Vitreomacular Traction Syndrome (VMT)

Vitreomacular Traction Syndrome (VMT)
SYMPTOMS Central scotoma, Central vision loss, Metamorphopsia
May also be asymptomatic especially when vitreomacular traction is minimal
SIGNS Loss of a foveal reflex, Glistening translucent membrane visible over the macula, Distortion of the foveal surface, Intraretinal structure changes, Elevation of the sensory retina at the fovea, Tractional cystoid macular edema, Epiretinal membrane, Cotton ball sign (Occurs due to inward traction of the photoreceptors), Full thickness macular hole, Tractional macular schisis, Adhesion with traction that occurs within a 3000 micron radius of the fovea
Traction can be focal (less than or equal to 1500 microns in size) or broad (greater than 1500 microns in size)
WORK-UP Full eye exam with dilated retinal exam, OCT analysis of the macula (signs of vitreomacular traction syndrome are best seen with an OCT), Fluorescein Angiography, Fundus Autofluorescence, Fundus photos, Infrared retinal imaging, Watzke-Allen test, Macular photostress test, Amsler grid
TREATMENT Observation can be considered if patient is asymptomatic or has mild symptoms with minimal tractional macula changes that are stable but referral to a retinal specialist for early traction release should be strongly considered (Observation is no longer recommended as studies found continued loss of vision, persistent tractional cystoid macular edema, and infrequent posterior vitreous detachment completion)
Give take home Amsler grid in order to monitor for change
Treatment includes a Pars plana vitrectomy, ILM peel, Internal gas tamponade (typically the patient needs to lie face down for 14 hours a day for 7-10 days), and Internal ILM flap
FOLLOW-UP If observing vitreomacular traction syndrome, patient should be seen back in 3-4 months
If macula is stable following treatment by retinal specialist, patient should be seen back in 6-12 months
ETIOLOGY Occurs due to a combination of posterior vitreous degeneration and firm attachment to the foveola and margins of the fovea. When the vitreous pulls away from the majority of the posterior pole/macula but stays attached to the margins of the fovea and foveola, there is anterior traction that is dynamic due to the elastic properties of the vitreous
DIFFERENTIAL DX Vitreomacular adhesion, Epiretinal membrane, Fibrovascular proliferation
NOTES Focal vitreomacular traction is more likely to lead to full thickness macular holes than broad vitreomacular traction
The presence of an epiretinal membrane exacerbates vitreomacular traction syndrome
Vitreomacular adhesion (VMA): Adhesion within a 3000 micron radius of the fovea with no change in foveal contour. Patients are asymptomatic
Vitreomacular Traction Syndrome (VMT): OCT of the macula demonstrating vitreomacular traction syndrome with an associated full thickness macular hole