vitreous

MARC P. JAPITANA MD
Department of Ophthalmology CLMMRH

APPLIED ANATOMY
VITREOUS HUMOR is an inert, transparent, jelly-like structure that fills the posterior 4/5 of the cavity of the eyeball normal volume 4 mL hydrophilic gel with optical functions mechanically stabili es the volume of the globe pathway for nutrients to reach the lens and retina

APPLIED ANATOMY
STRUCTURE OF THE VITREOUS composed of a network of randomly-oriented collagen fibrils interspersed with numerous spheroidal macromolecules of hyaluronic acid colapse ! conversion of gel into sol can be divided into: cortex and nucleus "main vitreous body#

APPLIED ANATOMY
CORTICAL VITREOUS lies adjacent to the retina posteriorly $ to the lens, ciliary body and onules anteriorly density of collagen fibrils is greater in the peripheral part condensation of these fibrils form false anatomic membranes% anterior hyaloid membrane and posterior hyaloid membrane

APPLIED ANATOMY
CORTICAL VITREOUS anterior hyaloid membrane is attached to the posterior lens posterior hyaloid membrane is loosely attached to the internal limiting membrane of the retina

APPLIED ANATOMY
MAIN VITREOUS BODY (NUCLEUS it has less dense fibrillar structure true biological gel site where li&uefaction of the vitreous gel starts first 'yaloid canal "(lo&uet)s (anal# 'yaloid artery of the fetus

APPLIED ANATOMY
Att!c"#ents VITREOUS BASE part of the vitreous about 4 mm across the ora serrata where the attachment is strongest* other firm attachments around the margins of the optic disc, foveal region and back of the crystalline lens "ligament of +ieger#

DISEASES OF THE VITREOUS

,itreous Li&uefaction ,itreous -pacities ,itreous .etachment ,itreous 'emorrhage ,itreo-/etinal .iseases

VITREOUS LIQUEFACTION
most common degenerative change in the vitreous on 0L1, absence of normal fibrillar structure and visible pockets of li&uefaction appearance of coarse aggregate material which moves freely in the free vitreous associated with collapse "synersis# and opacities in the vitreous --- black floaters in front of the eye

VITREOUS LIQUEFACTION
C!uses o$ L%&ue$!ct%on .egeneration "senile, myopic, retinitis pigmentosa# 2ost-inflammatory "following uveitis# 3rauma to the vitreous "blunt or perforating# 3hermal effects "following diathermy, photocoagulation and cryocoagulation# /adiation

VITREOUS DETACHMENT
2osterior ,itreous .etachment "2,.# .etachment of the ,itreous 4ase and 5nterior ,itreous

POSTERIOR VITREOUS DETACHMENT

separation of the cortical vitreous from retina anywhere posterior to the vitreous base
vitreous base is 3 4 mm wide area of attachment of vitreous to the ora serrata

2,. with vitreous li&uefaction "synchysis# and collapse "synersis# is of common occurrence in majority of the normal subjects above the age of 65 years

POSTERIOR VITREOUS DETACHMENT

occurs in eyes with senile li&uefaction, developing a hole in the posterior hyaloid membrane the synchytic fluid collects between the posterior hyaloid membrane and the internal limiting membrane of the retina, and leads to 2,. up to the base along with collapse of the remaining vitreous gel "synersis# more common among aphakics and myopes

POSTERIOR VITREOUS DETACHMENT

(L787(5L 9153:/10 associated with flashes of lights and floaters 0L1 collapsed vitreous behind the lens optically clear space between the detached posterior hyaloid phase and the retina 'e%ss r%n( or Fuc"s r%n( pathognomic sign

POSTERIOR VITREOUS DETACHMENT

(-;2L7(537-8 retinal breaks vitreous hemorrhage retinal hemorrhage cystoid maculopathy

VITREOUS BASE & ANTERIOR VITREOUS DETACHMENT

occurs following blunt trauma may be associated with
vitreous hemorrhage retinal hemorrhage anterior retinal dialysis dislocation of crystalline lens

VITREOUS OPACITIES
vitreous is a transparent structure any non-transparent structure present in it will form an opacity and cause symptoms of 9L-531/0

VITREOUS OPACITIES
MUSCAE VOLITANTES physiologic opacities residues primitive hyaloid vasculature perceived as fine dots and filaments, which drift in and out of the field against bright background

VITREOUS OPACITIES
)ERSISTENT HY)ER)LASTIC )RIMARY VITREOUS failure of the primary vitreous structure to regress combined with the hypoplasia of the posterior portion of vascular network white pupillary refle< "leucocoria# seen after birth associated with other anomalies such as congenital cataract, glaucoma, long and e<tended ciliary processes, micropthalmos and vitreous hemorrhage*

