Taut Posterior Hyaloid Face - what is this, and why has my eye doctor mentioned it?
If you have diabetic retinopathy and have been told you have a “taut posterior hyaloid face”, this page will help explain what this means.
Unlike the vitreomacular adhesion that many people develop as part of normal ageing, a taut posterior hyaloid is typically seen in diabetes and may be contributing to macular oedema that is difficult to treat with injections alone.
Unlike the vitreomacular adhesion that many people develop as part of normal ageing, a taut posterior hyaloid is typically seen in diabetes and may be contributing to macular oedema that is difficult to treat with injections alone.
If you have diabetic retinopathy and have been told you have a “taut posterior hyaloid face”, this page will help explain what this means.
Unlike the vitreomacular adhesion that many people develop as part of normal ageing, a taut posterior hyaloid is typically seen in diabetes and may be contributing to macular oedema that is difficult to treat with injections alone.
Unlike the vitreomacular adhesion that many people develop as part of normal ageing, a taut posterior hyaloid is typically seen in diabetes and may be contributing to macular oedema that is difficult to treat with injections alone.
How is this different from ordinary vitreomacular traction?
Ordinary VMTVMA VMT occurs in healthy eyes as part of incomplete vitreous separation. The attachment is typically small and focal, and many cases resolve spontaneously.
Taut posterior hyaloid is associated with diabetic retinopathy. The attachment tends to be broader, the membrane itself becomes thickened, and it is much less likely to release on its own. It is characteristically associated with diabetic macular oedema that responds poorly to standard treatments.
Ordinary VMTVMA VMT occurs in healthy eyes as part of incomplete vitreous separation. The attachment is typically small and focal, and many cases resolve spontaneously.
Taut posterior hyaloid is associated with diabetic retinopathy. The attachment tends to be broader, the membrane itself becomes thickened, and it is much less likely to release on its own. It is characteristically associated with diabetic macular oedema that responds poorly to standard treatments.
Why does this cause problems? Research shows that approximately 55% of eyes with an attached hyaloid have macular oedema, compared with only 20% of eyes where the vitreous has already separated. The thickened membrane pulls on the macula and may also act as a barrier that traps fluid and inflammatory substances. Diabetic macular oedema associated with a taut posterior hyaloid often responds poorly to laser and may show limited response to anti-VEGF injections alone.
How is it diagnosed? OCT scanning has transformed our ability to detect this condition. OCT can show the attached membrane, any thickening, and associated macular oedema with distortion of the normal foveal shape. Treatment options Anti-VEGF injections remain the first-line treatment for diabetic macular oedema. Eyes with taut hyaloid can still respond to injections, and this is typically tried first. However, if the mechanical pulling is significant, the response may be incomplete.
Vitrectomy surgery (removal of the vitreous gel along with the hyaloid membrane) is the definitive treatment when the traction is contributing significantly to the oedema. The largest published series reported that 49% of eyes gained two or more lines of vision and 82% achieved complete resolution of the macular oedema. Better outcomes are associated with better vision before surgery, absence of significant macular ischaemia, and earlier intervention before irreversible damage has occurred. What about proliferative diabetic retinopathy? Taut posterior hyaloid can coexist with proliferative diabetic retinopathy where abnormal new blood vessels have grown. If these vessels have developed fibrous attachments, surgery becomes more complex and the surgeon may need to carefully dissect these membranes away (delamination) in addition to removing the posterior hyaloid. Please see the separate information on vitrectomy and delamination for diabetic retinopathy if this applies to you.
Risks of surgery
As with any vitrectomy, risks include cataract progression, retinal detachment (1–3%), vitreous haemorrhage, and infection (rare but serious). Please see the general information on vitrectomy surgery. Summary Taut posterior hyaloid face is a vitreoretinal interface disorder seen in patients with diabetic retinopathy. It differs from ordinary vitreomacular traction in that the membrane is thickened, more broadly adherent, and associated with diabetic macular oedema that may respond poorly to injections alone. In carefully selected patients, vitrectomy with removal of the posterior hyaloid can achieve meaningful improvement in both anatomy and vision.
As with any vitrectomy, risks include cataract progression, retinal detachment (1–3%), vitreous haemorrhage, and infection (rare but serious). Please see the general information on vitrectomy surgery. Summary Taut posterior hyaloid face is a vitreoretinal interface disorder seen in patients with diabetic retinopathy. It differs from ordinary vitreomacular traction in that the membrane is thickened, more broadly adherent, and associated with diabetic macular oedema that may respond poorly to injections alone. In carefully selected patients, vitrectomy with removal of the posterior hyaloid can achieve meaningful improvement in both anatomy and vision.
Further reading: Pendergast SD, Hassan TS, Williams GA, et al. Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid. Am J Ophthalmol. 2000;130(2):178–186. PubMed