VitreousDisease The 4th department of China Medical University The department of ophthalmology of China Medical University.

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Presentation transcript:

VitreousDisease The 4th department of China Medical University The department of ophthalmology of China Medical University

Introduction Comprehend the morphous 、 constitution feature and physiologic function of vitreous Comprehend the general exam method of vitreous Comprehend the causes of Turbidity Comprehend the treatment of Turbidity (including operation of vitreous )

Morphous feature

Constitution feature Vitreous—transparent gel –99%: water –1%: collagen & hyaluronic acid No blood vessels Synchysis Turbidity

Physiologic function Function of vitreous body –Maintain eyeball shape –Refractive media –Elasticity –Metabolism

General exam method of vitreous Direct ophthalmoscope three-mirror contact lens Indirect ophthalmoscope 78/90D preset lens eyeground photography Ultrasound B

Synchysis Pathological feature Liquefaction :metabolism 、 oxidation reaction-- degradation of hyaluronic acid and collapse of collagen frame Syneresis: collapse of collagen frame Correlate factors: age 、 axis oculi 、 without len 、 myopia 、 trauma 、 inflimation 、 hemorrhage and so on.

Posterior vitreous detachment (PVD) PVD: the separation betwee postcortex and retina. Photopsia Rhegmatogenous retinal detachment ， (RRD) Abnormality of V-R borderline Tractive syndrome frontal membrane 、 IMH

Acute PVD PVD Without complicatio (85%) Tears retinal /hemorrhage (10-15%) retinal vessel avulsion/ hemorrhage ( rare )

Degeneration of vitreous Asteroid hyalosis Aynchysis scintillans Amyloidosis

Muscae volitants AND Floaters Physiological Muscae volitants embryo cell residue aerial image Floaters Liquefaction Syneresis PVD Inflammation hemorrhage

Vitreous hemorrhage Secondary Etiology: –Retinal vascular disease –Trauma or operation –Others: RD, PVD

Vitreous hemorrhage C.M. –Mild: floatings, vision blur –Severe: turbidity Vision decreased to LP Red reflex dissappear Complications: –Tractive RD –Ghost cell glaucoma

Vitreous hemorrhage D.D. –B-us examination –RD –Intraocular tumor

Vitreous hemorrhage Treatment : –Non-traumatic: Conservative: absorbants Vitrectomy: 3-6 mons –Traumatic: Vitrectomy in 2-3 wks

PVR (proliferative vitreo-retinopathy Caused by rhegmatogenous RD & penetrating eye injury. It is an excessive repair process. Cell-mediated pathologic process

PVR

Other Vitreous Disease Vitreous inflammation Vitreous parasite Familial exudative vitreoretinopathy (FEV) Vitreous dysplasia 1. tunica vasculosa lentis 2. persistent hyperplasia of primary vitreous 3. Blood vessel loop of frontal optic disc

Operation on vitreous Standard three incision 4mm behind limbus corneae Indication retinal vascular disease complicated RD complicated ocular trauma macula lutea disease vitreitis anterior segment of eye oper complication

25-Gauge Transconjunctiva sutureless vitrectomy system 25G TSVs Tradition D=9mm TSV systerm D=0.5mm Without suture line short time less painful recover quick Indication simple vitreous hemorrhage macula lutea disease