Posterior Vitreoschisis Research Articles

Anatomical findings of vitreoretinal interface in eyes with asteroid hyalosis

To investigate the anatomical features of vitreoretinal interface in eyes with asteroid hyalosis (AH) with optical coherence tomography (OCT) and intravitreal triamcinolone acetonide (TA) during vitreous surgery. This study was an interventional clinical case series. Records relating to ten eyes from ten patients who underwent a TA-assisted vitrectomy for the treatment of diverse vitreoretinal diseases complicated with AH. The posterior vitreoretinal interface was examined by preoperative OCT and by intraoperative visualization of posterior vitreous cortex utilizing TA. In eight of ten AH eyes, preoperative OCT revealed abnormal vitreoretinal adhesions. In four of these eight eyes, posterior vitreoschisis could be seen on OCT. In the other four of these eight eyes, a clear no posterior vitreous detachment (PVD) pattern could be seen on OCT. Although posterior vitreous cortex could not be clearly identified with preoperative OCT in two of ten AH eyes, a complete PVD was refuted by intraoperative visualization of the posterior vitreous cortex with TA identical to the other eight eyes. These results indicate that complete PVD appears to be unlikely to occur in eyes with AH. In addition, spontaneous PVD in eyes with AH might lead to vitreoschisis or residual whole layer or posterior vitreous cortex, possibly due to anomalous vitreoretinal adhesion.

Verschluss idiopathischer Makulaforamina nach Kryokoagulation der Glaskörperbasis

There are only few reports on the spontaneous resolution of idiopathic macular holes. We report on 9 cases of resolution of idiopathic macular holes after cryocoagulation of the vitreous base. We analyzed retrospectively 9 / 201 patients from 2005 - 2007, who were planned for a vitrectomy including peeling of the inner limiting membrane (ILM) due to an idiopathic macular hole. Each patient underwent cryocoagulation of the vitreous base 4 weeks ahead of the planned vitrectomy. At the first visit and the visit after cryocoagulation immediately before PPV was scheduled a complete clinical exam including OCT was performed. In all 9 cases macular hole had resolved within an average of 30 days after cryocoagulation. In 4 of these patients focal vitreoretinal adherences in the macula were detected in OCT before cryocoagulation was performed. These adhences had resolved after cryocoagulation. In 3 of these patients the posterior vitreous seemed still to adhere even after resolution of the macular hole after cryocoagulation. In 2 of these patients vitreous detachment seemed to have taken place before cryocoagulation as shown in the OCT scans, postoperatively an additional vitreous floater was detected by OCT so that a preoperative posterior vitreoschisis is assumed. Spontaneous resolution of idiopathic macular holes is very rare. After induction of vitreous detachment by cryocoagulation of the vitreous base, resolution of the macular hole seems to be more frequent. However, we do not recommend to delay vitrectomy due to a macular hole after cryocoagulation.

Optical Coherence Tomography Findings of Incomplete Posterior Vitreoschisis with Vitreomacular Traction Syndrome and Impending Macular Hole: A Case Report

Vitreomacular traction syndrome is a clinical entity characterized by partial posterior vitreous detachment in combination with persistent macular adherence. Recently, optical coherence tomography (OCT) allowed visualization of incomplete posterior vitreoschisis leading to vitreomacular traction. The authors report on a 57-year-old woman with blurred vision in her left eye. OCT scan showed incomplete posterior vitreoschisis with vitreomacular traction syndrome and impending macular hole in her left eye. The intraoperative findings together with the evidence that the internal limiting membrane (ILM) thickness is thinner than the axial resolution of the Stratus OCT (8 micronm) and a spontaneous ILM detachment has never been demonstrated are likely to support the hypothesis that posterior vitreoschisis exists and can be associated with vitreomacular traction syndrome.

