IVTS Group Classification of - PowerPoint Presentation

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IVTS Group Classification of VMA, VMT, and Macular Hole

Siamak Moradian MDOphthalmic Research Center (SBMU)Labbafinejad Medical Center

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The purpose of the consensus classification was to define the pathologic progression of anomalous PVD at the VMI based on OCT-derived anatomic findings.

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PVD result of a complex and inevitable set of events that occurs as the eye ages. The completion of vitreopapillary separation, often signaled by the appearance of the Weiss ring, is the acute, often symptomatic end of a years-long process.

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Anomalous PVDIn cases where liquefaction or gel contraction outpaces detachment of the vitreous cortex, an abnormal adhesion of the vitreous cortex to the ILM is present, a range of anomalous macular conditions can ensue that vary according to the strength and position of the remaining

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OCT Based Definition and Classification of VMA

VMA is characterized by an elevation of the cortical vitreous above the retinal surface, with the vitreous remaining attached within a 3-mm radius of the fovea without retinal abnormalities.

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VMA may be subclassified by size of the adhesion into either: (

1)focal ( 1500 μ) or(2) broad (>1500 μ); It remains unclear whether there is any prognostic difference between focal and broad VMA

.

Eyes

with VMA also may have other associated macular

abnormalities termed

concurrent

, and the

term

isolated

where

no ocular disease is present

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OCT Based Definition and Classification of VMT

OCT based criteria: (1) evidence of perifoveal vitreous cortex detachment from the retinal surface; (2) macular attachment of the vitreous cortex within a 3-mm radius of the fovea; and (3) association of attachment with distortion of the foveal surface, intraretinal structural changes, elevation of the fovea above the RPE, or a combination

thereof.

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VMT can be subclassified into either focal or broad, depending on the width of vitreous attachment

. Broad areas of attachment  Generalized thickening of the macula,

vascular

leakage on fluorescein angiography, macular

schisis

, and

CME.

Focal

areas of vitreous attachment



D

istort

the

foveal

surface

elevate

the

foveal

floor

pseudocysts

within the central

macula

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ERM Formation Autopsy studies reveal that residual vitreous remains on the surface of the retina in nearly half of all eyes with PVD.

This condition is called vitreoschisis. This residual vitreous may proliferate to form an ERM at any stage of vitreous separation.

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OCT Based FTMH Classification System (Size of Hole, Presence or Absence of VMT, Cause)

Aperture size predict anatomic treatment Macular holes: small, medium, or large based on aperture size(≤250μ, >250 - ≤400, >400μ). Nearly half of FTMHs are large at

the time of diagnosis .

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Presence or Absence of VMT. Only macular holes with concurrent VMT should be considered for pharmacologic

vitreolysis. Primary Versus SecondaryPrimary FTMH (formerly referred to as idiopathic) results from vitreous traction on the fovea from anomalous PVD. A

secondary FTMH is caused directly by other pathologic features and does not have pre

-existing

or concurrent

VMT:

(

1) blunt

trauma

(2) lightning

strike

(3) high myopia

(

4) macular

schisis

(5)

Mactel

type

2

(6) wet

AMD treated

with

anti-VEGF therapy

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Impending Macular Hole IMH should be used to describe a case in which FTMH is observed in one eye and VMT is observed on OCT in the fellow

eye. The finding of VMA in a fellow eye has been referred to as a stage 0 macular hole.5/8/2016

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Lamellar Macular Hole OCT-based features of LMH include the following: (1) an irregular foveal contour; (2) a defect in the inner fovea (may not have actual loss of tissue); (3)

schisis, typically between the OPL and ONL ; and (4) maintenance of an intact photoreceptor layer. VPA

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LMH has been reported in eyes after cataract surgery and in association with concomitant ocular conditions including myopia, uveitis, exudative AMD, and RD. Surgery

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Macular Pseudohole OCT base characteristics : invaginated or heaped

foveal edges, (2) concomitant ERM with central opening, (3) steep macular contour to the central fovea with near-normal CFT, and (4) no loss of retinal tissue. Management of macular pseudohole typically is conservative.

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Two different subtypes of lamellar macular hole were identified:Tractional and degenerative.

1)Tractional was characterized by Schitic separation of neurosensory retina I

ntact

ellipsoid layer

A

ssociated

with

tractional

ERM and

/or

VMT.

2)Degenerative characterized by

P

resence

of

intraretinal

cavitation that could affect all retinal

layers

A

ssociated

with

nontractional

epiretinal

proliferation and a retinal “bump.”

O

ften

presented with early ellipsoidal zone defect and its pathogenesis, although chronic and progressive, remains poorly understood.

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This classification was developed :1)Clinicians to speak a common language when discussing diseases of the VMI.

2)It is purely anatomically based, without regard to symptoms 3)This was designed to be simple, easy to remember, clinically applicable, helpful in predicting therapeutic outcomes, and useful for the execution and analysis of clinical trials.

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