UNASSIGNED: We present a case of a patient with preceding vitreomacular traction (VMT) who developed a full-thickness macular hole (FTMH) following his sixth intravitreal aflibercept injection for the treatment of age-related macular degeneration and review the literature on risk factors and pathogenesis of this adverse event.
UNASSIGNED: FTMH can occur after an extended number of repeat intravitreal injections in the setting of worsening vitreomacular adhesion or VMT. This patient\'s FTMH was successfully treated surgically in a timely manner, and additional injections were resumed safely.
UNASSIGNED: Patients with an unexpected decrease in vision after intravitreal injections should be reevaluated with optical coherence tomography to rule out alternative pathology including vitreomacular interface abnormalities. FTMH, if present, should be treated promptly to allow for resumption of therapy as needed and visual optimization.

BACKGROUND: A lamellar macular hole (LMH) is characterized by a distinct morphologic configuration and can be distinguished from related entities such as macular pseudohole (MPH) and epiretinal membrane with foveoschisis (ERM-FS) by clear morphologic features.
OBJECTIVE: Based on current knowledge, the pathophysiologic function of LMH in the spectrum of vitreomacular interface diseases will be described and therapeutic concepts will be presented.
METHODS: Current studies are supplemented by case reports to provide a schematic overview of the natural history and therapeutic concepts at the vitreomacular interface.
RESULTS: The LMH is as a retrospective marker for pathologic posterior vitreous detachment in adult patients and may be interpreted as the pathophysiologic center of tractional maculopathies. Various vitreomacular pathologies can result in LMH: a detached vitreomacular traction, a spontaneously closed penetrating macular hole, or an epiretinal membrane with foveoschisis. Pathophysiologically, a degenerative, progressive loss of the architecture of the foveal muller cell cone may be the underlaying mechanism, resulting in the typical undermining of the hole edges and occasionally in a full thickness macular hole. The optimal timing and the appropriate surgical method are the focus of current clinical studies.
CONCLUSIONS: The pathophysiology of LMH indicates a smooth transition of tractive maculopathies. These should be prospectively evaluated in order to develop evidence-based treatment strategies for LMH.
UNASSIGNED: HINTERGRUND: Das Makulaschichtforamen (LMH) zeichnet sich durch eine differenzierte, morphologische Konfiguration aus und lässt sich anhand eindeutiger morphologischer Merkmale von nahestehenden Entitäten wie dem makulären Pseudoforamen (MPH) und der epiretinalen Membran mit Foveoschisis (ERM-FS) abgrenzen. ZIEL: Anhand des aktuellen Wissenstands soll die pathophysiologische Funktion des LMH im Spektrum vitreoretinaler Grenzflächenerkrankungen beschrieben und therapeutische Konzepte sollen vorgestellt werden.
METHODS: Die verfügbare Studienlage wird durch Fallberichte erweitert, um zu einer schematischen Übersicht der Spontanverläufe und Therapiekonzepte am vitreomakulären Übergang zu gelangen.
UNASSIGNED: Das Makulaschichtforamen kann beim erwachsenen Patienten als retrospektiver Marker für eine stattgehabte pathologische hintere Glaskörperabhebung interpretiert werden und steht im pathophysiologischen Zentrum der traktiven Makulopathien. Verschiedene vitreomakuläre Pathologien können in einem LMH resultieren: eine gelöste vitreomakuläre Traktion, ein spontan verschlossenes durchgreifendes Makulaforamen oder eine epiretinale Membran mit Foveoschisis. Pathophysiologisch ist von einem degenerativen, progressiven Verlust der Architektur des fovealen Müller-Zell-Konus auszugehen, der in der typischen Unterminierung der Lochränder und vereinzelt im Verlauf auch in einem durchgreifenden Makulaforamen münden kann. Der optimale Zeitpunkt sowie die adäquate Operationsmethode stehen im Fokus aktueller klinischer Studien.
UNASSIGNED: Die Pathophysiologie des LMHs deutet auf einen fließenden Übergang der traktiven Makulopathien hin, die standardisiert und prospektiv ausgewertet werden sollten, um evidenzbasierte Therapiestrategien beim LMH entwickeln zu können.

