What is the fourth strongest vitreoretinal attachment?

• A. Macula
• B. Optic disc
• C. Posterior lens
• D. Vitreous base

Answer: (A)

The vitreous is anchored to the retina at a few key points, and these attachments differ in strength. The strongest is at the vitreous base near the ora serrata, where the cortex forms a solid bond with the peripheral retina. Next is the adhesion of the posterior vitreous cortex around the optic disc, where the interface with the retinal surface is particularly tight. The posterior hyaloid’s connection to the posterior lens capsule via Wieger’s ligament is also substantial, but not as robust as the base or the disc region. The fourth strongest (and thus relatively weakest) attachment is at the macula. The macular adhesion is comparatively modest, so the vitreous is more prone to separate from other sites first, with macular involvement occurring later or through tractional processes when portions of vitreous remain adherent there. This weaker macular attachment helps explain why macular traction phenomena can arise and why posterior vitreous detachment often leaves the macula attached longer than other areas.