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

2. 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 )

3. Morphous feature

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

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

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

7. 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.

8. 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

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

12. Degeneration of vitreous Asteroid hyalosis Aynchysis scintillans Amyloidosis

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

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

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

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

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

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

19. PVR

20. 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

21. 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

22. 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