Vitreomacular traction (VMT) with macular oedema can be managed conservatively as spontaneous resolution occurs in some cases.

At this time, the net transport of water again is zero and the tissue reaches a steady state – with macular oedema (Stefánsson 2009). Water accumulation lowers the osmotic pressure in the interstitial space and increases the osmotic pressure difference, until a new equilibrium is established between the hydrostatic and osmotic pressure differences. Water flows down this pressure gradient and accumulates in the tissue as oedema. The traction reduces the hydrostatic pressure in the retina, thus increasing the pressure difference between blood vessel and retinal tissue. In normal conditions, the hydrostatic and osmotic pressure differences between tissue and blood vessels are equal and opposite and no net transport of water takes place oedema is neither formed nor reduced (Hall & Guyton 2011). The osmotic pressure difference pulls water from tissue into blood vessels due to high osmotic activity of the macromolecules in blood. The hydrostatic pressure difference (created by the heart) between blood vessels and tissue drives water down a pressure gradient into the interstitial space. It states that fluid transport between tissue and blood vessels is controlled by hydrostatic and osmotic forces. Starling's law describes the formation of oedema in tissues. The two smaller arrows inside the retinal tissue indicate the counteracting forces according to Newton's third law which result in lowering of the hydrostatic pressure (P) in the retina. The force of a VMT is indicated with the large arrow (F). Optical coherent tomography image of the right eye at the initial examination showing vitreomacular traction (VMT) and macular oedema. The opposite pulling forces lower the hydrostatic pressure in the tissue between the forces (Fig. The force exerted by the vitreous gel pulls anteriorly on the retina, and this is met by an equal force in the retina pulling posteriorly towards the back of the eye. Newton's third law states: ‘To every action there is always opposed an equal reaction’ (Newton 1726), which in current terminology means that for every force, there is a counter-force acting in the opposite direction. The distortion is easy to understand, but what is the mechanism that translates mechanical traction into tissue oedema? In our case, the initial OCT image showed clear vitreous traction on the central macular area resulting in distortion and macular oedema. The traction causes retinal distortion and can cause various macular disorders, including cystoid macular oedema, macular hole and epiretinal membrane (Duker et al. Vitreomacular traction is caused by an incomplete PVD where the vitreous remains attached to the posterior retina, exerting traction on the macula. Optical coherent tomography (OCT) imaging was normal, except for minimal shadows on the image due to vitreous floaters. On examination, the vision was 1.0 in both eyes, a Weiss ring was visible on biomicroscopy in the vitreous cavity of the right eye and there were no signs of maculopathy. Before that appointment, he came to the clinic complaining of floaters in the right eye. A follow-up appointment was scheduled few weeks later. The patient was advised of the situation and did not receive any treatment. The right eye is on the left side of the figure and the left eye, on the right side.Ī diagnosis of VMT syndrome, due to incomplete PVD, was entertained. Fundus images (Zeiss VISUCAM 500), above, and optical coherent tomography (OCT) images (Topcon 3D OCT-2000 FA plus), below, showing vitreomacular traction (VMT) and macular oedema in the right eye and a partial posterior vitreous detachment without VMT in the left eye.

Vmt retina