Abstract

Volume.126 Number.11

A Review

Vitreous Imaging Using Ultra-widefield Optical Coherence Tomography and Elucidation of the Pathophysiology of Myopic Traction Maculopathy
Hiroyuki Takahashi
Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences

Vitreous liquefaction occurs during the early stage of high myopia. Although abnormal adhesion between the vitreous and retina is considered to cause retinal tear and detachment, visualizing the vitreous using high resolution imaging is difficult because of its high transparency and mobility. In joint research with an enterprise, we developed a prototype of ultra-widefield optical coherence tomography (OCT) by attaching the high refractive index lens to a swept-source OCT and by widening the scan area to 23×20 mm2 and scan depth to 5 mm. Using the ultra-widefield OCT, we scanned the eyes of 500 patients aged ≥ 50 years with high or non-high myopia as well as observed the images of 167 eyes showing the vitreous. The results revealed that the posterior vitreous detachment (PVD) occurred in the early stages of high myopia, developed asymmetrically, and was affected by the distortion of the scleral protrusion because of posterior staphyloma or other causes. Furthermore, the following two types of PVD were observed: multiple PVD (wherein the vitreous adhered to retinal vessels at multiple points) and multi-layered PVD (wherein the posterior vitreous detached and separated into multiple layers).
Moreover, we scanned the eyes of 97 children and young adults aged 6-30 years. We found that PVD was observed only in the eyes with high myopia, and its incidence increased with age. In addition, retinal tissues were detached by adherent vitreous, and a thickened vitreous cortex could be observed as a lesion in the ultra-widefield OCT images.
During vitreous surgery for myopic traction maculopathy (MTM), the membranous vitreous cortex is frequently observed on the surface of the retina. However, the effect of vitreous adhesion on the onset of MTM has been unclear. We performed a comparative analysis between eyes with and without myopic macular schisis (MMS) as well as a multiple regression analysis (using the age, axial length, posterior staphyloma, and vitreous adhesion to the retinal vessels as covariates) in 150 highly myopic eyes. The analyses revealed that the vitreous adhesion to the retinal vessels is a significant risk factor for MMS. Hence, observing the traction of the vitreous to the retinal blood vessels using ultra-widefield OCT is useful for the diagnosis and treatment of MTM.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 126: 958-967,2022.

Key words
Myopic traction maculopathy (MTM), Myopic macular schisis, Posterior vitreous detachment (PVD), Vitreoretinal adhesion, Pathologic myopia, Posterior staphyloma, Optical coherence tomography (OCT)
Reprint requests to
Hiroyuki Takahashi, M. D., Ph. D. Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences. 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan