Disorders of the vitreoretinal interface

Macular diseases involving the vitreoretinal interface are caused by abnormal cell migration and proliferation into or behind the posterior vitreous cortex or by vitreous traction onto the macula. Microperimetry has added new and extensive information in the study of retinal function in many macular diseases secondary to alteration of the vitreoretinal interface including epiretinal membranes, macular pseudoholes, and lamellar and full-thickness macular hole. In epiretinal membranes microperimetry shows a preservation of macular sensitivity in the initial stages, whereas it detects a significant reduction of macular sensitivity in the most advanced ones. In macular pseudoholes or lamellar macular holes normal or light reduction of sensitivity is documented. Full-thickness macular hole always corresponds to an absolute scotoma surrounded by a perilesional ring of relative scotoma, and retinal fixation moves to a retinal area immediately adjacent to the scotoma (preferred retinal locus). Surgery is sometimes a major therapeutic indication and the functional evaluation by microperimetry is mandatory to evaluate the clinical course of vitreomacular interface diseases, in a diagnostic work-up which includes visual acuity quantification and morphological evaluation by OCT. Better baseline retinal sensitivity is a positive prognostic factor in eyes undergoing surgery and presenting the same preoperative visual acuity. Visual acuity assessment without the information supplied by microperimetry may underestimate functional benefit of surgery.