Spectral domain optical coherence tomography for higher precision in the evaluation of vitreoretinal adhesions in exudative age-related macular degeneration.

Abstract

The role of changes at the vitreoretinal interface and vitreomacular traction forces in pathogenesis, and the course of exudative age-related macular degeneration (AMD) need further exploration. This study examines the localisation of adhesion and the direction of traction lines in eyes with exudative AMD. The cubes 512×128 of Cirrus optical coherence tomography (OCT) and volume scans of Spectralis OCT were reviewed in a consecutive series of patients presenting between December 2008 and March 2009 with vitreomacular adhesion in exudative AMD. 30 eyes of 25 patients with exudative AMD and vitreomacular adhesion were studied. 50% had type III lesions, 46.7% occult and 3.3% predominantly classic lesions. The localisation of the adhesion corresponded in 100% with the area of the neovascularisation (CNV), in 73.3% traction directed towards the CNV and in 83.3% towards the optic disc could be noted. Spectral domain OCT and 3D visualisation enabled clearer localisation of vitreomacular adhesion and definition of resulting traction lines. There is a high prevalence of type III lesions within eyes with vitreomacular adhesions, and complete correspondence between the location of the adhesion and the CNV. There is also a high incidence of vitreopapillary adhesion in these cases, suggesting a possible role in pathogenesis.