1. IVTS Group Classification of VMA, VMT, and Macular Hole
Siamak Moradian MD
Ophthalmic Research Center (SBMU)
Labbafinejad Medical Center

2. 11/19/2018
IVTS Group Classification Dr Moradian

3. The purpose of the consensus classification was to define the pathologic progression of anomalous PVD at the VMI based on OCT- derived anatomic findings.
11/19/2018
IVTS Group Classification Dr Moradian

4. PVD result of a complex and inevitable set of events that occurs as the eye ages. The completion of vitreopapillary separation, often signaled by the appearance of the Weiss ring, is the acute, often symptomatic end of a years-long process.
11/19/2018
IVTS Group Classification Dr Moradian

5. Anomalous PVD
In cases where liquefaction or gel contraction outpaces detachment of the vitreous cortex, an abnormal adhesion of the vitreous cortex to the ILM is present, a range of anomalous macular conditions can ensue that vary according to the strength and position of the remaining attachments resulting in tractional deformation of retinal tissue .
11/19/2018
IVTS Group Classification Dr Moradian

6. OCT Based Definition and Classification of VMA
VMA is characterized by an elevation of the cortical vitreous above the retinal surface, with the vitreous remaining attached within a 3-mm radius of the fovea without retinal abnormalities.
11/19/2018
IVTS Group Classification Dr Moradian

7. VMA may be subclassified by size of the adhesion into either: (1)focal ( 1500 μ) or(2) broad (>1500 μ); It remains unclear whether there is any prognostic difference between focal and broad VMA. Eyes with VMA also may have other associated macular abnormalities termed concurrent, and the term isolated where no ocular disease is present
11/19/2018
IVTS Group Classification Dr Moradian

8. 11/19/2018
IVTS Group Classification Dr Moradian

9. OCT Based Definition and Classification of VMT
OCT based criteria: (1) evidence of perifoveal vitreous cortex detachment from the retinal surface; (2) macular attachment of the vitreous cortex within a 3-mm radius of the fovea; and (3) association of attachment with distortion of the foveal surface, intraretinal structural changes, elevation of the fovea above the RPE, or a combination thereof.
11/19/2018
IVTS Group Classification Dr Moradian

10. VMT can be subclassified into either focal or broad, depending on the width of vitreous attachment . Broad areas of attachment  Generalized thickening of the macula, vascular leakage on fluorescein angiography, macular schisis, and CME. Focal areas of vitreous attachment  Distort the foveal surface elevate the foveal floor pseudocysts within the central macula
11/19/2018
IVTS Group Classification Dr Moradian

11. 11/19/2018
IVTS Group Classification Dr Moradian

12. ERM Formation
Autopsy studies reveal that residual vitreous remains on the surface of the retina in nearly half of all eyes with PVD. This condition is called vitreoschisis. This residual vitreous may proliferate to form an ERM at any stage of vitreous separation.
11/19/2018
IVTS Group Classification Dr Moradian

13. OCT Based FTMH Classification System (Size of Hole, Presence or Absence of VMT, Cause)
Aperture size predict anatomic treatment Macular holes: small, medium, or large based on aperture size(≤250μ, >250 - ≤400, >400μ). Nearly half of FTMHs are large at the time of diagnosis .
11/19/2018
IVTS Group Classification Dr Moradian

14. Presence or Absence of VMT.
Only macular holes with concurrent VMT should be considered for pharmacologic vitreolysis.
Primary Versus Secondary
Primary FTMH (formerly referred to as idiopathic) results from vitreous traction on the fovea from anomalous PVD.
A secondary FTMH is caused directly by other pathologic features and does not have pre-existing or concurrent VMT:
(1) blunt trauma (2) lightning strike (3) high myopia (4) macular schisis (5) Mactel type 2 (6) wet AMD treated with anti-VEGF therapy
11/19/2018
IVTS Group Classification Dr Moradian

15. 11/19/2018
IVTS Group Classification Dr Moradian

16. 11/19/2018
IVTS Group Classification Dr Moradian

17. 11/19/2018
IVTS Group Classification Dr Moradian

18. Impending Macular Hole
IMH should be used to describe a case in which FTMH is observed in one eye and VMT is observed on OCT in the fellow eye. The finding of VMA in a fellow eye has been referred to as a stage 0 macular hole.
11/19/2018
IVTS Group Classification Dr Moradian

19. Lamellar Macular Hole
OCT-based features of LMH include the following: (1) an irregular foveal contour; (2) a defect in the inner fovea (may not have actual loss of tissue); (3) schisis, typically between the OPL and ONL ; and (4) maintenance of an intact photoreceptor layer. VPA
11/19/2018
IVTS Group Classification Dr Moradian

20. 11/19/2018
IVTS Group Classification Dr Moradian

21. LMH has been reported in eyes after cataract surgery and in association with concomitant ocular conditions including myopia, uveitis, exudative AMD, and RD. Surgery for LMH remains controversial.
11/19/2018
IVTS Group Classification Dr Moradian

22. Macular Pseudohole OCT base characteristics :
invaginated or heaped foveal edges, (2) concomitant ERM with central opening, (3) steep macular contour to the central fovea with near-normal CFT, and (4) no loss of retinal tissue.
Management of macular pseudohole typically is conservative.
11/19/2018
IVTS Group Classification Dr Moradian

23. 11/19/2018
IVTS Group Classification Dr Moradian

24. 11/19/2018
IVTS Group Classification Dr Moradian

25. 11/19/2018
IVTS Group Classification Dr Moradian

26. Two different subtypes of lamellar macular hole were identified: Tractional and degenerative. 1)Tractional was characterized by Schitic separation of neurosensory retina Intact ellipsoid layer Associated with tractional ERM and/or VMT. 2)Degenerative characterized by Presence of intraretinal cavitation that could affect all retinal layers Associated with nontractional epiretinal proliferation and a retinal “bump.” Often presented with early ellipsoidal zone defect and its pathogenesis, although chronic and progressive, remains poorly understood.
11/19/2018
IVTS Group Classification Dr Moradian

27. This classification was developed : 1)Clinicians to speak a common language when discussing diseases of the VMI. 2)It is purely anatomically based, without regard to symptoms 3)This was designed to be simple, easy to remember, clinically applicable, helpful in predicting therapeutic outcomes, and useful for the execution and analysis of clinical trials.
11/19/2018
IVTS Group Classification Dr Moradian

29. Thanks For Your Attention
11/19/2018
IVTS Group Classification Dr Moradian

30. 11/19/2018
IVTS Group Classification Dr Moradian

31. 11/19/2018
IVTS Group Classification Dr Moradian

32. 11/19/2018
IVTS Group Classification Dr Moradian

33. 11/19/2018
IVTS Group Classification Dr Moradian

34. 11/19/2018
Dr Siamak Moradian

35. 11/19/2018
Dr Siamak Moradian

36. 11/19/2018
Dr Siamak Moradian

37. 11/19/2018
Dr Siamak Moradian

38. 11/19/2018
Dr Siamak Moradian

39. 11/19/2018
Dr Siamak Moradian