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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...