Vitreomacular observations. I. Vitreomacular adhesion and hole in the premacular hyaloid

Variations in vitreomacular adhesions and the significance of a hole in the premacular hyaloid membrane were studied clinically to better understand vitreomacular pathology.

With an El-Bayadi-Kajiura aspheric preset lens, the authors used a vitreous examination technique on 96 eyes, which were divided into three groups. Findings were recorded photographically.

Group 1 (25 eyes, 26%) included eyes with a partial posterior vitreous detachment and a residual vitreomacular attachment, but no hole in the premacular hyaloid. All eyes in this group, except one, showed another complication. Diabetic retinopathy and retinal vein occlusion were the most frequent problems noted. Premacular fibrosis, often present in these eyes, may have been precipitated by a vascular complication in the retina. In groups 2 and 3 (71 eyes, 74%), a hole was seen in the premacular hyaloid. Group 2 (46 eyes, 48%) comprised eyes showing a partial posterior vitreous detachment with a strand of vitreous that extruded through the hole in the posterior hyaloid and adhered to the macula. In group 3 (25 eyes, 26%), the hole in the premacular hyaloid was accompanied by a total posterior vitrous detachment. The most common complication noted in eyes in groups 2 and 3 was premacular fibrosis (34 of 71 eyes, 47.9%). The persistence of a residual vitreous attachment to the macula was accompanied by a significantly greater frequency of visual acuity equal to or worse than 20/200.

Variations in vitreomacular pathology seem to result from differences in the strength of the vitreomacular adhesion and in the process of vitreous liquefaction and shrinkage. In patients with a hole in the premacular hyaloid membrane, the vitreomacular attachment is stronger than the vitreous attachment to other parts of the retina. The latter feature may cause visual acuity deterioration. When there is a hole in the premacular hyaloid membrane, the presence or absence of a vitreomacular adhesion may affect the prognosis for macular function.