VITREOUS OPACITIES
)ERSISTENT HY)ER)LASTIC )RIMARY VITREOUS .ifferentials retinoblastoma, congenital cataract and /-2 (3 0can helps in diagnosis

VITREOUS OPACITIES
)ERSISTENT HY)ER)LASTIC )RIMARY VITREOUS 3reatment pars plana lensectomy e<cision of the membranes with anterior vitrectomy visual prognosis is poor

VITREOUS OPACITIES
INFLAMMATORY VITREOUS O)ACITIES e<udates poured into the vitreous in
anterior uveitis (iridocyclitis) posterior uveitis (choroiditis) pars planitis pan uveitis endophthalmitis

VITREOUS OPACITIES
VITREOUS A**RE*ATES AND CONDENSATION 'ITH LI+UEFACTION commonest cause of vitreous opacities condensation of collagen fibrillar network maybe senile, myopic, post-traumatic or postinflammatory in origin

VITREOUS OPACITIES
AMYLOID DE*ENERATION rare condition amorphous amyloid material is deposited in the vitreous part of generali ed amyloidosis

VITREOUS OPACITIES
ASTEROID HYALOSIS small, white rounded bodies suspended in the vitreous gel formed due to accumulation of calcium containing lipids unilateral, asymptomatic condition usually seen in old patients with healthy vitreous

VITREOUS OPACITIES
ASTEROID HYALOSIS genetic relationship between this condition, diabetes and hypercholesterolemia genesis is unknown effective treatment

VITREOUS OPACITIES
SYNCHYSIS SCINTILLANS vitreous is laden with small white angular and crystalline bodies with formed of cholesterol seen in damaged eyes that suffered trauma, vitreous hemorrhage or inflammatory disease in the past vitreous is li&uid and crystals sink in the bottom and stirred up with every movement

VITREOUS OPACITIES
SYNCHYSIS SCINTILLANS =beautiful shower of golden rain> on ophthalmoscopy symptomless untreatable

VITREOUS OPACITIES
RED O)ACITIES caused by small vitreous hemorrhages or leftouts of the massive vitreous hemorrhage

VITREOUS OPACITIES
TUMOR CELLS O)ACITIES maybe seen as free-floating opacities in some patients with retinoblastoma, and reticulum cell sarcoma

VITREOUS HEMORRHAGE
usually occurs from the retinal vessels may present as pre-retinal "sub-hyaloid# or an intragel hemorrhage intragel hemorrhage may involve anterior, middle, posterior or the whole vitreous body

VITREOUS HEMORRHAGE
CAUSES 0pontaneous vitreous hemorrhage from retinal breaks especially those associated with 2,. 3rauma to eye "blunt or perforating# 7nflammatory disease ,ascular disorders "'28 retinopathy or (/,-# ;etabolic diseases ".; retinopathy# 4lood dyscrasias

VITREOUS HEMORRHAGE
CAUSES 4leeding disorders 8eoplasms 7diopathic

VITREOUS HEMORRHAGE
CLINICAL FEATURES sudden development of floaters small hemorrhage painless loss of vision massive vitreous hemorrhage

VITREOUS HEMORRHAGE
SI*NS .istant direct ophthalmoscopy reveals black shadows against the red glow in small hemorrhage and no red glow in large hemorrhage .irect and indirect ophthalmoscopy may show presence of blood in the vitreous cavity :3? with 4 0can is particularly helpful

VITREOUS HEMORRHAGE
FATE OF VITREOUS HEMORRHA*E ,- Co#.lete !/sor.t%on may occur without organi ation and the vitreous becomes clear within 4-@ weeks 0- Or(!n%1!t%on of hemorrhage with formation of a yellowish-white debris occurs in persistent or recurrent bleeding

VITREOUS HEMORRHAGE
FATE OF VITREOUS HEMORRHA*E 2- Co#.l%c!t%ons like vitreous li&uefaction, degeneration and khaki cell glaucoma "in aphakia# may occur 3- Ret%n%t%s .rol%$er!ns may occur which may be complicated by tractional retinal detachment

VITREOUS HEMORRHAGE
TREATMENT ,- Conser4!t%4e tre!t#ent consist of bed rest, elevation of patient)s head and bilateral eye patches -- to allow the blood to settle down 0- Tre!t#ent o$ c!use- -nce the blood settles down, indirect ophthalmoscopy should be done to locate and further manage the causative lesion such as retinal break, phlebitis, etc*

VITREOUS HEMORRHAGE
TREATMENT 2- V%trecto#5 /5 .!rs .l!n! route should be considered to clear the vitreous, if the hemorrhage is not absorbed after A months

thank you!