The effect of this can be that the otherwise mobile vitreous tends to pull the surface of the macula forwards, stretching it into being thicker. Known as vitreomacular traction, this can have the same sort of effect on vision as macular oedema and epiretinal membranes, including distortion and blurring of central vision.
If the persistent attachment of the vitreous occurs only at the fovea, it is known as vitreofoveal traction (VFT) and causes visual problems in the absolute centre of vision. Yet another variation is present in diabetic retinopathy where the part of the vitreous in contact with the macula thickens and contracts like an epiretinal membrane. The macula is often thickened with poor vision, and many sessions of laser or intravitreal injections for the macular thickening prove unsuccessful. This type of vitreomacular traction is called taut posterior hyaloid face (vitreous) syndrome (TPHF).
What Happens If I Don't Have An Operation?
VFT can get better on its own by the vitreous detaching from the macula on its own in up to 30% of people. That is why it is often worth waiting a while before considering vitrectomy surgery with an ILM peel, unless there is good evidence that the vision is worsening or threatened.
Unfortunately, VMT and TPHF rarely get better by themselves and so vitrectomy surgery with an ILM peel is often recommended earlier.
What Is The Treatment For Vitreomacular Traction And Its Variants?
A vitrectomy operation is currently the treatment with the highest success rate; 80-90% of patients find their distortion (quality of vision) improves and 70-80% see better centrally (quantity of vision). There is an intravitreal injection available now (ocriplasmin) that may cause release of vitreofoveal traction, but it can have significant side effects with respect to vision, is not covered by the PBS and has a lower success rate than surgery.
If there are definite symptoms or signs suggesting worsening of traction, delaying treatment may mean results are not quite as good as with early surgery.
It is important, however to discuss the pros and cons of operating sooner or later with Dr Chauhan.
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