BACKGROUND: Laser skin resurfacing is a popular cosmetic procedure for noninvasive skin rejuvenation. Since health insurance plans often do not cover these types of procedures, patients often pay out of pocket. Consequently, there is an incentive to go abroad, where prices are more affordable. However, practitioners in destination countries may lack rigorous training on laser safety, regulatory oversight, or licensing, especially on devices used for \"cosmetic\" procedures. In certain cases, this can lead to tragic outcomes, especially when underqualified practitioners operate medical-grade laser devices.
METHODS: A 29-year-old woman suffered a retinal burn from a handheld Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser pulse device used to perform skin resurfacing treatment at a medical spa in Vietnam. The patient was not adequately informed about the potential risk to her vision and was not provided with any eye protection. A momentary, unintended laser exposure to the patient\'s right eye led to irreversible vision loss due to a macular burn. This incident caused immediate pain, followed by the sudden appearance of floaters, along with a retinal and vitreous hemorrhage. Despite treatment with off-label bevacizumab for the development of a choroidal neovascular membrane, vision remained at the level of counting fingers because of the presence of the macular scar.
CONCLUSIONS: When utilizing laser-based devices, it is crucial to employ safety measures, such as the wearing of safety goggles or the use of eye shields to protect ocular tissues from potential damage. The growing availability of cosmetic laser devices presents a substantial public health risk, because numerous operators lack adequate training in essential safety standards, or they neglect to follow them. Furthermore, patients seeking services abroad are subject to the regulatory practices of the destination country, which may not always enforce the requisite safety standards. Further research is needed to determine regional and global incidence of laser-related injuries to help direct educational and regulatory efforts.

OBJECTIVE: Vitreomacular traction (VMT) has unique presentations in eyes with diabetic retinopathy (DR). This study aimed to investigate the characteristics and clinical course of VMT in DR.
METHODS: A retrospective case series.
METHODS: Thirty eyes from 30 patients with DR and concurrent VMT were retrospectively enrolled. Baseline and final best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) characteristics were reported. Linear regression models were used to analyze the correlating factors for visual outcome.
RESULTS: Of the 30 eyes, a thickened posterior hyaloid membrane was noted in all cases and multi-layered traction from different directions in 14 eyes (46.7%). Twenty-one eyes (70%) had tractional macular retinoschisis, seven (23.3%) had foveal detachment, five (16.7%) had a lamellar macular hole, and three (10%) had a full-thickness macular hole, including two with macular hole retinal detachment. Three eyes had spontaneous release of the VMT within 3 months of observation. For the remaining 27 eyes receiving operations, the VMT, full-thickness macular hole, and serous foveal detachment all resolved postoperatively with residual macular schisis in 6 eyes (22.2%) only. None of the baseline OCT characteristics were associated with postoperative BCVA (P > .05).
CONCLUSIONS: VMT in DR had a thickened posterior hyaloid, and many of them had multi-layered traction and/or concurrent macular retinoschisis. Lamellar macular hole, full-thickness macular hole, or concurrent retinal detachment may also occur. Spontaneous resolution of VMT rarely occurred, and those who underwent operation for VMT had improved vision and macular structures with resolution of the macular hole and retinal detachment.

BACKGROUND: Intravitreal anti-vascular endothelial growth factor (VEGF) is the standard treatment for exudative age-related macular degeneration (AMD). The constitution of the vitreomacular interface varies greatly in cases of attached (with or without traction) or detached vitreous body, which can impact the effectiveness of the anti-VEGF treatment.
OBJECTIVE: Based on the current literature this article displays the current state of the science on whether the constitution of the vitreous body has an effect on the anti-VEGF treatment.
METHODS: The published data extracted from current trials and post hoc analyses concerning this topic are presented and put into the clinical context.
RESULTS: The presence of a vitreomacular adhesion reduces the efficacy of anti-VEGF treatment of exudative AMD. Posterior vitreous body detachment represents a positive prognostic factor concerning the efficacy of anti-VEGF treatment but not necessarily the prognosis for visual acuity.
CONCLUSIONS: Patients with attached vitreous body need a more intensive treatment monitoring compared to patients with detached vitreous body. Therefore, in eyes with initial posterior vitreous body detachment receiving a treat and extend regimen, the interval between anti-VEGF injections can be extended to 4 instead of 2 weeks without endangering the success of treatment.
UNASSIGNED: HINTERGRUND: Die Anti-VEGF(„vascular endothelial growth factor“)-Therapie ist die Standardtherapie zur Behandlung der exsudativen altersabhängigen Makuladegeneration (AMD). Bei anliegendem (mit oder ohne Traktion) oder abgehobenem Glaskörper besteht eine stark unterschiedliche Beschaffenheit des vitreomakulären Interface. Dies kann Auswirkungen auf die Effektivität der Anti-VEGF-Therapie haben.
UNASSIGNED: Es erfolgt die Darstellung des aktuellen Stands der Wissenschaft, ob und inwiefern die Beschaffenheit des Glaskörpers einen Einfluss auf die Anti-VEGF-Therapie hat.
METHODS: Die zu diesem Thema publizierten Daten aus klinischen Studien werden aufgeführt und in den klinischen Kontext gesetzt.
UNASSIGNED: Das Vorliegen einer vitreomakulären Adhäsion reduziert die Effektivität der Anti-VEGF-Therapie. Bezogen auf die Effektivität, aber nicht unbedingt auf die Visusprognose stellt die hintere Glaskörperabhebung einen prognostisch günstigen Faktor dar.
CONCLUSIONS: Patienten mit anliegendem Glaskörper benötigen ggf. eine intensivere Therapieüberwachung als Patienten mit einem abgehobenen Glaskörper. Deshalb kann bei Anwendung eines Treat-and-Extend-Schemas eine Intervallverlängerung bei Patienten mit initial abgehobenen Glaskörper ggf. schneller vorgenommen werden (4 anstatt 2 Wochen), ohne den Erfolg der Anti-VEGF-Therapie zu gefährden.

