[On correct clinical and pathogenetic OCT-based classification of vitreomacular interface pathologies]

Area of Science:

• Ophthalmology
• Retinal Imaging
• Pathogenesis

Background:

• The lack of a standardized classification for vitreomacular interface (VMI) pathology hinders effective professional communication and treatment planning.
• Current understanding of VMI pathologies is fragmented, necessitating a unified approach.

Purpose of the Study:

• To introduce a novel, prognostically significant clinical and pathogenetic classification of surgical VMI pathologies.
• To establish a classification system based on optical coherence tomography (OCT) findings.

Main Methods:

• A comprehensive review of published literature on VMI pathologies.
• Analysis of the authors' own clinical observations and OCT data.
• Development of a pathogenetic framework for VMI classification.

Main Results:

• Proposed classification begins with vitreomacular adhesion, detailing stages of epiretinal membrane (ERM) formation and contraction patterns (e.g., macular pseudohole, foveoschisis).
• Vitreomacular traction (VMT) is classified into four stages, with potential outcomes including asymptomatic resolution, lamellar macular holes, or full-thickness macular holes (FTMH).
• The classification integrates posterior vitreous detachment (PVD) and its role in ERM and VMT development.

Conclusions:

• The proposed OCT-based classification provides a comprehensive framework for primary surgical VMI pathologies.
• It utilizes modern pathogenetic concepts and clear OCT criteria for distinct nosological entities.
• This scheme standardizes research, improves communication, and streamlines clinical decision-making for VMI disorders.