Elsevier

Ophthalmology

Volume 120, Issue 12, December 2013, Pages 2611-2619
Ophthalmology

Original article
The International Vitreomacular Traction Study Group Classification of Vitreomacular Adhesion, Traction, and Macular Hole

https://doi.org/10.1016/j.ophtha.2013.07.042Get rights and content

Objective

The International Vitreomacular Traction Study (IVTS) Group was convened to develop an optical coherence tomography (OCT)-based anatomic classification system for diseases of the vitreomacular interface (VMI).

Design

The IVTS applied their clinical experience, after reviewing the relevant literature, to support the development of a strictly anatomic OCT-based classification system.

Participants

A panel of vitreoretinal disease experts was the foundation of the International Classification System.

Methods

Before the meeting, panel participants were asked to review 11 articles and to complete 3 questionnaires. The articles were preselected based on searches for comprehensive reviews covering diseases of the VMI. Responses to questionnaires and the group's opinions on definitions specified in the literature were used to guide the discussion.

Main Outcome Measures

Optical coherence tomography-based anatomic definitions and classification of vitreomacular adhesion, vitreomacular traction (VMT), and macular hole.

Results

Vitreomacular adhesion is defined as perifoveal vitreous separation with remaining vitreomacular attachment and unperturbed foveal morphologic features. It is an OCT finding that is almost always the result of normal vitreous aging, which may lead to pathologic conditions. Vitreomacular traction is characterized by anomalous posterior vitreous detachment accompanied by anatomic distortion of the fovea, which may include pseudocysts, macular schisis, cystoid macular edema, and subretinal fluid. Vitreomacular traction can be subclassified by the diameter of vitreous attachment to the macular surface as measured by OCT, with attachment of 1500 μm or less defined as focal and attachment of more than 1500 μm as broad. When associated with other macular disease, VMT is classified as concurrent. Full-thickness macular hole (FTMH) is defined as a foveal lesion with interruption of all retinal layers from the internal limiting membrane to the retinal pigment epithelium. Full-thickness macular hole is primary if caused by vitreous traction or secondary if directly the result of pathologic characteristics other than VMT. Full-thickness macular hole is subclassified by size of the hole as determined by OCT and the presence or absence of VMT.

Conclusions

This classification system will support systematic diagnosis and management by creating a clinically applicable system that is predictive of therapeutic outcomes and is useful for the execution and analysis of clinical studies.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Methods

A panel of vitreoretinal disease experts, the International Vitreomacular Traction Study (IVTS) Group, was convened to develop a consensus system for the classification of diseases of the VMI. The classification system presented herein is meant to facilitate systematic evidence-based identification, monitoring, and management of VMI diseases. The panel met with the goal of creating a system that is simple, easy to remember, evidence based, clinically applicable, predictive of surgical outcomes,

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    Financial Disclosure(s): The author(s) have made the following disclosure(s):

    Jay S. Duker: Consultant—ThromboGenics; Financial support—Carl Zeiss Meditec, Optovue

    Peter K. Kaiser: Consultant—Alcon, Bausch & Lomb, Novartis

    Susanne Binder: Financial support—Carl Zeiss Meditec

    Marc D. de Smet: Consultant—Allergan, Bayer, Janssen, Preceyes, Sanofi, ThromboGenics; Financial support—Janssen, Preceyes; Lecturer—Alcon, Allergan; Patents—ThromboGenics

    Alain Gaudric: Financial support—Alcon, Allergan, Bayer, Heidelberg Engineering, Novartis, ThromboGenics

    Elias Reichel: Consultant—ThromboGenics

    SriniVas R. Sadda: Consultant—Allergan, Genentech, Heidelberg Engineering, Regeneron; Financial support—Carl Zeiss Meditec, Optos, Optovue; Lecturer—Carl Zeiss Meditec; Patents—Topcon

    Jerry Sebag: Consultant, Equity owner—ThromboGenics

    Richard F. Spaide: Consultant—Bausch & Lomb, ThromboGenics, Topcon; Patents—Topcon

    Peter Stalmans: Financial support—Bausch & Lomb; Lecturer—Alcon, DORC International, Dutch Ophthalmic, Fluoron

    Meridius Health Communications, Inc, provided technical support for preparation of the manuscript. The panel meeting was funded by Meridius Health Communications through an unrestricted educational grant from ThromboGenics, Inc. The authors had complete editorial control over manuscript content.

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