Factors associated with foveoschisis and foveal detachment without macular hole in high myopia

To investigate the associated factors of foveoschisis and foveal detachment without macular hole in highly myopic eyes. A cross-sectional study of 124 eyes of 68 highly myopic patients was performed. The patients underwent complete ocular examination, fundus photography, and optical coherence tomography (OCT). Of the 124 eyes, 10 (8%, 10/124) had foveoschisis or foveal detachment without a macular hole on OCT examination. On the basis of univariate analysis, six variables were associated with the pathologic changes, including age over 40 years (P=0.018), spherical equivalent over 10 D (P=0.042), axial length over 31 mm (P=0.001), macular chorioretinal atrophy (P=0.00003), posterior staphyloma (P=0.0003), and vitreoretinal interface factors, including epiretinal membrane, posterior vitreoschisis, and vitreomacular traction (P=0.00002). In the multivariate analysis, three factors were independently associated with foveoschisis and foveal detachment without macular hole in high myopia: axial length, macular chorioretinal atrophy, and vitreoretinal interface factors. Foveoschisis and foveal detachment without macular hole are sight-threatening disorders in highly myopic eyes. Axial length, macular chorioretinal atrophy, and vitreoretinal interface factors were independently associated with these pathological conditions. Thus, both intraocular and outer ocular wall factors play important roles and merit further study.

Optical Coherence Tomography Imaging of Surgical Resolution of Bilateral Vitreomacular Traction Syndrome Related to Incomplete Posterior Vitreoschisis: A Case Report

To report a case of surgical resolution of bilateral vitreomacular traction syndrome related to incomplete posterior vitreoschisis as documented by optical coherence tomography (Stratus OCT, Carl Zeiss Meditec, Dublin, CA). In both eyes of a 72-year-old man with bilateral blurred vision, OCT examination disclosed a relevant increase in mean foveal thickness (right eye = 714 microm; left eye = 757 microm) due to a vitreomacular traction syndrome. At the edges of the most highly elevated area of vitreo-macular traction, OCT scans showed a characteristic splitting of the hyperreflective signal in both eyes, usually identified as posterior vitreous cortex. Both eyes underwent vitrectomy with epiretinal membrane peeling. Postoperative OCT examination showed vitreomacular traction resolution in both eyes with an evident decrease in mean foveal thickness (right eye = 364 microm; left eye = 335 microm). Right visual acuity improved from 20/200 to 20/50; left visual acuity changed from 20/150 to 20/40. OCT was a useful tool in identifying an unusual case of bilateral vitreomacular traction syndrome linked to incomplete posterior vitreoschisis and following a favorable course after surgical management.

Posterior Vitreoschisis: An Echographic Finding in Proliferative Diabetic Retinopathy

To describe the echographic characteristics of splitting the outer posterior cortical vitreous in patients with proliferative diabetic retinopathy and vitreous hemorrhage. The authors retrospectively reviewed the echographic findings in 270 patients who were evaluated at the Doheny Eye Institute between January 1983 to December 1989 for proliferative diabetic retinopathy and vitreous hemorrhage. None of the eyes had undergone pars plana vitrectomy before echographic examination. Forty-five patients (17%) had echographic evidence of splitting of the outer posterior vitreous cortex, a finding the authors have termed posterior vitreoschisis. In all patients, differentiation of the posterior vitreoschisis from a true posterior hyaloid detachment was possible, either on the initial or on serial echographic examination, by the separate detachment of the inner wall of the vitreoschisis cavity and the true posterior hyaloid from the retinal surface. The vitreoschisis cavities often were found to contain unclotted blood. In some eyes, the inner wall of the vitreoschisis cavity was adherent to the apex of the most highly elevated area of traction retinal detachment, suggesting that posterior vitreoschisis may itself result in clinically significant vitreoretinal traction, independent of the presence or extent of true posterior hyaloid separation. The authors' finding suggest that spontaneous splitting of the outer posterior vitreous cortex may occur in patients with proliferative diabetic retinopathy and vitreous hemorrhage, which may mimic a true posterior cortical vitreous detachment on echographic examination. Preoperative recognition of posterior vitreoschisis may be important in the surgical management of these patients.

Biomicroscopic Findings of Posterior Vitreoschisis

ABSTRACT The clinical entity of posterior vitreoschisis, splitting of the posterior cortical vitreous, is not well known. We confirmed its presence biomicroscopically in cases with posterior vitreous detachment and found it mostly associated with retinal vascular diseases, usually manifesting as two dense vitreous membranes with defects. When posterior vitreoschisis develops in an otherwise normal eye, it may not manifest as two membranes, but can form a crescent-shaped, optically empty space in the posterior vitreous cavity. Because its management is different, posterior vitreoschisis should be differentiated from other, apparently similar, conditions, especially posterior vitreous detachment.