Vitreomakuläres Traktionssyndrom (VMTS)

Zusammenfassung

Das vitreomakuläre Traktionssyndrom ist gekennzeichnet durch eine anomale hintere Glaskörperabhebung (AHGA) mit persistierender symptomatischer Glaskörperadhäsion an der Makula. Diese Adhäsion bedingt eine Verdickung der Makula, ein Makulaödem und damit eine verminderte Sehschärfe. Moderne bildgebende Verfahren wie das hochauflösende Spectral Domain OCT (SD-OCT) ermöglichen einen immer detaillierteren Einblick in die retinale Mikrostruktur und den vitreoretinalen Übergang. Vitreomakuläre Adhärenzen und Traktionen und deren Auswirkung auf die Netzhaut lassen sich damit genau darstellen. Das vitreomakuläre Traktionssyndrom wurde und wird bis heute chirurgisch behandelt. In Studien zur pharmakologischen Vitreolyse konnte bei Patienten mit symptomatischer vitreomakulärer Adhäsion und Traktion ein therapeutischer Effekt nachgewiesen werden. Diese Studienergebnisse stellen einen wichtigen Schritt hin zur pharmakologischen Behandlung der vitreomakulären Adhäsion mit Traktion dar.

Abstract

In vitreomacular traction syndrome (VMTS) an anomalous posterior vitreous detachment (APVD) with persistant symptomatic vitreoretinal adhesion is seen. The adhesion leads to a thickened macula, to macular oedema and a reduction of BCVA. Modern imaging techniques like spectral domain OCT (SD-OCT) allow a detailed imaging of the retinal microstructure and the vitreoretinal interface. Vitreomacular adhesions and their effect on the retina can be visualised. Until now, the treatment option for VMTS was and is vitreoretinal surgery. In studies pharmacological vitreolysis has shown a therapeutic effect in patients with symptomatic adhesion and traction. The results of these studies represent an important step towards a pharmacological treatment of VMTS.

Schlüsselwörter

vitreomakuläres Traktionssyndrom - pathologische hintere Glaskörperabhebung - pharmakologische Vitreolyse - Ocriplasmin

Key words

vitreomacular traction syndrome - anomalous posterior vitreous detachment (APVD) - pharmacological vitreolysis - ocriplasmin

