55 subjects: 16 with macular hole, 11 with lamellar hole, and 28 with MP. The main outcome measures were the presence of posterior vitreous detachment by ultrasound, and the findings of VPA and intraretinal cysts by OCT/SLO.

Posterior vitreous detachment was detected by ultrasound in 26/28 (92.9%) eyes with MP, 6/11 (54.5%) eyes with lamellar hole (P < 0.05), and 4/16 (25%) eyes with macular hole (P < 0.00001). Optical coherence tomography/scanning laser ophthalmoscopy detected VPA in 14/16 (87.5%) macular hole eyes, 4/11 (36.4%) lamellar hole eyes (P < 0.05), and 5/28 (17.9%) MP eyes (P < 0.00005). Intraretinal cysts were present in 4/5 (80%) MP eyes with VPA but only 1/23 (4.3%) MP eyes without VPA (P < 0.005).

Vitreo-papillary adhesion was significantly more common in full-thickness macular hole than lamellar hole or MP. When present in MP, VPA was frequently associated with intraretinal cysts. Hence, VPA may have an important influence on the vectors of force at the vitreo-retinal interface inducing holes and cysts.