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Keywords:

  • macular hole;
  • macular pucker;
  • posterior vitreous cortex;
  • posterior vitreous detachment;
  • vitrectomy;
  • vitreoretinal interface

Abstract.

Purpose:  To find the most reliable and efficient noninvasive technique to clinically detect a posterior vitreous detachment.

Methods:  In a prospective study of 30 eyes in 30 patients with macular pucker or macular hole formation, the posterior vitreous cortex was examined 1 day prior to a scheduled vitrectomy. Three independent investigators classified the posterior vitreous cortex of each eye as ‘attached’ or ‘detached’ via slit-lamp biomicroscopy (BM), 10-MHz B-scan ultrasonography (I³ Innovative Imaging Inc.), and optical coherence tomography [OCT III Stratus® (Carl Zeiss Meditec Inc.) and RTVue-100 OCT (Optovue Corp.)]. These preoperative findings were then compared during a triamcinolone acetonide-assisted vitrectomy 1 day later.

Results:  Triamcinolone acetonide-assisted vitrectomy showed in 60% a posterior vitreous detachment and in 40% an attached posterior vitreous cortex. Preoperatively conducted B-scan ultrasonography and BM revealed the highest, correct evaluation of the posterior vitreous status. The prediction of the OCT was confirmed intraoperatively in 12.5%. In all other cases, the evaluation by OCT was not possible or was inadequate.

Conclusion:  The prognostic most reliable but investigator-dependent methods to clinically detect whether the posterior vitreous cortex is detached are B-scan ultrasonography and BM. The objective technique of the high-resolution, two-dimensional time-domain OCT allows only in a few cases a clear differentiation of preretinal structures.