Mr Venki Sundaram
Consultant Ophthalmic Surgeon
MD FRCOphth MRCOphth BMBCh BSc

Vitreous traction disorders

The vitreous in the clear jelly-like material which forms the majority of the contents in the eye. After the eye develops, the vitreous does not play any particular role, and can instead cause certain conditions which affect the retina. These include Vitreomacular Traction and Small Macular Holes.

Vitreous traction disorders

Vitreomacular Traction (VMT)

VMT is a condition where there is an abnormal connection between the vitreous jelly, and the central retinal region known as the macular. This can result in "traction" being placed of the retinal tissue causing misalignment of the photoreceptors (see Image 1), leading to reduced vision and distortion of images.

Treatment

  • In some cases, the abnormal vitreous traction can resolve by itself and not further action is needed.
  • In patients who continue to be affected with blurred vision or distortion, a therapy known as Jetrea, can be given into the eye in specific patients, which can release the vitreous attachment and help relieve symptoms.

VMT

Image 1 – an example of VMT, where the vitreous jelly is pulling on the central retina, causing it to be disrupted

Small Macular Holes

These are small holes (less than 400 microns) that can occur in the central retina (Image 2), resulting in reduced and distorted vision. They are thought to develop as a result of abnormal tractional forces around the macula.

Treatment

  • In some cases, these small holes can resolve on their own and no further action is needed.
  • In a proportion of cases, the holes can progress in size, at which stage a surgical procedure is usually advised to improve symptoms.
  • In cases where small macular holes persist, Jetrea injection therapy can be effective in relieving the traction on the macula, and help to close the hole.

Macular hole

Image 2 – an example of a small macular hole in a patient with reduced vision