5/28/2018 vitreous- hemorrhage
1/52
vitreous
MARC P. JAPITANA MD
Department of OphthalmologyCLMMRH
5/28/2018 vitreous- hemorrhage
2/52
APPLIED ANATOMY
VITREOUS HUMOR
is an inert, transparent, jelly-like structure that
fills the posterior 4/5 of the cavity of the eyeball
normal volume 4 mL
hydrophilic gel with optical functions
mechanically stabilies the volume of the globe pathway for nutrients to reach the lens and
retina
5/28/2018 vitreous- hemorrhage
3/52
APPLIED ANATOMY
STRUCTURE OF THE VITREOUS
composed of a network of randomly-oriented
collagen fibrils interspersed with numerous
spheroidal macromolecules of hyaluronic acid
colapse ! conversion of gel into sol
can be divided into: cortex and nucleus"mainvitreous body#
5/28/2018 vitreous- hemorrhage
4/52
APPLIED ANATOMY
CORTICAL VITREOUS
lies adjacent to the retina posteriorly $ to the
lens, ciliary body and onules anteriorly
density of collagen fibrils is greater in the
peripheral part
condensation of these fibrils form false anatomicmembranes% anterior hyaloid membrane and
posterior hyaloid membrane
5/28/2018 vitreous- hemorrhage
5/52
APPLIED ANATOMY
CORTICAL VITREOUS
anterior hyaloid membrane is attached to the
posterior lens
posterior hyaloid membrane is loosely attached
to the internal limiting membrane of the retina
5/28/2018 vitreous- hemorrhage
6/52
APPLIED ANATOMY
MAIN VITREOUS BODY (NUCLEUS
it has less dense fibrillar structure
true biological gel
site where li&uefaction of the vitreous gel starts
first
'yaloid canal "(lo&uet)s (anal# 'yaloid arteryof the fetus
5/28/2018 vitreous- hemorrhage
7/52
APPLIED ANATOMY
Att!c"#ents
VITREOUS BASE part of the vitreous about 4
mm across the ora serrata where the
attachment is strongest*
other firm attachments around the margins of
the optic disc, foveal region and back of thecrystalline lens "ligament of +ieger#
5/28/2018 vitreous- hemorrhage
8/52
5/28/2018 vitreous- hemorrhage
9/52
5/28/2018 vitreous- hemorrhage
10/52
DISEASES OF THE VITREOUS
itreous Li&uefaction
itreous pacities
itreous .etachment
itreous 'emorrhage
itreo-etinal .iseases
5/28/2018 vitreous- hemorrhage
11/52
VITREOUS LIQUEFACTION
most common degenerative change in the
vitreous
on 0L1, absence of normal fibrillar structure and
visible pockets of li&uefaction
appearance of coarse aggregate material which
moves freely in the free vitreous
associated with collapse "synersis# andopacities in the vitreous --- black floaters in front
of the eye
5/28/2018 vitreous- hemorrhage
12/52
VITREOUS LIQUEFACTION
C!uses o$ L%&ue$!ct%on
.egeneration "senile, myopic, retinitis
pigmentosa#
2ost-inflammatory "following uveitis#
3rauma to the vitreous "blunt or perforating#
3hermal effects "following diathermy,photocoagulation and cryocoagulation#
adiation
5/28/2018 vitreous- hemorrhage
13/52
VITREOUS DETACHMENT
2osterior itreous .etachment "2.#
.etachment of the itreous ase and nterior
itreous
5/28/2018 vitreous- hemorrhage
14/52
POSTERIOR VITREOUS
DETACHMENT
separation of the cortical vitreous from retina
anywhere posterior to the vitreous base
vitreous base is 3 4 mm wide area of attachment of
vitreous to the ora serrata
2. with vitreous li&uefaction "synchysis# and
collapse "synersis# is of common occurrence in
majority of the normal subjects above the age of
65 years
5/28/2018 vitreous- hemorrhage
15/52
POSTERIOR VITREOUS
