Vitrectomy for macular pucker and vitreomacular traction syndrome

During the course of a so-called posterior vitreous detachment, a thin layer of the posterior vitreous cortex often remains adherent to the underlying retina. Tangential stretch of this vitreous pseudomembrane may cause vitreomacular traction syndrome, edema, and macular hole formation. The same process appears to underlie the development of true epimacular membranes (idiopathic macular pucker). Vitrectomy is generally agreed to be the most appropriate treatment for these clinical situations. We evaluated the incidence of vitreomacular adhesion and of visual improvement after vitrectomy of eyes with macular pucker (group 1; n=60) and vitreomacular traction syndrome (group 2; n=50). Vitreomacular attachment was assessed during vitrectomy under the condition of continuous air infusion. In the two groups, complete or partial vitreous attachment to the macula was observed in 57.4% and 74%, respectively. We conclude that vitreomacular adhesion is a common feature of the two clinical situations. Visual improvement was achieved in 73% of both groups. High rates of postoperative visual acuities of 20/50 or better (60.6% in group-1; 65.7% in group-2 cases) occurred only in eyes with preoperative values of 20/100 or better. It is reported that the visual outcome of vitreoretinal surgery for the two clinical conditions deteriorates with increasing duration after initial manifestation. Vitrectomy should not be postponed in patients who complain of disturbing visual symptoms such as reduced visual acuity, metamorphopsia and disturbance of binocular reading. This revised version was published online in July 2006 with corrections to the Cover Date.     

Spontaneous separation in idiopathic vitreomacular traction syndrome associated with contralateral full-thickness macular hole

PURPOSE: Vitreomacular traction syndrome (VMTS) and full-thickness macular hole are two different well-known entities that on follow-up may be subjected to clinical modifications. Precisely, a spontaneous separation of idiopathic VMTS occurred in three eyes of three patients relieving in addition traction of the posterior hyaloid that had led also to a focal macular retinal pigment epithelial detachment (RPE). An association to a full-thickness macular hole was observed in the contralateral eye of one of the patients. METHODS: This is a retrospective study of three patients evaluated with fluorescein angiography and documented with optical coherence tomography using the Stratus (OCT) model 3000, with scans analysis and protocols analysis, measuring the size and shape of vitreomacular adhesions, macular thickness changes before and after the spontaneous separation of the tractional posterior hyaloid adhesion. In addition, the vitreous was evaluated with contact lens slit lamp biomicroscopy and ultrasound. The associated contralateral macular hole in one of the patients was surgically treated. RESULTS: Two of the three eyes with spontaneous separation of the VMTS recovered 20/25 central visual acuity; the other eye maintained the initial 20/50 visual acuity. The treated macular hole recovered 20/100 corrected visual acuity. CONCLUSIONS: Spontaneous separation of posterior hyaloid is a possible outcome during follow-up of idiopathic VMTS that can be well evaluated and documented with OCT while macular fluorescein angiography may be silent in cases like these presently reported. Central vision recovery can be excellent following the spontaneous separation, which releases anterior-posterior traction including on the retinal pigment epithelium and decreases macular thickness as measured with OCT. Therefore, regarding management, the indication for vitrectomy should be delayed awaiting the spontaneous release of vitreomacular traction in 4 to 6 months. The association between idiopathic VMTS in one eye and full-thickness macular hole in the opposite eye of one patient is an important pathophysiologic consideration.     

玻璃体黄斑牵引综合征的临床及光相干断层 扫描图像特征

目的观察玻璃体黄斑牵引综合征的光相干断层扫描（OCT）图像特征及临床意义。方法回顾分析经OCT、荧光素眼底血管造影及B型超声检查确诊并经手术证实的25例玻璃体黄斑牵引综合征患者的临床资料，观察玻璃体黄斑牵引综合征的OCT图像特征。结果玻璃体黄斑牵引综合征的OCT图像主要表现为玻璃体反射光带牵拉视网膜，25例大致可分为5种特征，其中，玻璃体黄斑牵引综合征合并黄斑囊样水肿10例，玻璃体黄斑牵引综合征合并视网膜脱离5例，玻璃体黄斑牵引综合征合并黄斑裂孔3例，玻璃体黄斑牵引综合征合并黄斑视网膜前膜6例，玻璃体黄斑牵引综合征合并黄斑劈裂1例。结论玻璃体黄斑牵引综合征的OCT图像主要表现为玻璃体反射光带牵拉视网膜；OCT检查对玻璃体黄斑牵引综合征的诊断及追踪病情发展有重要作用。(中华眼底病杂志,2005,21:86-89)     