• Literatur

• 1 Reese AB, Jones IS, Cooper WC. Vitreomacular traction syndrome confirmed histologically. Am J Ophthalmol 1970; 69: 975-977
• 2 Barak Y, Ihnen MA, Schaal S. Spectral domain optical coherence tomography in the diagnosis and management of vitreoretinal interface pathologies. J Ophthalmol 2012; 2012: 876472
• 3 Sebag J, Wang MY. Combined Spectral-Domain optical Coherence Tomography/Scanning Laser Ophthalmoscopy Imaging of vitreous and the vitreo-retinal Interface, medical Retina, Focus on retinal Imaging. Holz FG, Spaide RF, eds. Essentials in Ophthalmology. Berlin, Heidelberg: Springer Verlag; 2010: 157-168
• 4 Benz MS, Packo KH, Gonzalez V et al. A placebo-controlled trial of microplasmin intravitreous injection to facilitate posterior vitreous detachment before vitrectomy. Ophthalmology 2010; 117: 791-797
• 5 de Smet MD, Gandorfer A, Stalmans P et al. Microplasmin intravitreal administration in patients with vitreomacular traction scheduled for vitrectomy: the MIVI I trial. Ophthalmology 2009; 116: 1349-1355
• 6 Gandorfer A. Pharmakologische Vitreolyse. Klin Monatsbl Augenheilkd 2011; 228: 201-207
• 7 Haller JA. The vitreomacular interface and Ocriplamin. Retina Subspecialty Day AAO 2011.
• 8 Stalmans P, Benz MS, Gandorfer A et al. MIVI-TRUST Study Group. Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes. N Engl J Med 2012; 367: 606-615
• 9 Sebag J. Anomalous posterior vitreous detachment: a unifying concept in vitreo-retinal disease. Graefes Arch Clin Exp Ophthalmol 2004; 242: 690-698
• 10 Gandorfer A, Rohleder M, Kampik A. Epiretinal pathology of vitreomacular traction syndrome. Br J Ophthalmol 2002; 86: 902-909
• 11 Johnson MW. Posterior vitreous detachment: evolution and complications of its early stages. Am J Ophthalmol 2010; 149: 371-382
• 12 Koizumi H, Spaide RF, Fisher YL et al. Three-dimensional evaluation of vitreomacular traction and epiretinal membrane using spectral-domain optical coherence tomography. Am J Ophthalmol 2008; 145: 509-517
• 13 Sebag J, Balazs EA. Morphology and ultrastructure of human vitreous fibers. Invest Ophthalmol Vis Sci 1989; 30: 1867-1871
• 14 Sebag J. Age-related differences in the human vitreoretinal interface. Arch Ophthalmol 1991; 109: 966-971
• 15 Sebag J, Gupta P, Rosen RR et al. Macular holes and macular pucker: the role of vitreoschisis as imaged by optical coherence tomography/scanning laser ophthalmoscopy. Trans Am Ophthalmol Soc 2007; 105: 121-129 discussion 129–131
• 16 Sebag J. Molecular biology of pharmacologic vitreolysis. Trans Am Ophthalmol Soc 2005; 103: 473-494
• 17 Schneider EW, Johnson MW. Emerging nonsurgical methods for the treatment of vitreomacular adhesion: a review. Clin Ophthalmol 2011; 5: 1151-1165
• 18 Bishop PN. Structural macromolecules and supramolecular organisation of the vitreous gel. Prog Retin Eye Res 2000; 19: 323-344
• 19 Kohno T, Sorgente N, Ishibashi T et al. Immunofluorescent studies of fibronectin and laminin in the human eye. Invest Ophthalmol Vis Sci 1987; 28: 506-514
• 20 Ponsioen TL, van Luyn MJ, van der Worp RJ et al. Collagen distribution in the human vitreoretinal interface. Invest Ophthalmol Vis Sci 2008; 49: 4089-4095
• 21 Terranova VP, Rohrbach DH, Martin GR. Role of laminin in the attachment of PAM 212 (epithelial) cells to basement membrane collagen. Cell 1980; 22: 719-726
• 22 Engvall E, Ruoslahti E, Miller EJ. Affinity of fibronectin to collagens of different genetic types and to fibrinogen. J Exp Med 1978; 147: 1584-1595
• 23 Uchino E, Uemura A, Ohba N. Initial stages of posterior vitreous detachment in healthy eyes of older persons evaluated by optical coherence tomography. Arch Ophthalmol 2001; 119: 1475-1479
• 24 Uchino E, Uemura A, Doi N et al. Postsurgical evaluation of idiopathic vitreomacular traction syndrome by optical coherence tomography. Am J Ophthalmol 2001; 132: 122-123
• 25 Schwab C, Ivastinovic D, Borkenstein A et al. Prevalence of early and late stages of physiologic PVD in emmetropic elderly population. Acta Ophthalmol 2012; 90: e179-e184
• 26 Sivaprasad S, Ockrim Z, Massaoutis P et al. Posterior hyaloid changes following intravitreal triamcinolone and macular laser for diffuse diabetic macular edema. Retina 2008; 28: 1435-1442
• 27 Krebs I, Brannath W, Glittenberg C et al. Posterior vitreomacular adhesion: a potential risk factor for exudative age-related macular degeneration?. Am J Ophthalmol 2007; 144: 741-746
• 28 Maier M, Pfrommer S, Burzer S et al. [Vitreomacular interface and posterior vitreomacular adhesion in exudative age-related macular degeneration (AMD): an OCT-based comparative study]. Klin Monatsbl Augenheilkd 2012; 229: 1030-1035
• 29 Akiba J, Quiroz MA, Trempe CL. Role of posterior vitreous detachment in idiopathic macular holes. Ophthalmology 1990; 97: 1610-1613
• 30 Sonmez K, Capone A, Trese MT et al. Vitreomacular traction syndrome: impact of anatomical configuration on anatonical and visual outcomes. Retina 2008; 28: 1207-1214
• 31 Bottós JM, Elizalde J, Rodrigues EB et al. Current concepts in vitreomacular traction syndrome. Curr Opin Ophthalmol 2012; 23: 195-201
• 32 Ivastinovic D, Schwab C, Borkenstein A et al. Evolution of early changes at the vitreoretinal interface after cataract surgery determined by optical coherence tomography and ultrasonography. Am J Ophthalmol 2012; 153: 705-709
• 33 Mirshahi A, Hoehn F, Lorenz K et al. Incidence of posterior vitreous detachment after cataract surgery. J Cataract Refract Surg 2009; 35: 987-991
• 34 Rouvas A, Petrou P, Ladas I et al. Spontaneous resolution of vitreomacular traction following ranibizumab (Lucentis) injection. Eur J Ophthalmol 2008; 18: 301-303
• 35 McDonald HR, Johnson RN, Schatz H. Surgical results in vitreomacular traction syndrome. Ophthalmology 1994; 101: 1397-1403
• 36 Koerner F, Garweg J. Vitrectomy for macular pucker and vitreomacular traction syndrome. Doc Ophthalmol 1999; 97: 449-458
• 37 Witkin AJ, Patron ME, Castro LC et al. Anatomic and visual outcomes of vitrectomy for vitreomacular traction syndrome. Ophthalmic Surg Lasers Imaging 2010; 41: 425-431
• 38 Issa SA, Connor A, Habib M, Steel DH. Comparison of retinal breaks observed during 23 gauge transconjunctival vitrectomy versus conventional 20 gauge surgery for proliferative diabetic retinopathy. Clin Ophthalmol 2011; 20: 109-114
• 39 Oshima Y, Kadonosono K, Yamaji H et al. Japan Microincision Vitrectomy Surgery Study Group. Multicenter survey with a systematic overview of acute-onset endophthalmitis after transconjunctival microincision vitrectomy surgery. Am J Ophthalmol 2010; 150: 716-725
• 40 Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina 2005; 25: 208-211
• 41 Sebag J. Pharmacologic vitreolysis. Retina 1998; 18: 1-3
• 42 Mojana F, Cheng L, Bartsch DU et al. The role of abnormal vitreomacular adhesion in age-related macular degeneration: spectral optical coherence tomography and surgical results. Am J Ophthalmol 2008; 146: 218-227
• 43 Sebag J. Pharmacologic vitreolysis – premise and promise of the first decade. Retina 2009; 29: 871-874