Vitreomacular Traction (VMT)

*Please note that this information is for illustrative purposes only, providing a general overview on the topics listed. For any specific questions or concerns regarding your condition, please contact our office so that you can consult with the appropriate person or department to address your needs.

Vitreomacular Traction (VMT)

Vitreomacular Traction (VMT) is a condition that is caused by the partial separation of the vitreous gel from the retina with persistent adhesion of the vitreous to the center of the retina (fovea).

Early in life the vitreous gel (analogous to the yolk of an egg) fills the entire inner cavity of the eye (like the yolk fills the eggshell). When you are young the vitreous gel is firmly adherent to the entire surface of the retina (the retina is analogous to the thin membrane on the inside of an eggshell). As you age the vitreous gel changes in composition from thick Jello-like gel to a more thin fluid-like gel. This change eventually leads to spontaneous separation of the vitreous gel from the retina.

In some patients the vitreous gel will begin to separate from the retina but remain attached at the fovea (the center of the macula where your fine vision comes from). As the vitreous gel continues to separate the focal area of adhesion at the fovea will pull and tent up the retina at the fovea. This pulling, known as viteomacular traction (VMT), causes symptoms like blurred or decreased central vision, distortion of straight lines, and sometimes objects will appear larger in the affected eye.

The treatments for VMT include medical (Jetrea) and surgical options (Vitrectomy surgery) both of which induce a physical separation of the vitreous gel from its underlying retinal adhesions.

Medical Treatment

Jetrea (a.k.a. Ocriplasmin 2.5mg/ml) is a proteolytic enzyme indicated for the treatment of VMT (see Ocriplasmin (generic name for Jetrea) is a recombinant protease with activity against laminin and fibronectin (components of the vitreoretinal interface). It works by dissolving the proteins that link the vitreous to the macula and fovea (center of the retina) resulting in the posterior detachment of the vitreous gel from the retina.

Jetrea appears to be affective in in treating symptomatic VMT patients with a focal vitreoretinal adhesion of 500 microns or less.  In this group of patients, we have seen Jetrea effective at inducing a complete vitreoretinal separation in approximately 40-43% of patients.  For patients that do not respond to Jetrea, we recommend vitrectomy surgery to physically separate the vitreous from its macular adhesions.

Side effects of Jetrea therapy include (but are not limited to) transient reductions in vision in 7.7% of patients that can take 2 to 26 weeks to improve.  Jetrea was FDA approved for use in the US on October 17, 2012.

The Retina Center of New Jersey, LLC participated in the Phase 4 Clinical Trials using Jetrea for symptomatic VMT (see link to research department).

Other compounds currently in development for the treatment of VMT and pharmacologic vitreolysis include bacterial collagenase, hyaluronidase, dispase, and TPA.  A compound named ALG-1001 may become a potential future competitor for Jetrea. ALG-1001 is and anti-integrin oligopeptide that inhibits cell adhesion. This compound binds to multiple integrin-receptor sites on cells, preventing adhesion and promoting development of a PVD. Animal studies have shown up to a 60% effectiveness in inducing a PVD in rabbit models.  This drug may also be used as an adjunctive agent to anti-VEGF therapy in the treatment of wet AMD, diabetes and vein occlusions.

Surgical Treatment

Vitrectomy surgery with physical separation of the vitreomacular adehesions is the gold standard for treatment of VMT. The procedure is performed under local anesthesia, in either one of our outpatient surgical centers or local hospitals (see link to our surgical centers and hospitals).

The surgery is performed through three 25-gauge ports (about the width of a wire paper clip). The surgery is performed by placing an infusion canula, a light pipe & a vitrectomy cutter through each of the 3 ports. The infusion cannula keeps a constant pressure in the eye while the vitrectomy cutter removes the vitreous gel. As the gel is removed, balance salt solution replaces the gel in the vitreous cavity. The gel that is adherent to the retina is gently lifted off the optic nerve and macula to separate the vitreomacular adhesions and relieve the VMT. The light pipe is used by the surgeon to see the vitreous being removed inside the eye.  After enough vitreous is removed the surgeon removes the surgical instruments and trocars (3 ports) and the operation is complete. No sutures are typically needed in up to 95% of cases. Antibiotic ointment and a patch are placed over the eye for one night and removed the following day by the technician in our office.

Vision is usually blurry the first day after surgery but typically improves to your pre-operative vision or better about one week after surgery. Continued visual improvement often occurs over the first 6-8 weeks but some patients experience improvement even up to 6 months after surgery.

Patients typically experience little to no pain following surgery. Surface or external irritation (feeling of having something in your eye) is common. A deeper or more intense eye pain is not typical and may signal a more serious issue such as high intraocular pressure, serous or hemorrhagic choroidals or infection. A deeper or more intense eye pain needs to be reported to your physician immediately.

​Post-Operative Restrictions

 Post-Operative restrictions are for 4 weeks after surgery and include:

  • Bending at the waist putting your head below your waist (such as bending to tie your shoes). Bending at the knees with your head up is allowed.
  • Heavy lifting greater than 15-20 lbs.
  • Strenuous activity (including lifting weights, running, yoga, pilates, aerobics, yard work, snow shoveling, laundry, housecleaning, sexual intercourse) is not recommended as it will increase your risk of developing a retina tear or detachment.  Walking, for exercise, after surgery is allowed (in patients who do not require post-operative head down position).
  • Showering is allowed immediately after surgery but be sure to keep your eyes closed to prevent shower water from entering your eye.
  • Swimming after surgery should be avoided for 4 weeks. You should not go under water for the first 4 weeks after surgery.
  • Working restrictions are job dependent.  Patients with desk jobs or who perform light stationary office work may sometimes resume work 2-3 days after surgery.  Patients with jobs that require heavy lifting or strenuous activity may be required to be out of work for 2-4 weeks.  Ask your physician about your individual work restrictions.  We will be happy to provide you with a doctor’s note for your work and/or complete your temporary disability paperwork.

Risks & Benefits of Surgery

The benefit of vitrectomy surgery is the potential for improved vision, reduced distortion of straight lines (when present pre-operatively), and reduction or elimination of floaters.

The risks of vitrectomy surgery include but are not limited to:

  • More rapid cataract progression (in up to 20% of patients the lens may harden or become cloudy more rapidly after the vitreous gel is removed) that may require cataract surgery 1-2 years after the vitrectomy procedure.
  • Vitreous (less than 5%) or choroidal (less than 1%) hemorrhage
  • Retinal break or tear (less than 5%) or Retinal Detachment (less than 1%)
  • Infection/Endophthalmitis (less than 1 in 500 patients)
  • Permanent loss of vision/Blindness (approx. 1 in 10,000)

*Please note that this information is for illustrative purposes only, providing a general overview on the topics listed. For any specific questions or concerns regarding your condition, please contact our office so that you can consult with the appropriate person or department to address your needs.