Traction maculopathies--pathogenesis and diagnostics

Traction maculopathies are a group of age-related degenerative diseases characterized by pathology of vitreomacular interface including idiopathic epimacular membranes, vitreomacular traction syndrome and idiopathic macular hole. The disorders develop due to mechanical forces caused by focal condensation or incomplete detachement of vitreous and shrinkage of pathological membranes. The forces can be tangential to retinal surface in epiretinal membranes, anterior-posterior in vitreomacular traction syndrome and oblique (trampoline) in idiopathic macular hole. Authors discuss pathogenesis and diagnostics of traction maculopathies with use of optical coherence tomography and microperimetry, based on current literature. This work presents also idiopathic macular hole classification with use of optical coherence tomography images compared with biomicroscopic classification by Gass.     

At home utilization of low-vision aids by the visually impaired

BACKGROUND: A pathological vitreomacular adhesion is a common pathogenetic mechanism of various clinical entities such as idiopathic epimacular membrane, vitreomacular traction syndrome, and macular hole. Vitrectomy is recommended for these disorders. Anatomical and functional results in 207 operated eyes are discussed. PATIENTS AND METHODS: The results of a vitrectomy in 3 groups of patients were compared: idiopathic epimacular membrane (group 1, n = 52), vitreomacular traction syndrome (group 2, n = 48); macular hole (group 3, n = 107; 33 eyes without and 74 eyes with retinal detachment). After excision of the vitreous gel, a thin layer of epimacular vitreous cortex was identified and excised by gentle aspiration under continuous air infusion. In 50 of the 107 eyes of group 3, the vitrectomy was combined with the application of a drop of autologous blood to the macular hole. RESULTS: A vitreomacular adhesion existed in 56% of group 1, 74% of group 2, and 84% of group 3. The visual acuity improved in 54%, 62% and 50% of eyes of the 3 groups, respectively. More eyes with an initial visual acuity of at least 40/200 achieved final vision of 80/200 or better (57%, 65% and 48% of group 1 to 3, respectively) than eyes with acuities of less than 80/200. A postoperative cataract was the main reason for reduced visual results in all cases. In group 3-eyes with retinal detachment and/or myopia, a significant postoperative visual improvement was achieved only after application of autologous blood to the macular hole. CONCLUSION: A pathological vitreomacular adhesion was identified in the majority of patients with idiopathic epimacular membranes, vitreomacular traction syndrome, and macular hole, respectively. Vitreoretinal surgery for syndromes with vitreomacular traction is indicated as it warrants a significant improvement of visual function and relief of metamorphopsia.     

玻璃体黄斑牵引综合征的手术疗效探讨

目的探讨玻璃体黄斑牵引综合征患者行玻璃体手术治疗的临床效果。方法对1998年7月至2002年1月连续住院行玻璃体手术治疗的16例(16只眼)玻璃体黄斑牵引综合征患者的临床资料进行回顾性分析。结果16例患者均经手术解除玻璃体对黄斑部的牵引,术后3例失访,13例随访资料完整。术后10只眼视力提高,2只眼视力无改善,1只眼视力减退。其中视力≥0．1者由术前的6只眼增至术后的8只眼;术前视力≤0．02者有5只眼,术后视力均有不同程度的提高。2只眼术中发生黄斑裂孔,1只眼术后白内障形成,1只眼术后3个月发现黄斑板层裂孔,1只眼术后3个月出现黄斑皱褶。结论玻璃体手术能够有效解除玻璃体对黄斑部的牵引,阻止患者视力进一步下降,并提高部分患者的视力。（中华眼科杂志,2004,40：670-673)     

Surgical management of vitreomacular traction syndromes

A series of 106 consecutive symptomatic eyes considered to be at high risk for idiopathic macular holes developing underwent pars plana vitrectomy with membrane peeling. One of three types of vitreomacular traction was noted intraoperatively in all the eyes. The elimination of the vitreomacular traction resulted in improved vision in 89% of the eyes, no change in 7%, and decreased vision in 4%. A total of 62% of the patients were women (median age, 67 years). Follow-up ranged from 6 months to 118 months (average, 35 months). Complications included accelerated nuclear sclerosis in 16% and a 2% incidence of retinal detachment, macular pucker, and macular holes.     

Macular pseudoholes. Clinical features and accuracy of diagnosis.

