Vitreous

Question 1

Vitreous

Answer 1

Inert jelly like structure has an optical function as a refractive medium and a supportive function supporting both retina and lens
Maintains form of eyeball

Question 2

Age changes in the vitreous

Answer 2

Most people above 60 years like affection, ‏ ‏ shrinkage and PVD

Vitreous detachement
occurs in three forms; posterior,Basal, Anterior

Posterior; is separation of vitreous from the retina posterior to the vitreous base [Part attached to ora serrata]-Occurs mostly as an aging process, common in high myopes and in diabetics they complain of acute onset of photopsia flashes and floaters. Benign unless evidence of vitrio retinal adhesion or traction
Risk of retinal detachement.
Anterior; and basal; Ocular trauma and usually associated with vitreous hemorrhage.

Question 3

Causes Virtuous hemorrhage

Answer 3

Hemorrhage derived from retinal Vessels and collects either intravitreal or peri-retinal[Sub hyaloid hemorrhage]
Causes;
Traumatic due to blunt or penetrating trauma -without trauma ; Due to underlying ocular diseases; Retinopathies-CRVthrombosis-retinal tears in myopic patient-Eales’(peripheral retinal periphlebitis) disease-ocular malignancy

Question 4

Clinical manifestations of vitreous hemorrhage

Answer 4

Clinically; acute onset of floaters and fall of vision
On examination-; absent red reflex fundus not seen
Ultrasonography-; with a B scan is useful shows scattered echoes of varying amplitude of the vitreous cavity and may detect associated PVD or retinal detach
Sup hyaloid hemorrhage-; remains on closet and settles down with gravity taking a boat shape

Question 5

Treatment of vitreous hemorrhage

Answer 5

Bedrest with head elevated and Eyes padded for one week,

in case of improvement patient is allowed to move and seen at two monthly intervals.

If there is no or little improvement after six months; pars plans vitrectomy is done.

Question 6

Muscae volitantes(vitrous floaters)

Answer 6

AreMoving dark spots in front of the eye due to presence of vitreous floaters that cast their shadow on the retina.
Common causes; onset of PVD in old age-causes of vitreous hemorrhage described before-
in addition;
—Astroid hyalosis : floaters are calcium soaps that appear as large white bodies.
—Synchysis scintillans: floaters are cholesterol crystals golden yellow freely mobile in the vitreous
— Amyloid degeneration; familial generalized amyloidosis with marked vitreous floatersAnd polyneuropathy.

Question 7

Vitrectomy

Answer 7

1) posterior [pars plana vitrectomy]; Is vitreous removal through sclerectomy incisions at the pars plana
Indicated in these conditions;
long standing vitreous hemorrhage or dense vitreous opacities

Removal of traction as in retinal detachment with proliferative diabetic retinopathy of giant retinal tears

Early endophthalmitis

Posterior intraocular foreign body

2) anterior vitrectomy; through Limbal Incision, automated vitrectomy probe or manual technique, indicated if vitreous loss or prolapse into anterior chamber occursDuring anterior segment surgery