From the Guidelines
Syneresis and vitreomacular adhesion are primarily caused by the natural aging process, with syneresis occurring as the vitreous liquefies and collapses, and vitreomacular adhesion happening when the posterior vitreous partially detaches from the retina but remains attached at the macula. This process is influenced by biochemical changes in the vitreous, including degradation of hyaluronic acid and collagen fibers, leading to pockets of liquid forming within the gel structure 1. The primary cause of syneresis is age, typically beginning around age 40, but factors such as myopia, trauma, inflammation, and certain genetic disorders can accelerate this process.
Key Factors Contributing to Syneresis and Vitreomacular Adhesion
- Age: The natural aging process is the primary cause of both syneresis and vitreomacular adhesion, with the risk increasing after the age of 40 1.
- Myopia: Nearsightedness can accelerate the process of syneresis and increase the risk of vitreomacular adhesion.
- Trauma: Ocular trauma can lead to inflammation and increase the risk of developing syneresis and vitreomacular adhesion.
- Inflammation: Ocular inflammation can contribute to the development of syneresis and vitreomacular adhesion.
- Genetic disorders: Certain genetic disorders can increase the risk of developing syneresis and vitreomacular adhesion.
Clinical Implications
Vitreomacular adhesion can progress to vitreomacular traction syndrome or even macular holes, potentially causing vision distortion or loss 1. Regular eye examinations are recommended for early detection and management of complications. The combination of attachment at the macula with surrounding vitreous separation creates traction and may lead to thickening, distortion, intraretinal cystoid changes, and even subretinal fluid or tractional detachment at the macula. Epiretinal membranes can also lead to macular traction and similar visual symptoms, resulting in loss of visual acuity, metamorphopsia, difficulty in using both eyes together, and even diplopia.
From the Research
Causes of Syneresis
- Syneresis is not directly mentioned in the provided studies, however, it can be related to the vitreomacular interface abnormalities and vitreomacular adhesion discussed in the studies 2, 3, 4.
- Vitreomacular adhesion is a condition where the vitreous gel is abnormally attached to the macula, which can cause traction and lead to macular complications.
- The studies suggest that vitreomacular adhesion can be associated with age-related macular degeneration (AMD) 2 and diabetic macular edema (DME) 3.
Causes of Vitreomacular Adhesion
- Vitreomacular adhesion can be caused by the abnormal attachment of the vitreous gel to the macula, which can occur due to various factors such as age-related posterior vitreous detachment (PVD) 4.
- The size of the vitreomacular adhesion can vary by diagnosis and can be measured using optical coherence tomography (OCT) or other examination techniques 4.
- Vitreomacular adhesion can lead to macular complications such as tractional forces, which can antagonize the effect of anti-vascular endothelial growth factor (anti-VEGF) treatment and cause pharmacological resistance in patients with DME or AMD 2, 3.
Relationship between Vitreomacular Adhesion and Anti-VEGF Treatment
- The presence of vitreomacular adhesion can reduce the therapeutic effects of anti-VEGF agents in patients with DME or AMD 3.
- Studies have shown that patients with vitreomacular adhesion and DME or AMD may not respond as well to anti-VEGF treatment as those without vitreomacular adhesion 2, 3.
- Surgical or spontaneous separation of the residual vitreomacular adhesion can lead to partial or complete resolution of the symptoms and signs of macular traction 4.