Complete Posterior Vitreous Detachment Research Articles

Vitrectomy for Impending Idiopathic Macular Holes

We performed pars plana vitrectomy in 15 patients with physical changes and visual loss believed to indicate impending macular hole formation. Twelve (80%) of 15 eyes have not progressed to macular holes during a minimum follow-up period of 15 months (average, 26 months). In these 12 patients final vision was within one line of the preoperative vision in four eyes, improved two or more lines in five eyes, and was two lines worse in three eyes. Decreased vision in all three eyes was the result of progressive lenticular nuclear sclerosis. A thin sheet of cortical vitreous fibers was sometimes found intraoperatively on the surface of the retina, despite an apparent complete posterior vitreous detachment.

Vitreous cortex remnants at the fovea after spontaneous vitreous detachment.

We performed a scanning electron microscopic observation of the posterior retinal surface of 59 autopsy eyes with spontaneous vitreous detachment. In 26 eyes (44%), there were remnants of the posterior vitreous membrane in the foveal area. These vitreous cortex remnants formed three basic patterns. They appeared either as disc-shaped collagenous membranes covering the fovea, as rings along the foveal margin, or forming a structure that resembles a cyst. Each of these patterns seemed to have a counterpart to various known clinical situations. These findings imply that remnants of the vitreous cortex membrane frequently remain attached to the fovea after apparent complete posterior vitreous detachment. The observed features would provide morphological basis for the interpretation of several clinical conditions that take place along the vitreoretinal interface at the fovea.

Role of the Vitreous in Diabetic Retinopathy: I. Vitreous Changes in Diabetic Retinopathy and in Physiologic Aging

The vitreoretinal relationships in 1021 eyes of 570 patients with diabetic retinopathy and in 857 normal eyes were studied retrospectively in an attempt to identify the vitreous changes specifically related to diabetes. Complete posterior vitreous detachment (PVD) occurred in diabetic patients largely as part of the aging process, but proliferation interfered with its development. Complete PVD with nonproliferative diabetic retinopathy in the younger age groups was more prevalent in eyes treated by panretinal photocoagulation (PRP) than in untreated eyes and thus might have an association with PRP treatment. Partial PVD, seen mainly in proliferative diabetic retinopathy, had no correlation with aging. In the eyes of patients who were younger when diabetes was diagnosed, the development of partial PVD had a close correlation with the duration of diabetes. The data suggest the need for a clinical trial of early photocoagulation, before partial PVD develops, in younger-onset diabetic patients showing early proliferative changes.

Biomicroscopic Study of the Vitreous in Macular Breaks

The vitreous in 74 eyes with macular breaks was studied using the El Bayadi-Kajiura preset lens mounted on a slit lamp. Fifteen of the eyes had macular breaks secondary to various causes, and 59 eyes had idiopathic senile macular breaks. Vitreous traction, indicated by the presence of opercula or visible vitreous strands, was present in 29 (49%) of the idiopathic cases. In 17 of 31 eyes without posterior vitreous detachment (PVD), an operculum was seen. In these eyes, intravitreous traction was suspected to be the cause of macular breaks. Opercula were seen attached to the posterior hyaloid membrane in six of the nine eyes with partial PVD. An operculum corresponding to the macular break was observed on the posterior hyaloid membrane in only five of 19 eyes with complete PVD. Of the 15 eyes with macular breaks secondary to various causes, complete PVD was seen in 10 eyes, one of which had an operculum. One eye had no PVD, and four eyes had partial PVD. Opercula were detected in two of the latter eyes. In one eye of the senile group and one eye of the secondary group, partial PVD caused traction at the edges of the macular break, resulting in retinal detachment.

Vitreous Changes in Retinal Branch Vein Occlusion

The vitreous was studied in 50 eyes with retinal branch vein occlusion (RBVO) and compared to an age-matched control group. The incidence of partial vitreous detachment was significantly higher (22%) in the RBVO group than in the control group (2.2%) (P < 0.01). The incidence of preretinal neovascularization in the RBVO group was 22%. No new vessels formed in eyes with complete posterior vitreous detachment (P < 0.05). The risk of vitreous hemorrhage was greatest in patients with partial vitreous detachment (64%). There was no significant correlation between the status of the vitreoretinal relationship and the development of macular edema, which occurred in 56% of the patients. In two patients, intermittent vitreous traction on the fovea may have influenced the evolution of chronic macular edema and lamellar hole formation.Vascular occlusive disease of the retina produces significant changes in the overlying vitreous. These vitreous changes in turn influence the development of complications following retinal vascular occlusions.