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Abstract
To summarize emerging concepts regarding the onset and progression, traction effects,
and complications of the early stages of age-related posterior vitreous detachment
(PVD).
Interpretive essay.
Review and synthesis of selected literature, with clinical illustrations, interpretation,
and perspective.
Imaging of the vitreoretinal interface with optical coherence tomography has shown
that PVD begins in the perifoveal macula. Recent longitudinal studies have demonstrated
conclusively that early PVD stages persist chronically and progress slowly over months
to years. Vitreous traction forces resulting from perifoveal PVD with a small vitreofoveolar
adhesion (500 microm or less) may cause localized cystoid foveal thickening or one
of several macular hole conditions. Traction associated with larger adhesion zones
may cause or exacerbate a separate group of macular disorders. Ultrastructural studies
suggest that epiretinal membrane develops from cortical vitreous remnants left on
the retinal surface after PVD and plays an important role in traction vitreomaculopathies.
Age-related PVD is an insidious, chronic event that begins in the perifoveal macula
and evolves over a prolonged period before vitreopapillary separation. Although asymptomatic
in most individuals, its early stages may be complicated by a variety of macular and
optic disc pathologic features, determined in part by the size and strength of the
residual vitreoretinal adhesion.
(c) 2010 Elsevier Inc. All rights reserved.