Classifications of Vitreo-Macular Tractions Classifications of Vitreo-Macular Tractions F Bandello MD, FEBO M Battaglia Parodi, MD Department of Ophthalmology University Vita-Salute San Raffaele Hospital, Milano
Jun 30, 2015
Classifications ofVitreo-Macular Tractions
Classifications ofVitreo-Macular Tractions
F Bandello MD, FEBO M Battaglia Parodi, MD
Department of OphthalmologyUniversity Vita-Salute
San Raffaele Hospital, Milano
Financial DisclosureFinancial Disclosure
Advisory Board Member for:
Alcon
Alimera
Allergan
Bausch and Lomb
Bayer
Genentech
Novagali
Novartis
Pfizer
Hoffmann-La Roche
Sanofi-Aventis
Farmila-Théa
Thrombogenics
Why a New ClassificationWhy a New Classification
•Competing definitions
•Availability of spectral domain OCT
•New therapeutic modalities
AIM:• OCT based anatomic classification• Consistent nomenclature• Use in all settings (Dx, Rx, Studies)• Adaptable
Consensus ClassificationConsensus Classification
Interface ClassificationInterface Classification
Classification Subclassification Localization
VM adhesion focal (≤ 1500 µm)broad (≥ 1500 µm) Isolated or concurrent
VM Traction focal (≤ 1500 µm)broad (≥ 1500 µm) Isolated or concurrent
Macular Hole*Small (≤ 250 µm)
Medium (>250 - ≤ 400 µm)Large (> 400 µm)
With or without VMT
* can be primary or secondary
Based on Based on
•Analysis of at least 1 OCT B scan
•Ideally:
•Cube scan
•Transverse scan analysis (above the retinal plane)
Vitreomacular AdhesionVitreomacular Adhesion
•Evidence for perifoveal vitreous cortex detachment from the retinal surface
•Macular attachment within central 3000µm radius of fovea
•No change in retinal structure
•Focal (≤ 1500 µm) or broad (≥ 1500 µm)
VMAVMA
Vitreomacular Traction (VMT)Vitreomacular Traction (VMT)
•Evidence of perifoveal vitreous cortex detachment from the retinal surface
•Macular attachement of the vitreous cortex within a 3 mm radius of the fovea
•Attachment to the retina associated with distortion of:
• Foveal surface
• Intraretinal structural changes
• Elevation of fovea above the RPE
•No full-thickness interruption of retinal layers
VMTVMT
VMTVMT
VMTVMT
de Smet MD et al. Ophthalmologica 2013
VMTVMT
Transverse C-Scan
VMTVMT
Full Thickness Macular Hole (FTMH)
Full Thickness Macular Hole (FTMH)
•Full thickness foveal lesion involving all layers of the retina
•Classified across the narrowest point of the hole
• Small (≤ 250 µm)
• Medium (>250 µm and ≤ 400 µm)
• Large (> 400 µm)
•Presence or absence of VMT
•Primary or secondary process
Classification of Macular HolesClassification of Macular Holes
Usual classification IVMT study classificationStage 0 VMA
Stage 1: impending hole VMT
Stage 2: Small hole Small or medium FTMH +/- VMT
Stage 3: Large hole Medium or large FTMH +/- VMT
Stage 4: FTMH with PVD ANY hole without VMT
FTMHFTMH
FTMHFTMH
FTMH - Primary or Secondary ProcessFTMH - Primary or Secondary Process
•Primary - VMT
•Secondary -
• Trauma
• High myopia
• Macular schisis
• MacTel type 2
• 2nd to ME from Uveitis - AMD - RVO
Macular PseudoholeMacular Pseudohole
• Invaginated or heaped foveal edges
•Concomitant ERM with central opening
•Steep macular contour to the central fovea with near normal central foveal thickness
•No loss of retinal tissue
Lamellar Macular Hole (LMH)Lamellar Macular Hole (LMH)
• Irregular foveal contour
•Defect of inner fovea (± tissue loss)
• Intraretinal splitting (schisis)
•Maintenance of an intact photoreceptor layer
Interface ClassificationInterface Classification
Classification Subclassification Localization
VM adhesion focal (≤ 1500 µm)broad (≥ 1500 µm) Isolated or concurrent
VM Traction focal (≤ 1500 µm)broad (≥ 1500 µm) Isolated or concurrent
Macular Hole*Small (≤ 250 µm)
Medium (>250 - ≤ 400 µm)Large (> 400 µm)
With or without VMT
* can be primary or secondary