BACKGROUND: Epimacular membrane with pseudohole is an important vitreomacular disorder that belongs in the differential diagnosis of impending and established macular hole. To better characterize this lesion, the authors attempted to identify various features of eyes with epimacular membrane and pseudohole. METHODS: Demographic, clinical, photographic, and fluorescein angiographic data for 14 eyes with epimacular membrane and pseudohole were reviewed. Horizontal and vertical diameters of the pseudoholes were measured, and the original diagnosis was recorded for each eye. Fluorescein angiography was performed in 11 eyes. RESULTS: The mean age of patients with macular pseudoholes was 61.6 years, and median visual acuity for pseudohole eyes was 20/30. Mean horizontal and vertical diameters of the pseudoholes were 384 and 410 microns, respectively. None of the eyes with pseudoholes had the characteristic ophthalmoscopic features associated with full-thickness macular holes or impending macular holes. Results of fluorescein angiography showed three eyes with increased tortuosity or abnormal straightening of the perifoveal vessels; three eyes with a foveal window defect; and three eyes with late leakage from the perifoveal vessels. The original diagnosis of the initial examining physician was correct in only 43% of eyes with epimacular membrane and pseudohole. CONCLUSION: Epimacular membrane with pseudohole may be an underdiagnosed lesion and commonly mistaken for impending macular hole, full-thickness hole, or lamellar hole. These data may be of use as more patients are being considered for recently advocated surgical treatments for impending and established macular hole.     

Postsurgical evaluation of idiopathic vitreomacular traction syndrome by optical coherence tomography.

PURPOSE: To report a case of idiopathic vitreomacular traction syndrome with preoperative and postoperative evaluation by optical coherence tomography. DESIGN: Interventional case report. METHODS: A 62-year-old woman presented with blurred vision in the left eye because of idiopathic vitreomacular traction syndrome, and she underwent a pars plana vitrectomy. Optical coherence tomography was performed before and after surgery. RESULTS: Preoperative optical coherence tomography, right eye, revealed residual adhesion of incomplete posterior vitreous detachment and edematous, thickened outer retina in the macula. A successful vitrectomy relieved vitreoretinal traction with nearly complete resolution of cystoid macular edema within 1 month after surgery, followed in subsequent months by gradual foveal depression resembling a lamellar macular hole. Resolution of subretinal serous fluid was delayed with complete disappearance, some 12 months after surgery, which correlated with a gradual improvement in visual acuity. CONCLUSION: Optical coherence tomography provides a sensitive anatomical evaluation of vitreomacular traction syndrome. Reorganization of retinal tissue after surgical intervention for vitreoretinal traction may be slower than is apparent from conventional examinations.     

玻璃体黄斑牵引综合征的三维频域相干光断层扫描图像特征

目的 探讨玻璃体黄斑牵引综合征的三维频域相干光断层扫描(OCT)图像特征.方法 回顾性系列病例研究.收集18例经三维频域OCT检查确诊的玻璃体黄斑牵引综合征患者的临床资料进行回顾性分析,着重观察其三维频域OCT检测图像特征.根据频域OCT定量检测的玻璃体与黄斑区视网膜附着粘连的范围,将玻璃体黄斑牵引综合征分为局灶型和宽大型两类.运用线性回归法分析所有患者的最小分辨角对数视力(logMAR视力)与黄斑中心凹部视网膜厚度的关系.结果 玻璃体黄斑牵引综合征患者的频域OCT检测图像清晰,其病变特征明显.18例患者中,病变呈局灶型14例,宽大型4例;合并黄斑前膜8例,合并黄斑全层裂孔2例,合并黄斑板层裂孔2例.18只眼的logMAR视力为0.15～1.22,其黄斑中心凹视网膜厚度为275～899 μm,经线性回归分析,显示所有患者的logMAR视力与黄斑中心凹的视网膜厚度呈中度线性正相关(r=0.616,P=0.007).结论 三维频域OCT检测可以直观地显示眼底病变三维结构,对玻璃体黄斑牵引综合征患者的诊断和随访具有重要作用.     

