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Vitreous

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Introduction

There are 3 fluid filled compartments in the eye:

The vitreous cavity is the largest of these compartments. The volume of the vitreous cavity makes up approximately four-fifths of the total volume of the globe, and contains an average volume of approximately 4mL of gel-like fluid. The vitreous is transparent, and functions in transporting nutrients to the lens, ciliary body and retina. The vitreous is about twice the viscosity of water, due to mucopolysaccharide hyaluronic acid. Hyalocytes are found in the vitreous, which are believed to be modified histiocytes, glial cells or fibroblasts. Fine collagen fibrils are also found which are composed mostly of type II collagen. The larger fibers are interspersed in the vitreous and connected by the fine connecting fibrils, with liquid channels and hyaluronic acid filling the space between these fibers and fibrils.

The vitreous fibrils merge with the non-pigmented epithelium of the pars plana and the internal limiting membrane (ILM) of the retina. The vitreous also adheres to the disc margin, near the macula, and along retinal vessels. Anteriorly, the vitreous adheres to the posterior lens capsule via the hyaloideocapsular ligament. During fetal development a hyaloid vasculature emerges that connects the posterior pole of the lens to the margin of the optic nerve head. Regression of this fetal vasculature may leave a Cloquet canal, and in adults a “Mittendorf dot” may appear on the lens as a normal variant.

Vitreous consists of 99% water, and is composed of Type II + IX collagen, glycoproteins, and other soluble proteins.The most secure attachment of vitreous is to vitreous base,which is a 360° band that straddles ova serrata and this extends more posteriorly w/ increasing age.

There are 5 Vitreous attachments:

  1. Vitreous base (strongest)
  2. Margins of optic nerve head
  3. Along major retinalvessels
  4. Circular area around fovea
  5. At edges of lattice degeneration

Vitreous Embryology

Embryologic development proceeds in 3 stages:

  1. Primary vitreous –fibrillary components, mesenchymal cells, vascular components: the hyaloid artery, vasa hyaloide a propria, and tunica vasculosa lentis
  2. 2° vitreous –9th weeks gestation–primary vitreous degenerates to become hyaloid canal secondary vitreous develops as a relatively acellular and avascular structure. The cells of secondary vitreous are called hyalocytes.
  3. 3° vitreous –lens zonular fibers-aka “zonules of Zinn”

Vitreous Pathology

Development

Persistent Fetal Vasculatureor PFV(formerly known as persistent hyperplastic primary vitreousor PHPV)

Mamalis Vitreous 01  Mamalis Vitreous 01

Slit Lamp Photograph of Bergmeister Papillae

Mamalis Vitreous 02  Mamalis Vitreous 02

Gross Photograph of Bergmeister Papillae

Mamalis Vitreous 03  Mamalis Vitreous 03

Gross Photograph of remnant hyaloid artery

Mamalis Vitreous 04  Mamalis Vitreous 04

Low magnification view of remnant hyaloid artery

Mamalis Vitreous 05  Mamalis Vitreous 05

External slit lamp photograph of clinically significant PHV

Mamalis Vitreous 06  Mamalis Vitreous 06

Mass in the lens pulling and contracting the ciliary processes forward

Mamalis Vitreous 07  Mamalis Vitreous 07

Gross Photograph of mass with remnant hyaloid artery

Mamalis Vitreous 08  Mamalis Vitreous 08

Gross photograph of mass with optic nerve stalk

Mamalis Vitreous 09  Mamalis Vitreous 09

Low magnification view of mass pushing ciliary body

Bergmeister Papillae

Mittendorf Dot

Vitreous Cyst

Clinically significant PFV

Inflammatory conditions

Degeneration

Syneresis: Liquefaction of the gel

Vitreous Hemorrhage:

Mamalis Vitreous 10  Mamalis Vitreous 10

Slit lamp photograph of Asteroid Hyalosis

Mamalis Vitreous 11  Mamalis Vitreous 11

Gross Photograph of Asteroid Hyalosis

Mamalis Vitreous 12  Mamalis Vitreous 12

Photomicrograph of asteroid bodies

Mamalis Vitreous 13  Mamalis Vitreous 13

Polarized light photomicrograph of asteroid body, showing birefringence

Mamalis Vitreous 14  Mamalis Vitreous 14

Slit lamp photograph of Synchysis scintillans

Asteroid Hyalosis:

Vitreous Amyloidosis:

Mamalis Vitreous 15  Mamalis Vitreous 15

Gross Photograph of PVD

Posterior Vitreous Detachment(PVD):

Mamalis Vitreous 16  Mamalis Vitreous 16

Gross Photograph of funnel-shaped RDR

Rhegmetogenous RD: retinal tear from trauma or PVD

Neoplasms

Vitreous Lymphoma: