The vitreous humor is a transparent, gel-like material that fills the space within the eye between the lens and the retina. The vitreous is encapsulated in a thin shell called the vitreous cortex, and the cortex in young, healthy eyes is usually sealed to the retina.
As the eye ages, or in certain pathologic conditions, the vitreous cortex can pull away from the retina, leading to a condition known as posterior vitreous detachment (PVD). This detachment usually occurs as part of the normal aging process.
There are instances where a PVD is incomplete, leaving the vitreous partially attached to the retina, and causing tractional (pulling) forces that can cause anatomical damage. The resulting condition is called vitreomacular traction (VMT) syndrome.
VMT syndrome can lead to different maculopathies or disorders in the macular area (at the center of the retina), such as full- or partial-thickness macular holes, epiretinal membranes, and cystoid macular edema. These disorders are often associated with reduced sharpness of vision (visual acuity) or other visual complications.
SYMPTOMS IN DETAIL
The most common symptoms experienced by patients with VMT syndrome are:
Some of these symptoms can be mild and develop slowly; however, chronic tractional effects can lead to continued visual loss if left untreated. In some cases, a distortion of a visual picture could be experienced without necessarily having a reduction in sharpness of vision.
Age-related degeneration of the gel-like vitreous humor leads to the formation of pockets of fluid within the vitreous, causing contraction and loss of volume. The separation of the vitreous gel from the retina occurs as a result of the gel becoming liquid (liquefaction) and the continuous anterior-posterior (front-back) and tractional forces stretching on the macula over time.
Weakening of the attachments of the vitreous cortex and the internal limiting membrane (ILM) of the retina could also lead to partial detachment of the posterior hyaloid membrane, leading to PVD and potentially VMT.
VMT syndrome is most common in older adults and women due to age-related vitreous changes and vitreous liquefaction associated with declining post-menopausal estrogen levels, respectively.
Treatment and prognosis
There are currently 3 main options for treating VMT syndrome.
Most patients with VMT maintain good visual acuity in the affected eye, even if treatment is required.