Macular holes: classification,epidemiology, natural history and treatment

BACKGROUND: Macular hole is a retinal disease primarily affecting elderly women. Its overall prevalence in the Danish population is estimated to be 0.14%. The majority of cases are unilateral. The fully developed macular hole evolves through a series of stages starting with an impending hole. About half of impending macular holes regress spontaneously. The remaining half progress to full thickness macular holes. In a patient with a macular hole in one eye, the risk of development of a macular hole in the fellow eye is less than 2% if posterior vitreous detachment is present. If the posterior vitreous is attached, the risk is approximately 15%. If an impending hole is found in the other eye, the risk rises to 50%. TREATMENT AND OUTCOMES: Macular hole surgery is able to close full thickness macular holes in approximately 90% of cases. Visual acuity of 20/50 or better can be obtained in approximately half of patients with recent onset of symptoms. Complications include retinal detachment, endophthalmitis, late reopening of an initially successfully closed hole and retinal pigment epithelial abnormalities. Retinal detachment should be expected in less than 5% of cases.     

Tomographic features and surgical outcomes of vitreomacular traction syndrome

PURPOSE: To study the relation between preoperative macular changes and surgical outcomes in vitreomacular traction syndrome. DESIGN: Prospective study. METHODS: We prospectively examined 14 eyes of 13 patients (aged 48 to 82 years; mean 66.1) with vitreomacular traction syndrome using optical coherence tomography (OCT) before and after vitreous surgery. RESULTS: OCT demonstrated two types of partial posterior vitreous detachment: incomplete V-shaped detachment in 10 eyes (group 1) and partial detachment temporal to the fovea but attached nasally in 4 eyes (group 2). Preoperative OCT showed foveal retinal detachment in all eyes in group 1; the detached retina was intact in 2 eyes and edematous with (6 eyes) or without (2 eyes) cystic changes. After surgery, these 10 eyes had a normal foveal configuration accompanied by visual improvement. In group 2, 3 of the 4 eyes had prominent cystoid macular edema (CME) without foveal retinal detachment before surgery. After surgery, 2 eyes developed a full-thickness macular hole, 1 had persistent CME, and 1 developed macular atrophy. The visual acuity decreased in 2 eyes and remained the same in 2 eyes. CONCLUSIONS: Two types of vitreous traction develop in vitreomacular traction syndrome: an incomplete V-shaped posterior vitreous detachment that leads to foveal retinal detachment, the surgical outcome of which is favorable, and partial posterior vitreous detachment temporal to the fovea in which prominent CME developed, which may result in a macular hole or macular atrophy postoperatively.     

Vitrectomy for traction macular edema

Purpose: Traction macular edema may develop through contraction of macular epiretinal membranes (ERM), or due to persistant vitreomacular traction during the evolution of vitreomacular traction syndrome (VMS). The purpose of this retrospective study was to determine the effect of vitreous surgery and the release of the vitreomacular traction or the removal of epiretinal membranes, on the evolution of traction induced macular edema. Material and methods: Fourteen eyes from 14 patients presenting with idiopathic or secondary epiretinal membranes, and 11 eyes from 10 patients presenting with vitreomacular traction syndrome, underwent vitrectomy for reduced vision and cystoid macular edema, identified by slit-lamp examination and fluorescein angiography. No coexistent ocular conditions that might have caused macular traction were present. History, preoperative eye examination, operative findings, postoperative course and final examination as well as pre- and postoperative fluorescein angiography were reviewed. Results: In the ERM group, cystoid macular edema disappeared in all cases during the postoperative period and the mean visual acuity (VA) at the end of the follow-up (0.48 ± 0.23) significantly increased compared to the preoperative one (0.29 ± 0.2) (p=0.004). In the group of patients suffering from VMS, the posterior vitreous traction on the macula was released and macular edema disappeared in all cases but one. The mean v.a. at the end of the follow-up (0.42 ± 0.24) significantly increased compared to the preoperative one (0.18 ± 0.1) (p=0.01). Complications included intraoperative small petechias and postoperative progressive nuclear sclerosis, retinal detachment and retinal pigment epitheliopathy. Conclusions: Cystoid macular edema may develop secondary to vitreomacular traction syndrome or epiretinal membrane contraction. Vitrectomy is effective in releasing macular traction which, in turn, may induce a decrease of the macular edema with improvement of visual acuity. This revised version was published online in July 2006 with corrections to the Cover Date.     

玻璃体黄斑牵引综合征的手术疗效观察

目的 探讨玻璃体手术治疗玻璃体黄斑牵引综合征的临床效果及光相干断层扫描、荧光素眼底造影对手术疗效的评价.方法 经裂隙灯前置镜、间接眼底镜检查、B超、光相干断层扫描(OCT)、荧光素眼底血管造影(FFA)等检查确诊为玻璃体黄斑牵引综合征行玻璃体手术的患者30例(30只眼)的临床资料进行回顾性分析.结果 30只眼经手术解除玻璃体对黄斑部的牵引.术后20只眼视力提高.术后黄斑区牵引处OCT测量高度平均减小267μm,有明显改善.术前荧光素眼底血管造影检查存在黄斑囊样水肿伴渗漏,术后明显减轻.术前合并高度近视眼者视力预后不佳.结论 玻璃体手术能够有效解除玻璃体对黄斑部的牵引,阻止患者视力进一步下降,减轻黄斑水肿及渗漏,是治疗玻璃体黄斑牵引综合征的有效方法.光相干断层扫描及荧光素眼底造影检查可以对手术疗效进行评价,有利于术后随访.

Abstract：

Objective To evaluate the efficacy of vitreous surgery for patients with vitreomacular traction syndrome. Methods Of 30 patients (30 eyes) who underwent vitrectomy for vitreomacular traction syndrome were retrospectively analyzed. Results Vitreomacular traction was released successfully, and a better visual acuity was obtained in 20 eyes. Mean macular thickness decreased by 267μ m postoperatively. The eyes showed statistically significant improvement in visual acuity and central macular thickness (P <0.05). Optical coherence tomography (OCT) and fluorescein fundus angiography (FFA) showed macular edema gradually alleviated after vitreous surgery. Preoperative high myopia was associated with prognosis of postoperative visual acuity (P<0.05). Conclusions Vitrectomy can relieve macular traction, and is effective for decreasing macular thickness and improvement of vision in vitreomacular traction syndrome. OCT and FFA are useful for evaluation and follow-up for vitreomacular traction syndrome.     

表面麻醉下25G经结膜无缝合玻璃体视网膜手术的临床应用

目的 观察表面麻醉下行25G经结膜无缝合玻璃体视网膜手术的疗效、适应证和并发症。 方法 回顾分析22例爱尔卡因滴眼液表面麻醉下采用25G经结膜无缝合玻璃体切割手术系统（TSV25G）行玻璃体视网膜手术患者的临床及随访资料。22例患者均为单眼患病接受治疗。其中特发性黄斑裂孔10只眼，特发性黄斑前膜6只眼，玻璃体黄斑牵引综合征4只眼，视网膜分支静脉阻塞玻璃体积血2只眼。根据病情行视网膜前膜、黄斑前膜和（或）内界膜剥离，气液交换和全氟丙烷（C₃F₈）气体眼内充填 。手术后随访1~11个月，平均随访时间6.4个月。主要观察分析手术中的镇痛效果、患者合作程度、手术效果以及手术中和手术后并发症。 结果 所有手术眼均可在表面麻醉下顺利完成手术操作。手术时间20~25min，平均手术时间约22min。手术中患者无特别不适，能配合手术；手术后2d内手术创口结膜轻度水肿，7d后已无明显痕迹。1个月时仅在巩膜表面见一浅的色素沉着点。手术后一过性眼压升高2只眼，晶状体后囊羽毛状混浊5只眼，玻璃体积血1只眼，结膜下气泡2只眼。未发生感染性眼内炎、医源性视网膜裂孔及视网膜脱离、脉络膜脱离以及其他与切口相关的并发症。特发性黄斑裂孔患者9只眼裂孔闭合，1只眼裂孔缩小但未闭合，特发性黄斑前膜、玻璃体黄斑牵引综合征、视网膜分支静脉阻塞玻璃体积血均治愈。 结论 表面麻醉下的25G经结膜无缝合玻璃体视网膜手术具有手术操作简单、时间短、创伤小、并发症少、手术后恢复快等优点，主要适用于特发性黄斑裂孔、特发性黄斑前膜、玻璃体黄斑牵引综合征、单纯玻璃体积血等手术操作相对简单的疾病的玻璃体视网膜手术治疗。 （中华眼底病杂志，2004，20：133-136）     

光学相干断层扫描在玻璃体黄斑界面疾病中的临床应用进展

玻璃体黄斑界面疾病主要包括玻璃体黄斑牵引综合征、特发性黄斑视网膜前膜和特发性黄斑裂孔。光学相干断层扫描(optical coherence tom ography,OCT)作为一种新的能提供高分辨活体组织横截面图像的非损伤性影像学检查技术,具有独特的高分辨率、无损伤性等特点,自临床广泛应用以来,为临床玻璃体黄斑界面疾病的诊断、鉴别诊断、病情的监测以及定量评估、治疗方案的选择等方面提供了重要信息及参考价值。我们对玻璃体黄斑界面疾病在OCT图像中的解剖形态学特征的了解,促进了临床对疾病发生、发展的认识。下面我们就OCT在玻璃体黄斑界面疾病的应用进展加以综述。     

