IntJOphthalmol,Vo1.10,No.12,Dec.2010www.U0.cnTel:02941224517283085628Email:IJO.2000@163.corn·Originalarticle·ChronicmacularedemaassociatedwithextrafovealvitreoretinaltractionAaronTrevino1.MichaelRMartinez1.AvinoamOphirl,DivisionofOphthalmology,Hillel-YaffeMedicalCenter,Hadera,IsraelTheRuthandBruceRappaportFacultyofMedicine,TheTechnion,Haifa,IsraelCorrespondenceto:AvinoamOphir.DivisionofOphthalmology,Hillel—YaffeMedicalCenter,Hadera,Israe1.ophthalmology@hy.health.gov.ilReceived:2010—09·08Accepted:2010—11·16Abstract·AIM:TodescribeanassociationbetweenextrafoveaIvitreoretinaltractionandchronicmacularedema.eitherdifuse(DiME)orcystoid(CME),bytheuseofopticalcoherencetomography(OCT).·METHODS:ChartsandOCTfindingsoftwopatientswithpersistentDiMEorpersistentDiMEaccompaniedbyCME.bothassociatedwithextrafoyeaIvitreoustractionmembraneswereanalyzed.Excludedwereeyesthateitherhadanothervitre0retinOpathVthatcoulda仟ecttheanalysis,hadundergoneparsplanavitrectomyorthathadbeentreatedbyintravitrealmedications.Anage—matchednormalcontrolgroupforOCT(n=12)allowedfortheauantificatiOnofthenormaImacularthicknesses.·RESULTS:Onepatient(oneeye)followingperforatingocularinjuryandonepatient(oneeye)ofidiopathicorigin,bothwithchronicmacularedemarefractivetoconventionaItreatment.werefoundtobeassociatedwithextrafoveaIvitreoretinaItractionineacheye.RetinaIedemathatwasunderlyingthetractionsiteineacheyewasincontinuumwiththecentraImacularedema.thusmanifestingasdi仟usemacularedema.TheautomaticcentraI6.radiaIIinesprogramintheOCTenabledthedetectionofthetractionsiteinoneeye.whileintheothereyethediagnosiswasachievedonlywiththeadditionaluseoftheLinegroupprogram.·CONCLUSION:Chronicdi仟usemacularedemamightberelatedtoextrafoveaIvitreoretinaItraction.CarefuIsearchwiththediverseOCTprogramsshouldbemadeinordertodetectextrafovealtractionsites.Furtherstudiesandalargercohortarerequiredtocomparetheeficacyofearlyvitrectomyorpharmacologicvitreolysisversusthecurrenttherapeuticapproachesinthesesituations.·KEWVORDS:extrafovealvitreoustraction;macularedema;opticalcoherencetomography;ocularperforationDOI:10.3969/j.issn.1672—5123.2010.12.001TrevinoA,MartinezMR,OphirA.Chronicmacularedemaassociatedwithextrafovealvitreoretinaltraction./ntJOpbtbalmol(CuojiYankeZazhi2010;10(12):2231-2235INTRoDUCTIoNMacularedemamayappearpatternandisrelatedtoinadiffuseand/orcystoiddiverseetiologiesincludingocularvasculardiseases(i.e.diabeticretinopathyandretinalveinocclusion)aswellasnon—vascularcircumstancessuchaspseudophakia,penetratingocularinjuryanduveitis.Theonsetofmacularedemahasbeenassociatedwiththebreakdownoftheblood—retinalbarriercausedbydiversemechanismsliketheexpressionofinflammatorymediators(e.g.,prostaglandins)’and/orvascularendothelialgrowthfactor(VEGF).OtherdocumentedcausesofmacularedemaarethoseassociatedwithtractionalforcessuchasvitreofovealtI_acti0n【]aswellasvitI_eoustractionmembI_anesthatarelocatedextrafoveallv【415].eitherretinalorattheopticnervehead(ONH;i.e.vitreopapillarytraction).Epiretinalmembranes(ERM)havealsobeenfoundtobeassociatedwithmacularedema[.Prompttreatmentofmacularedemaisrequiredsinceirreversiblemacularchangesmightoccurifmacularedemaispresentforalongtime.Variouspharmacologicagentsarecommonlyusedforthetreatment,includingto...