Vitreous
Asteroid bodies
- Bensons disease
- 90% unilateral over age 60
- Calcium soaps attached to fibers
Attachments
- Posterior lens face
- Weigers attachment
- Firm in young people
- Vitreous base around Ora
- Very strong attachment
- Optic nerve
- Macula
- Weak oval attachment that weakens more with age
Anterior vitreous detachment
- Rare due to strong vitreous base attachment
- Due to trauma
- Cells in vitreous and visible fibers
- Probable retinal tear
Posterior vitreous detachment PVD
- 90% of Aphakes degeneration Follow up in 6 mo.
- PVD and ring or line floater Follow up in 3 mo.
- PVD and photopsia Follow up monthly for 3 mo.
- PVD and pigment in vitreous Follow up weekly for 6 wk’s
Floaters
- Classic floater shower Vitreous hemorrhage or retinal tear
- Cobweb shape Vitreous hemorrhage
- Insect shaped Operculated retinal tear
- Photopsia in 50% for weeks to years
- Metamorphopsia from macular edema secondary to tugging at the macula
- may lead to a macular hole
- 10% associated with retinal breaks
- 50% of retinal detachmentsdo not have history of flashes or floaters
- 50% of symptomatic retinal breaks progress to retinal detachment
- 2.5% of symptomatic PVD
- Acute tears become detached within 6 weeks
Fibrillary degeneration
- Liquefaction
- Liquefied vitreous penetrates RPE and pigment is released as “Tobacco
dust”
- Synersis (Shrinking)
- White without pressure
Genetic disorders
- Acquired retinoschisis
- Extends to ora
- Asymptotic
Amlyoid degeneration of vitreous (Primary heredofamial amyloidosis)
- Primary
- Amyloid deposits in heart, thyroid, nerves and muscles
- Secondary
- Amyloid deposits in liver, kidneys, adrenals
- Diplopia
- Photophobia
- Vitreous opacities
- Retinal hemorrhages
Coat's disease (Congenital retinal telangiectasia)
- Associated with
- Beading
- Dilated capillaries
- Loops
- Neovascularization
- Retinal edema
- Can occur anywhere in the retina
- Hallmark is localized fusiform dilation of the retinal vessels
- Effects both arteries and veins
- Looks like little light bulbs
- Idiopathic
- Leaking lipoproteinaceous fluid
- Yellow-white to green subretinal lipid exudate
- Lebers miliary aneurysms is a less sever form than Coats
- May be present at birth, but 1/3 of cases identified are older
than 30 when identified
- Most often male (80%)
- Treatment is obliterate the telangiectasis and stop the exudation
- Unilateral
- Worst case results in:
- Total exudative retinal detachment
- Rubeosis irides
- Glaucoma
- Phthis bulbi
Coats syndrome (Not congenital or hereditary)
- Retinal detachment with massive exudation
- Associated with:
- Branch retinal vein occlusion
- Muscular dystrophy
- Retinitis pigmentosa
- Retrolental fibroplasia
Congenital hereditary retinoschisis
- Recessive sex linked primarily males
- Bilateral splitting of retina in inferior temporal quadrant
- Normally not out to ora
- Pigmented demarcation lines
- Vitreous degeneration
- Cystic macula changes
Familial exudative vitreoretinopathy
- Autosomal dominate
- Bilateral gradual blindness due to neovascularization
Goldmann-Favre’s vitreotapetretinal degeneration
- Progressive loss of acuity associated with retinoschisis and pigmented
chorioretinal degeneration
- Bilateral autosomal recessive
Wagners hereditary degeneration
- 100% penetrance
- Vitreous degeneration at an early age and myopia
- Gray - white preretinal membranes form and eventual retinal detachment
Paravascular vitreous attachments (Retinal tufts)
- Strong adhesion between vitreous and equator
- May lead to retinal detachment
Persistent hyperplastic primary vitreous
- Anterior
- Cataracts
- Glaucoma
- Microcornea,
- Failure of regression of primary vitreous
- Looks like retinopathy of prematurity but in full term no 02 Babies
- Pale, hypoplastic disc and condensed vitreous
- Posterior
Snchesis scintillans
- Bilateral flat cholesterol crystals that sink to bottom
- Maybe nonexistent condition
Systemic conditions affecting vitreous
Ehlers-Danlos syndrome
Marfans syndrome
- Vitreous liquefaction
- PVD
Pseudoxanthoma elasticum
- Vitreous liquefaction
- PVD
- Brown cells in vitreous
Retinitis pigmentosa
- Vitreous liquefaction
- PVD
- Brown cells in vitreous
Vitreous hemorrhage
Retrovitrous
- Floaters and loss of acuity
- Bright red blood that moves easily
Intravitrous
- Blood in vitreous
- Clots easily
|