DETACHMENT
occurs in eyes with senile li&uefaction,
developing a hole in the posterior hyaloid
membrane
the synchytic fluid collects between the posteriorhyaloid membrane and the internal limiting
membrane of the retina, and leads to 2. up to
the base along with collapse of the remaining
vitreous gel "synersis#
more common among aphakics and myopes
5/28/2018 vitreous- hemorrhage
16/52
5/28/2018 vitreous- hemorrhage
17/52
POSTERIOR VITREOUS
DETACHMENT
(L787(L 913:10
associated with flashes of lights and floaters
0L1 collapsed vitreous behind the lens
optically clear space between the detached
posterior hyaloid phase and the retina
'e%ss r%n or Fuc"s r%n pathognomic sign
5/28/2018 vitreous- hemorrhage
18/52
5/28/2018 vitreous- hemorrhage
19/52
POSTERIOR VITREOUS
DETACHMENT
(;2L7(378
retinal breaks
vitreous hemorrhage
retinal hemorrhage
cystoid maculopathy
5/28/2018 vitreous- hemorrhage
20/52
VITREOUS BASE & ANTERIOR
VITREOUS DETACHMENT
occurs following blunt trauma
may be associated with
vitreous hemorrhage
retinal hemorrhage
anterior retinal dialysis
dislocation of crystalline lens
5/28/2018 vitreous- hemorrhage
21/52
VITREOUS OPACITIES
vitreous is a transparent structure
any non-transparent structure present in it will
form an opacity and cause symptoms of
9L310
5/28/2018 vitreous- hemorrhage
22/52
VITREOUS OPACITIES
MUSCAE VOLITANTES
physiologic opacities
residues primitive hyaloid vasculature
perceived as fine dots and filaments, which drift
in and out of the field against bright background
5/28/2018 vitreous- hemorrhage
23/52
VITREOUS OPACITIES
)ERSISTENT HY)ER)LASTIC )RIMARY
VITREOUS
failure of the primary vitreous structure to regress
combined with the hypoplasia of the posterior
portion of vascular network
white pupillary refle< "leucocoria# seen after birth
associated with other anomalies such as congenitalcataract, glaucoma, long and e
5/28/2018 vitreous- hemorrhage
24/52
VITREOUS OPACITIES
)ERSISTENT HY)ER)LASTIC )RIMARY
VITREOUS
.ifferentials
retinoblastoma, congenital cataract and 2
(3 0can helps in diagnosis
5/28/2018 vitreous- hemorrhage
25/52
VITREOUS OPACITIES
)ERSISTENT HY)ER)LASTIC )RIMARY
VITREOUS
3reatment
pars plana lensectomy
e
5/28/2018 vitreous- hemorrhage
26/52
VITREOUS OPACITIES
INFLAMMATORY VITREOUS O)ACITIES
e
5/28/2018 vitreous- hemorrhage
27/52
VITREOUS OPACITIES
VITREOUS A**RE*ATES AND
CONDENSATION 'ITH LI+UEFACTION
commonest cause of vitreous opacities condensation of collagen fibrillar network
maybe senile, myopic, post-traumatic or post-
inflammatory in origin
5/28/2018 vitreous- hemorrhage
28/52
VITREOUS OPACITIES
AMYLOID DE*ENERATION
rare condition
amorphous amyloid material is deposited in thevitreous
part of generalied amyloidosis
5/28/2018 vitreous- hemorrhage
29/52
5/28/2018 vitreous- hemorrhage
30/52
5/28/2018 vitreous- hemorrhage
31/52
VITREOUS OPACITIES
ASTEROID HYALOSIS
small, white rounded bodies suspended in the
vitreous gel formed due to accumulation of calcium
containing lipids
unilateral, asymptomatic condition usually seen
in old patients with healthy vitreous
5/28/2018 vitreous- hemorrhage
32/52
VITREOUS OPACITIES
ASTEROID HYALOSIS
genetic relationship between this condition,
diabetes and hypercholesterolemia genesis is unknown
effective treatment
5/28/2018 vitreous- hemorrhage
33/52
5/28/2018 vitreous- hemorrhage
34/52
5/28/2018 vitreous- hemorrhage
35/52
5/28/2018 vitreous- hemorrhage
36/52
VITREOUS OPACITIES
SYNCHYSIS SCINTILLANS
vitreous is laden with small white angular and
crystalline bodies with formed of cholesterol seen in damaged eyes that suffered trauma,
vitreous hemorrhage or inflammatory disease in
the past
vitreous is li&uid and crystals sink in the bottomand stirred up with every movement
5/28/2018 vitreous- hemorrhage
37/52
VITREOUS OPACITIES
SYNCHYSIS SCINTILLANS
=beautiful shower of golden rain> on
ophthalmoscopy symptomless
untreatable
5/28/2018 vitreous- hemorrhage
38/52
5/28/2018 vitreous- hemorrhage
39/52
VITREOUS OPACITIES
RED O)ACITIES
caused by small vitreous hemorrhages or left-
outs of the massive vitreous hemorrhage
5/28/2018 vitreous- hemorrhage
40/52
5/28/2018 vitreous- hemorrhage
41/52
VITREOUS OPACITIES
TUMOR CELLS O)ACITIES
maybe seen as free-floating opacities in some
patients with retinoblastoma, and reticulum cellsarcoma
5/28/2018 vitreous- hemorrhage
42/52
VITREOUS HEMORRHAGE
usually occurs from the retinal vessels
may present as pre-retinal "sub-hyaloid# or an
intragel hemorrhage
intragel hemorrhage may involve anterior,middle, posterior or the whole vitreous body
5/28/2018 vitreous- hemorrhage
43/52
5/28/2018 vitreous- hemorrhage
44/52
VITREOUS HEMORRHAGE
CAUSES
0pontaneous vitreous hemorrhage from retinal
breaks especially those associated with 2.
3rauma to eye "blunt or perforating#
7nflammatory disease
ascular disorders "'28 retinopathy or (# ;etabolic diseases ".; retinopathy#
lood dyscrasias
5/28/2018 vitreous- hemorrhage
45/52
VITREOUS HEMORRHAGE
CAUSES
leeding disorders
8eoplasms
7diopathic
5/28/2018 vitreous- hemorrhage
46/52
VITREOUS HEMORRHAGE
CLINICAL FEATURES
sudden development of floaters small
hemorrhage
painless loss of vision massive vitreous
hemorrhage
5/28/2018 vitreous- hemorrhage
47/52
VITREOUS HEMORRHAGE
SI*NS
.istant direct ophthalmoscopy reveals black
shadows against the red glow in smallhemorrhage and no red glow in large
hemorrhage
.irect and indirect ophthalmoscopy may show
presence of blood in the vitreous cavity
:3? with 0can is particularly helpful
5/28/2018 vitreous- hemorrhage
48/52
VITREOUS HEMORRHAGE
FATE OF VITREOUS HEMORRHA*E
,- Co#.lete !/sor.t%on may occur without
organiation and the vitreous becomes clearwithin 4-@ weeks
0- Or!n%1!t%onof hemorrhage with formation ofa yellowish-white debris occurs in persistent or
recurrent bleeding
5/28/2018 vitreous- hemorrhage
49/52
VITREOUS HEMORRHAGE
FATE OF VITREOUS HEMORRHA*E
2- Co#.l%c!t%ons like vitreous li&uefaction,
degeneration and khaki cell glaucoma "inaphakia# may occur
3- Ret%n%t%s .rol%$er!ns may occur which may becomplicated by tractional retinal detachment
5/28/2018 vitreous- hemorrhage
50/52
VITREOUS HEMORRHAGE
TREATMENT
,- Conser4!t%4e tre!t#ent consist of bed rest,
elevation of patient)s head and bilateral eyepatches -- to allow the blood to settle down
0- Tre!t#ent o$ c!use- nce the blood settles
down, indirect ophthalmoscopy should be done
to locate and further manage the causative
lesion such as retinal break, phlebitis, etc*
5/28/2018 vitreous- hemorrhage
51/52
VITREOUS HEMORRHAGE
TREATMENT
2- V%trecto#5 /5 .!rs .l!n! route should be
considered to clear the vitreous, if thehemorrhage is not absorbed after A months
5/28/2018 vitreous- hemorrhage
52/52
thank you!