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