VITREOMACULAR OBSERVATIONS .1. VITREOMACULAR ADHESION AND HOLE IN THEPREMACULAR HYALOID

Purpose: Variations in vitreomacular adhesions and the significance of a hole in the premacular hyaloid membrane were studied clinically to better understand vitreomacular pathology. Methods: With an El-Bayadi- Kajiura aspheric preset lens, the authors used a vitreous examination technique on 96 eyes, which were divided into three groups. Findings w ere recorded photographically. Results: Group 1 (25 eyes, 26%) include d eyes with a partial posterior vitreous detachment and a residual vit reomacular attachment, but no hole in the premacular hyaloid. All eyes in this group, except one, showed another complication. Diabetic reti nopathy and retinal vein occlusion were the most frequent problems not ed. Premacular fibrosis, often present in these eyes, may have been pr ecipitated by a vascular complication in the retina. In groups 2 and 3 (71 eyes, 74%), a hole was seen in the premacular hyaloid. Group 2 (4 6 eyes, 48%) comprised eyes showing a partial posterior vitreous detac hment with a strand of vitreous that extruded through the hole in the posterior hyaloid and adhered to the macula. In group 3 (25 eyes, 26%) , the hole in the premacular hyaloid was accompanied by a total poster ior vitreous detachment. The most common complication noted in eyes in groups 2 and 3 was premacular fibrosis (34 of 71 eyes, 47.9%). The pe rsistence of a residual vitreous attachment to the macula was accompan ied by a significantly greater frequency of visual acuity equal to or worse than 20/ 200. Conclusions: Variations in vitreomacular pathology seem to result from differences in the strength of the vitreomacular adhesion and in the process of vitreous liquefaction and shrinkage. In patients with a hole in the premacular hyaloid membrane, the vitreoma cular attachment is stronger than the vitreous attachment to other par ts of the retina. The latter feature may cause visual acuity deteriora tion. When there is a hole in the premacular hyaloid membrane, the pre sence or absence of a vitreomacular adhesion may affect the prognosis for macular function.