Mechanistic Insights into the Pathogenesis of Proliferative and Nonproliferative Vitreomacular Traction
Mechanistic Insights into the Pathogenesis of Proliferative and Nonproliferative Vitreomacular Traction
复制标题
增殖性和非增殖性玻璃体黄斑牵引发病机制的机制见解
DOI：
10.1016/j.ajo.2021.11.026
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发表时间：
2022
影响因子：
4.2
通讯作者：
MORI KEISUKE
中科院分区：
文献类型：
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作者：
ITO YOKO;TAKATSUDO YUKI;GEHLBACH PETER L.;MORI KEISUKE
通过使用新的光学相干断层扫描（OCT）方法、广角蒙太奇和伪运动OCT成像系统，描述玻璃体黄斑牵引（VMT）中的玻璃体视网膜界面。获得基线眼底扫描。这些之后是扫描获得的眼睛跟踪系统进行垂直和水平眼球运动后立即进行。三个扫描，然后叠加比较后玻璃体的轮廓和位置的变化。VMT的受试者被归类为VMT与（“增殖”，48.0%）和没有（“非增殖”，52.0%）增厚后玻璃体。非增殖性VMT眼和增殖性VMT眼的视网膜前膜发生率分别为26.9%和95.8%（P= 3.6 × 10-7）。增殖性VMT眼无一例玻璃体后壁呈波浪形，非增殖性VMT眼有57.7%的玻璃体后壁呈波浪形（P= 4.0 × 10-6）。无增殖性VMT眼，而91.7%的非增殖性VMT眼，在眼球运动后出现运动诱导的玻璃体后壁改变（P= 2.0 × 10-8）。34.6%的非增殖性VMT眼和8.3%的增殖性VMT眼的玻璃体后脱离超出扫描区域（P= 0.040）。结论通过动态评价VMT患者的玻璃体视网膜界面，增殖性VMT与黄斑增厚的后玻璃体的静态收缩力有关。这种收缩力在大多数非绷紧和移动的玻璃体的VMT眼（非增殖性VMT）中并不强烈。VMT及其相关并发症由至少2种不同的病理生理机制决定。
PURPOSETo describe the vitreoretinal interface in vitreomacular traction (VMT) by using novel optical coherence tomography (OCT) methods; wide-angle montage, and pseudomotion OCT imaging systems.DESIGNObservational case series.METHODSWide-angle montage OCT images of horizontal and vertical scans through the fovea were acquired in 50 eyes of 46 consecutive patients with VMT. Baseline fundus scans were obtained. These were followed by scans acquired with an eye-tracking system performed immediately after vertical and horizontal eye movements. Three scans were then superimposed to compare changes in the contour and position of the posterior vitreous.RESULTSThe subjects were classified as VMT with (“proliferative”; 48.0%) and without (“nonproliferative”; 52.0%) thickened posterior vitreous. Epiretinal membrane was observed in 26.9% of nonproliferative and 95.8% of proliferative VMT eyes (P= 3.6 × 10–7). No eye of proliferative and 57.7% of nonproliferative VMT eyes had wavy contoured posterior vitreous (P= 4.0 × 10–6). None with proliferative VMT, but 91.7% of nonproliferative VMT eyes, showed motion induced changes of posterior vitreous following eye movement (P= 2.0 × 10–8). The posterior vitreous detachment extended beyond the scanned area in 34.6% of nonproliferative and 8.3% of proliferative VMT eyes (P= .040).CONCLUSIONSBy dynamically evaluating the vitreoretinal interface of patients with VMT, the static contraction forces of a thickened posterior vitreous at the macula are implicated in proliferative VMT. This contractile force is not strongly implicated in the majority of VMT eyes with nontaut and more mobile vitreous (nonproliferative VMT). VMT and its associated complications are determined by at least 2 different pathophysiological mechanisms.