title: VITRECTOMY FOR INTERMEDIATE AGE-RELATED MACULAR DEGENERATION ASSOCIATED WITH TANGENTIAL VITREOMACULAR TRACTION: A CLINICOPATHOLOGIC CORRELATION.
abstract: OBJECTIVE
  To describe the morphologic characteristics of the vitreomacular interface in intermediate age-related macular degeneration associated with tangential traction due to premacular membrane formation and to correlate with optical coherence tomography (OCT) findings and clinical data.
  
  
  METHODS
  Premacular membrane specimens were removed sequentially with the internal limiting membrane from 27 eyes of 26 patients with intermediate age-related macular degeneration during standard vitrectomy. Specimens were processed for immunocytochemical staining of epiretinal cells and extracellular matrix components. Ultrastructural analysis was performed using transmission electron microscopy. Spectral domain optical coherence tomography images and patient charts were evaluated in retrospect.
  
  
  RESULTS
  Immunocytochemistry revealed hyalocytes and myofibroblasts as predominant cell types. Ultrastructural analysis demonstrated evidence of vitreoschisis in all eyes. Myofibroblasts with contractile properties were observed to span between folds of the internal limiting membrane and vitreous cortex collagen. Retinal pigment epithelial cells or inflammatory cells were not detected. Mean visual acuity (Snellen) showed significant improvement from 20/72 ± 20/36 to 20/41 ± 20/32 (P < 0.001) after a mean follow-up period of 19 months (median, 17 months). During this period, none of the eyes required anti-vascular endothelial growth factor therapy.
  
  
  CONCLUSIONS
  Fibrocellular premacular proliferation in intermediate age-related macular degeneration predominantly consists of vitreous collagen, hyalocytes, and myofibroblasts with contractile properties. Vitreoschisis and vitreous-derived cells appear to play an important role in traction formation of this subgroup of eyes. In patients with intermediate age-related macular degeneration and contractile premacular membrane, release of traction by vitrectomy with internal limiting membrane peeling results in significantly functional and anatomical improvement.
authors.affiliation: Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Jean
authors.initials: J
authors.lastname: Ziada
authors.forename: Felix
authors.initials: F
authors.lastname: Hagenau
authors.forename: Denise
authors.initials: D
authors.lastname: Compera
authors.forename: Armin
authors.initials: A
authors.lastname: Wolf
authors.forename: Renate
authors.initials: R
authors.lastname: Scheler
authors.forename: Markus M
authors.initials: MM
authors.lastname: Schaumberger
authors.forename: Siegfried G
authors.initials: SG
authors.lastname: Priglinger
authors.forename: Ricarda G
authors.initials: RG
authors.lastname: Schumann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000473:pathology* / Q000601:surgery / Q000648:ultrastructure; D005260:Female; D006801:Humans; D008268:Macular Degeneration / Q000473:pathology / Q000601:surgery; D008297:Male; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D014821:Vitrectomy / Q000379:methods