Hassan Mortada (Cairo, Egypt); Jerzy Nawrocki (Lodz, Poland)

Introduction

The vitreo-retinal interface has 2 components, the posterior cortical vitreous (collagen type II) and the internal limiting membrane (collagen type IV). Several pathological entities may take place at the Vitreomacular interface including: idiopathic macular hole, lamellar macular hole, Epimacular membrane, Vitreomacular traction syndrome and myopic traction maculopathy (myopic foveoschisis, myopic macular hole without retinal detachment and myopic macular hole retinal detachment). Vitreoretinal interface changes may be encountered in association with diabetic retinopathy (diffuse diabetic macular edema and proliferative diabetic retinopathy). Recently, vitreoretinal interface changes have been incriminated in the pathogenesis of exudative age-related macular degeneration. In addition, certain vitreoretinal disorders may be encountered, that cannot be classified to any of the above, and may represent more than one disorder occurring together. Some of these disorders may be inter-related or represent different stages of the same disorder. Tremendous advances in definition; diagnosis and understanding these disorders have been made after the introduction and evolution of Optical Coherence Tomography (OCT). The pathogenesis of these disorders is still not fully understood and several hypotheses have been speculated: Partial posterior vitreous detachment with persistent vitreo-macular adhesion and traction, splitting of the posterior cortical vitreous (vitreoschisis) with persistent adhesion and traction induced by the outer layer and the internal limiting membrane may act as a scaffold for the proliferation of contractile cells. The rationale of surgical treatment is based on complete relieve of traction on the macular area. In most disorders, this can be achieved by identification, peeling and excision of the posterior cortical vitreous, epimacular membranes and internal limiting membrane. Different stains have been proposed to facilitate visualization and complete peeling of these rather transparent membranes.

Synopsis:

This course will highlight recent trends in diagnosis and management of various vitreo-macular interface disorders. In didactic format, a brief account on the anatomy and pathogenesis of these disorders will be presented. Recent literature on the pathogenesis and treatment of non-full thickness macular hole will be discussed. Controversial issues regarding the indications for surgery in certain disorders like lamellar macular hole and myopic foveoschisis and the extent of peeling will be presented. According to the pathogenesis of each disorder, the rationale for treatment will be discussed. Both instructors, to illustrate their preferred techniques for identification and peeling of the posterior hyaloid, epiretinal membrane and internal limiting membrane, will use many surgical videos and animations. The problem of failed macular hole surgery will be intensely addressed. The role of inverted ILM flap technique for prevention and treatment of persistent macular hole will be discussed.

Objectives:

At the end of the course, attendees will be able to:

  1. Make up their minds regarding the diagnosis and indications for surgical interference in various vitreo-macular interface disorders.
  2. Choose between different techniques for identification, visualization and peeling of posterior hyaloid, Epimacular membranes and ILM.
  3. Learn tips & tricks to enhance their surgical skills to peel the posterior hyaloid and ILM in various Vitreomacular disorders.
  4. Deal with failed macular hole surgery
  5. Choose between different techniques for management of myopic foveoschisis.