Role of Tractional Forces and Internal Limiting Membrane in Macular Hole Formation: Insights from Intraoperative Optical Coherence Tomography

We report the case of a 69-year-old patient who underwent vitrectomy for vitreomacular traction (VMT) and developed a postoperative macular hole that was observed 1 week after surgery. The hole did not close by in-office fluid-gas exchange alone, but was achieved after repeat surgery with internal limiting membrane (ILM) peeling. Intraoperative OCT (iOCT) images from the first surgery revealed an occult macular hole that formed after VMT release. We discuss how iOCT findings provide insight into the role of the ILM in macular hole formation and emphasize the importance of carefully inspecting iOCT images in real time to avoid missing small but important findings.Key Words: Optical coherence tomography, Vitreomacular traction, Macular hole, Internal limiting membrane     

Diagnosis of vitreoretinal adhesions in macular disease with optical coherence tomography

PURPOSE: To compare the relative incidence of vitreoretinal adhesions associated with partial vitreous separation within the macula diagnosed with optical coherence tomography (OCT) with that of those diagnosed with biomicroscopy. METHODS: The authors obtained linear cross-sectional retinal images using OCT in patients with selected macular diseases. Additional studies included biomicroscopy, fundus photography, fluorescein angiography, and B-scan ultrasonography. RESULTS: Optical coherence tomography was performed on 132 eyes of 119 patients. Vitreoretinal adhesions within the macula were identified using OCT in 39 eyes (30%) with the following diagnoses: idiopathic epiretinal membrane (n = 13), diabetic retinopathy (n = 7), idiopathic macular hole (n = 7), cystoid macular edema (n = 7), and vitreomacular traction syndrome (n = 5). Biomicroscopy identified vitreoretinal adhesions in only 11 eyes (8%). Two distinct vitreoretinal adhesion patterns were identified with OCT, each associated with partial separation of the posterior hyaloid face: focal (n = 25) and multifocal (n = 14). CONCLUSIONS: Optical coherence tomography is more sensitive than biomicroscopy in identifying vitreoretinal adhesions associated with macular disease.     

Optical coherence tomography evidence of rapid progression from vitreomacular traction to full thickness macular hole

The authors present a case of a patient with idiopathic vitreomacular traction who subsequently developed a full thickness macular hole 3 weeks following the onset of metamorphopsia. Vitreomacular traction is a well described phenomenon and has been known to resolve spontaneously and in this patient the conservative approach was adopted initially. However, she progressed rapidly to a full thickness macular hole and therefore, the authors recommend close monitoring of such patients with a view to early vitrectomy to prevent progressive morbidity.     

Epiretinal pathology of diffuse diabetic macular edema associated with vitreomacular traction

PURPOSE: To investigate the ultrastructure of the vitreomacular interface in patients with diffuse diabetic macular edema (DDME) associated with vitreomacular traction. DESIGN: Laboratory investigation. METHODS: Fifty-five consecutive patients with DDME underwent vitrectomy with en-bloc removal of the inner limiting membrane (ILM) and epimacular tissue. Six patients were operated on both eyes. Sixty-one specimens harvested during vitrectomy were analyzed by electron microscopy. RESULTS: Preoperatively, a thickened premacular cortical vitreous was present in 47 eyes. Native vitreous collagen with single cells interspersed within the collagenous layer or a cellular monolayer were the ultrastructural features in these eyes. Twenty-three eyes showed an epimacular membrane. In eyes with obvious signs of tangential vitreomacular traction, multilayered membranes situated on a layer of native vitreous collagen were found. Fibroblasts and fibrous astrocytes were the predominant cell types; myofibroblasts and macrophages were also present. Sixty of 61 specimens showed native vitreous collagen covering the ILM. Macular edema resolved in 58 eyes and persisted in 3 eyes. No recurrent fibrocellular proliferation was observed during the follow-up period of 18 months (mean, 3 to 56 months). CONCLUSIONS: The vitreomacular interface in eyes with DDME is characterized by a layer of native vitreous collagen and a varying cellular component. Tangential vitreomacular traction is associated with multilayered membranes situated on a layer of vitreous collagen. Resolution of macular edema does not depend on the presence and removal of contractile membranes. In eyes without tangential traction, complete removal of epimacular tissue also leads to fluid resorption.