On correct clinical and pathogenetic OCT-based classification of vitreomacular interface pathologies
Currently, there is no universally accepted classification of vitreomacular interface (VMI) pathology, which complicates professional communication and the choice of treatment strategies. This article presents our perspective on a feasible and prognostically significant clinical and pathogenetic OCT...
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| Vydané v: | Vestnik oftal'mologii Ročník 141; číslo 2; s. 16 |
|---|---|
| Hlavní autori: | , , |
| Médium: | Journal Article |
| Jazyk: | English Russian |
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Russia (Federation)
2025
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| ISSN: | 0042-465X |
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| Abstract | Currently, there is no universally accepted classification of vitreomacular interface (VMI) pathology, which complicates professional communication and the choice of treatment strategies.
This article presents our perspective on a feasible and prognostically significant clinical and pathogenetic OCT-based classification of surgical VMI pathologies.
In order to develop a classification approach to categorize the most common changes in VMI based on pathogenesis we summarized published literature and our own observations.
Based on pathogenesis, classification begins with vitreomacular adhesion. The formation of an epiretinal membrane (ERM) can result from the development of posterior vitreous detachment (PVD) along the path of vitreoschisis. The severity of retinal changes and the presence of ectopic internal foveal layers distinguish four stages of ERM. ERM can exhibit various contraction patterns. If proliferative tissue contracts with centripetal tension on the retina, it may result in ERM with a macular pseudohole. Centrifugal contraction may may lead to the formation of intraretinal cystic spaces, resulting in ERM with foveoschisis. If PVD occurs in the presence of strong local vitreomacular fixation, vitreomacular traction (VMT) may develop, which is also classified into four stages. VMT can resolve either asymptomatically or with the formation of a retinal tissue defect, leading to the development of a full-thickness macular hole (FTMH). In cases where tractional forces during PVD create a retinal defect without causing an FTMH, secondary processes may be initiated, leading to an OCT pattern of lamellar macular hole, which in rare instances may progress to FTMH.
The proposed classification scheme encompasses the full spectrum of primary surgical VMI pathologies, is based on modern pathogenetic concepts, and relies on clear OCT-defined criteria for each nosological entity. The scheme relies on specific morphological criteria and delineates the stages of pathological processes, facilitating research standardization and streamlining treatment decision-making. |
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| AbstractList | Currently, there is no universally accepted classification of vitreomacular interface (VMI) pathology, which complicates professional communication and the choice of treatment strategies.
This article presents our perspective on a feasible and prognostically significant clinical and pathogenetic OCT-based classification of surgical VMI pathologies.
In order to develop a classification approach to categorize the most common changes in VMI based on pathogenesis we summarized published literature and our own observations.
Based on pathogenesis, classification begins with vitreomacular adhesion. The formation of an epiretinal membrane (ERM) can result from the development of posterior vitreous detachment (PVD) along the path of vitreoschisis. The severity of retinal changes and the presence of ectopic internal foveal layers distinguish four stages of ERM. ERM can exhibit various contraction patterns. If proliferative tissue contracts with centripetal tension on the retina, it may result in ERM with a macular pseudohole. Centrifugal contraction may may lead to the formation of intraretinal cystic spaces, resulting in ERM with foveoschisis. If PVD occurs in the presence of strong local vitreomacular fixation, vitreomacular traction (VMT) may develop, which is also classified into four stages. VMT can resolve either asymptomatically or with the formation of a retinal tissue defect, leading to the development of a full-thickness macular hole (FTMH). In cases where tractional forces during PVD create a retinal defect without causing an FTMH, secondary processes may be initiated, leading to an OCT pattern of lamellar macular hole, which in rare instances may progress to FTMH.