The vitreous body is an anatomically and biochemically complex structure. Because of its proximity and firm adherence to the retina, researchers have examined the link between these two structures and how their individual pathologies might be connected. Several experimental and clinical studies have already demonstrated the important role of vitreous in the pathogenesis of retinal disorders. This narrative review highlights the role of the vitreous in retinal diseases and the improvements that have been made since the introduction of optical coherence tomography. This leads to a better understanding of vitreoretinal diseases and demonstrates its determinant role in other retinal pathologies, such as diabetic retinopathy or age-related macular degeneration. As we deepen our knowledge of the vitreous\'s structure, function, and abnormal conditions, we can better link the changes in diseases and identify effective treatments.

BACKGROUND: The aim of this study was to examine if choroidal vascularity index (CVI) is different in eyes with unilateral vitreomacular traction (VMT) from their healthy fellow eyes; and whether different treatments affect the CVI.
METHODS: The baseline and 8-week post treatment CVIs of 56 unilateral VMT patients that underwent spontaneous resolution (n = 30), vitreoretinal surgery (n = 16) or pneumatic vitreolysis (n = 10) were compared with fellow eyes using paired samples t-test. Partial correlation analyses correcting age and gender was used for calculations between treatment groups. P values < 0.05 were considered statistically significant.
RESULTS: The mean baseline CVI for VMT and control eyes had no statistically significant difference (p = 0.81, r= -0.38). The post traction release follow-up CVI of VMT eyes and contralateral eyes had no significant difference (p = 0.12, r = 0.49). In spontaneous resolution group, vitreoretinal surgery group and pneumatic vitreolysis group the baseline and follow up CVIs of VMT eyes were statistically similar (p = 0.72, p = 0.32 and p = 0.79 respectively).Spontaneous detachment patients\' CVIs showed a 0.57±5.81% increase, vitreoretinal surgery group had a reduction of 1.098±4.76%, and the pneumatic vitreolysis patients showed a CVI reduction of 0.307±4.24%. However, none of these changes was found to be statistically significant when compared between the groups (p = 0.21, r = 0.02).
CONCLUSIONS: Previous studies have argued that vitreomacular traction might have a role on the choroidal changes seen in the vitreoretinal interface disorders. This study has shown that VMT alone does not cause any significant changes in choroidal vascular index pre or post traction release.

