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Uploaded bySakshi Sahni
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TOPIC vireous.pptx

The vitreous body serves optical and mechanical functions in the eye. It develops from neuroectoderm and provides a pathway for nutrients. Vitreous opacities appear as floating spots and are caused by developmental remnants, degeneration, inflammation or trauma. Vitreous detachment involves separation from the retina and can cause flashes or floaters, occasionally leading to retinal tears or detachment. Vitrectomy techniques such as three-port pars plana removal are used to treat various vitreous pathologies or as part of retinal surgery.

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TOPIC:VITREOUS DR SAKSHI SAHNI ASST PROF DEPTT OF OPHTHALMOLOGY ASCOMS
 Functions :  Serves mainly optical functions  Mechanically stabilises the eyeball  Pathway for nutrients to reach the lens and retina.
Embryology :  vitreous body Derived from neuroectoderm of optic disc.  During stages of development ,secondary vitreous fills the cavity , primary vitreous along with hyaloid vessels is pushed anteriorly and ultimately disappears.  Tertiary vitreous is developed from neuroectoderm in the ciliary region and is represented by the ciliary zonules.
 Vitreous base : part of the vitreous 4mm across ora serrata.  It is the strongest attachment.  Anterior face of the vitreous cortex is attached to the posterior surface of the lens
 In rest of the retina , vitreous cortex is loosely attached to the ILM being comparatively less loose along the major retinal vessels
 Vitreous opacities  Extremely annoying as they cast a shadow on the retina and  Appear as black spot moving in and out ofVF  Patient complains of moving flies or insects infront of eyes  Pathologically these are clumped cells or strands of vitreous gel which become less transparent than rest of the vitreous
VITREOUS OPACITIES :  Developmental opacities:  Located in the canal of cloquet  Are remnants of hyaloid system  Degenerative changes :  Asteroid hyalosis  Synchisis schintillans  Amyloid degeneration
 Unilateral  Old age  asymptomatic
 It affects the damaged eyes which have suffered from trauma ,VH, inflammatory diseases in the past.  Pathognomic feature is crystals settle down with every pause after stir.  Golden shower of rain.  Can occur at any age
Amyloid degeneration:  Amyloidosis is a localised or systemic condition in which there is extracellular deposition of fibrillary protein  Involvement of vitreous occurs in familial amyloidosis  Characterised by polyneuropathy ,prominent corneal nerves and pupillary light near dissociation.  Vitreous opacities take a typical GLASS WOOL appearance.
 these get attached to the posterior lens by thick footplates  Can lead to severe visual impairment  Rx : vitrectomy  RED CELL OPACITIES:  Cause isVH  TUMOUR CELL OPACITIES:  Free floating opacities in patients of RB, reticulum cell sarcoma and intraocular lymphomas
Vitreous cyst:  Congenital  Acquired  Cause : trauma , inflammation.  Can be : pigmented : arises from ciliary body pigment epithelium  or non pigmented: arise from the remnants of primary hyaloid vascular system.  Can be free floating or attached to optic disc  Rx: laser cystotomy or vitrectomy .
 Can present as  Bergmeister papilla : seen as a tuft at the optic disc  Mittendorf dot: seen on the post lens surface
Terson syndrome:  Combination of intraocular and subarachnoid haemorrhage secondary to aneurysmal rupture from ant communicating artery.  Bilateral  Preretinal or intraretinal haem. Breaks up into the vitreous  Rx not required  Prognosis is usaually good
 Anterior vitrectomy: removal of ant.Vitreous  Core vitrectomy; removal of central bulk of vitreous  Subtotal and total vitrectomy:  TECHNIQUESOFVITRECTOMY:  Open sky vitrectomy: performed through the primary wound to manage the disturbed vitreous in cataract surgery, aphakic keratoplasty and globe rupture.
 Pars plana vitrectomy:  One port :done with multifunction vitrectomy probe ( infusion ,suction and cutter(VSC)  Three port: illumination probe  Infusion cannula  Cutter n suction cannula.
Vitreous substitutes  Used in vitreoretinal surgery  Function :  To restore IOP  To provide intraocular tamponade
 Silicone oil:  Benefit is that it allows more controlled retinal manipulation during vitreoretinal surgery.
Posterior vitreous detachment: separation of cortical vitreous from retina anywhere posterior to vitreous base Cause : collagen cross linking and selective loss of retinal adherence are the primary events. s/s: Flashes of light /photopsia occurs because if mechanical stimulation of retina due to vitreous traction.
 Floaters /cogweb  Biomicroscopic examination:  Collapsed vitreous: behind the lens and an optically clear space between detached posterior hyaloid face and retina .  Weiss ring : ring of attachment of vitreos to optic disc.(pathognomic)
Complications:  Retinal breaks  VH  Retinal haem  RD  Management:  Uncomplicated PVD: F/U  Retinal tear complicating PVD requires LPC  VH /RD
 THANK YOU