The proposed classification scheme encompasses the full spectrum of primary surgical VMI pathologies, is based on modern pathogenetic concepts, and relies on clear OCT-defined criteria for each nosological entity. The scheme relies on specific morphological criteria and delineates the stages of pathological processes, facilitating research standardization and streamlining treatment decision-making. Currently, there is no universally accepted classification of vitreomacular interface (VMI) pathology, which complicates professional communication and the choice of treatment strategies.Currently, there is no universally accepted classification of vitreomacular interface (VMI) pathology, which complicates professional communication and the choice of treatment strategies.This article presents our perspective on a feasible and prognostically significant clinical and pathogenetic OCT-based classification of surgical VMI pathologies.PURPOSEThis article presents our perspective on a feasible and prognostically significant clinical and pathogenetic OCT-based classification of surgical VMI pathologies.In order to develop a classification approach to categorize the most common changes in VMI based on pathogenesis we summarized published literature and our own observations.MATERIAL AND METHODSIn order to develop a classification approach to categorize the most common changes in VMI based on pathogenesis we summarized published literature and our own observations.Based on pathogenesis, classification begins with vitreomacular adhesion. The formation of an epiretinal membrane (ERM) can result from the development of posterior vitreous detachment (PVD) along the path of vitreoschisis. The severity of retinal changes and the presence of ectopic internal foveal layers distinguish four stages of ERM. ERM can exhibit various contraction patterns. If proliferative tissue contracts with centripetal tension on the retina, it may result in ERM with a macular pseudohole. Centrifugal contraction may may lead to the formation of intraretinal cystic spaces, resulting in ERM with foveoschisis. If PVD occurs in the presence of strong local vitreomacular fixation, vitreomacular traction (VMT) may develop, which is also classified into four stages. VMT can resolve either asymptomatically or with the formation of a retinal tissue defect, leading to the development of a full-thickness macular hole (FTMH). In cases where tractional forces during PVD create a retinal defect without causing an FTMH, secondary processes may be initiated, leading to an OCT pattern of lamellar macular hole, which in rare instances may progress to FTMH.RESULTSBased on pathogenesis, classification begins with vitreomacular adhesion. The formation of an epiretinal membrane (ERM) can result from the development of posterior vitreous detachment (PVD) along the path of vitreoschisis. The severity of retinal changes and the presence of ectopic internal foveal layers distinguish four stages of ERM. ERM can exhibit various contraction patterns. If proliferative tissue contracts with centripetal tension on the retina, it may result in ERM with a macular pseudohole. Centrifugal contraction may may lead to the formation of intraretinal cystic spaces, resulting in ERM with foveoschisis. If PVD occurs in the presence of strong local vitreomacular fixation, vitreomacular traction (VMT) may develop, which is also classified into four stages. VMT can resolve either asymptomatically or with the formation of a retinal tissue defect, leading to the development of a full-thickness macular hole (FTMH). In cases where tractional forces during PVD create a retinal defect without causing an FTMH, secondary processes may be initiated, leading to an OCT pattern of lamellar macular hole, which in rare instances may progress to FTMH.The proposed classification scheme encompasses the full spectrum of primary surgical VMI pathologies, is based on modern pathogenetic concepts, and relies on clear OCT-defined criteria for each nosological entity. The scheme relies on specific morphological criteria and delineates the stages of pathological processes, facilitating research standardization and streamlining treatment decision-making.CONCLUSIONThe proposed classification scheme encompasses the full spectrum of primary surgical VMI pathologies, is based on modern pathogenetic concepts, and relies on clear OCT-defined criteria for each nosological entity. The scheme relies on specific morphological criteria and delineates the stages of pathological processes, facilitating research standardization and streamlining treatment decision-making. |
| Author | Miroshnikov, V V Kovalev, S A Ivanishko, Yu A |
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| SubjectTerms | Epiretinal Membrane - classification Epiretinal Membrane - diagnosis Epiretinal Membrane - etiology Humans Macula Lutea - diagnostic imaging Macula Lutea - pathology Retinal Diseases - classification Retinal Diseases - diagnosis Tomography, Optical Coherence - methods Vitreous Body - diagnostic imaging Vitreous Body - pathology Vitreous Detachment - classification Vitreous Detachment - diagnosis |
| Title | On correct clinical and pathogenetic OCT-based classification of vitreomacular interface pathologies |
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