BACKGROUND: To measure the degree of curvature of the retinal artery trajectory (RAT) and retinal vein trajectory (RVT) in the eyes of patients with vitreomacular traction (VMT) and compare them with their healthy fellow eyes.
METHODS: This was a retrospective, cross-sectional, case-control study of 58 eyes of 29 patients with unilateral VMT. The participants were divided into two groups. Group 1 VMT was defined as having only morphological changes, while group 2 VMT was defined as morphological changes accompanied by the presence of a cyst or hole to quantify the severity of the disease. The RATs and RVTs were assessed from the color fundus photographs using the ImageJ program. The fundus photographs were rotated 90°. The course of the retinal arteries and veins were marked on a color fundus photograph and fitted to a second-degree polynomial curve (axe[x]/100+bx+c). The coefficient \'\'a\'\' was the width and steepness of the trajectories. The comparison between the RAT and RVT of VMT and healthy fellow eyes was investigated and the association between the RAT and RVT and the severity of disease were determined using the Image J program.
RESULTS: Eleven subjects were male, and 18 subjects were female. The mean ± SD age was 70.6 ± 7.6 years. Eighteen of the eyes had VMT in the right and 11 of the eyes had VMT in the left eye. Eleven eyes were in group 1 and 18 eyes were in group 2. Axial length (AL) was similar between the two groups (22.63 ± 1.20 mm vs 22.45 ± 1.45 mm p = 0.83) (Table 1). The mean RAT was 0.60 ± 0.18 in eyes with VMT and 0.51 ± 0.17in healthy eyes (p = 0.063). The mean RVT was 0.74 ± 0.24 in eyes with VMT and 0.62 ± 0.25 in healthy eyes for the whole group (p = 0.02). In group 1, the mean RVT of the eyes with VMT was statistically significantly higher than the healthy eyes (p = 0.014). There was not any statistically significant difference for the other parameters evaluated between eyes with VMT and healthy eyes according to the groups and the whole group. (Tables 2-4) CONCLUSION: Unlike other vitreoretinal interface diseases such as epiretinal membrane and macular hole, VMT may be characterized by a narrower RVT, which is characterized by a larger \"a\" value.

UNASSIGNED: A swept-source optical coherence tomography angiography (SS-OCTA) analysis of vasculature in vitreomacular traction (VMT) before and after surgery as well as 15 months\' \"watchful waiting\" follow-up data.
UNASSIGNED: A retrospective analysis of 38 eyes. Patients were divided into group 1: untreated (20 eyes); group 2: untreated, spontaneous release of traction (4 eyes); and group 3: vitrectomy (14 eyes).
UNASSIGNED: In all cases, SS-OCTA of the choriocapillaris revealed a hyporeflective area, which disappeared after traction release. In group 1, none of the analyzed factors significantly changed. In group 2, visual acuity (VA) improved from 0.3 logMAR to 0.1 logMAR. None of the following parameters significantly changed: central choroidal thickness, superficial fovea avascular zone (sFAZ), deep fovea avascular zone (dFAZ), and vessel densities. In 1 eye a lamellar macular hole formed. Factors increasing the chances of spontaneous release of traction were width of traction and central retinal thickness (P < .05). In group 3, VA improved from 0.27 Snellen (0.6 logMAR) to 0.44 Snellen (0.4 logMAR) (P < .05). Postoperative OCTA revealed significant decreases in central retinal thickness (P < .001), the parameters sFAZ, and dFAZ (P < .05).
UNASSIGNED: sFAZ and dFAZ decreased after vitrectomy but not after spontaneous release of traction. VA was better in eyes with spontaneous release of traction. The degree of improvement in VA was greater in the vitrectomy group. In all cases a hyporeflective area is visible in the choriocapillaris layer in SS-OCTA. It disappears when traction is released. Early treatment, at least in patients with lower VA, might be beneficial.

Fovea centralis, located at the center of the macula, is packed with cone photoreceptors and is responsible for central visual acuity. Isolated foveal photoreceptor disruption may occur in a variety of hereditary, degenerative, traumatic, and toxic chorioretinal diseases. These have been known previously by multiple synonyms including macular microhole, foveal spot, and outer foveal microdefects. A common clinical feature underlying these conditions is the presence of apparently normal fovea or subtle hypopigmented lesion at the foveal or juxtafoveal area. A detailed history along with high-resolution optical coherence tomography is often helpful to derive a conclusive diagnosis in majority of these cases. Focal photoreceptor disruption usually involves loss or rarefaction of ellipsoid/interdigitation zone, either in isolation or associated with external limiting membrane or retinal pigment epithelium disruption in the fovea. Vitreomacular interface (VMI) disorders including vitreomacular traction, posterior vitreous detachment, epiretinal membrane, and impending macular hole possibly remain the most common cause. Retinal dystrophies such as cone dystrophy, occult macular dystrophy, and achromatopsia may present with diminution of vision and normal appearing fundus in a younger age group. Other causes include photic retinopathy (e.g., from a history of sun gazing or laser pointer exposure), blunt trauma, drug exposure (e.g., poppers maculopathy or tamoxifen retinopathy), and acute retinal pigment epitheliopathy (ARPE). Visual prognosis depends on the underlying etiology with complete recovery common in the subset of patients with VMI, and ARPE, whereas persistent outer retinal defects are the rule in other conditions. We discuss the differential diagnoses that lead to isolated foveal photoreceptor defects. Identifying and understanding the underlying disease processes that cause foveal photoreceptor disruption may help predict visual prognosis.