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vitreous- hemorrhage

Text of vitreous- hemorrhage

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    vitreous

    MARC P. JAPITANA MD

    Department of OphthalmologyCLMMRH

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    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

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    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#

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    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

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    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

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    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

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    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#

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    DISEASES OF THE VITREOUS

    itreous Li&uefaction

    itreous pacities

    itreous .etachment

    itreous 'emorrhage

    itreo-etinal .iseases

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    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

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    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

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    VITREOUS DETACHMENT

    2osterior itreous .etachment "2.#

    .etachment of the itreous ase and nterior

    itreous

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    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

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    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

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    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

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    POSTERIOR VITREOUS

    DETACHMENT

    (;2L7(378

    retinal breaks

    vitreous hemorrhage

    retinal hemorrhage

    cystoid maculopathy

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    VITREOUS BASE & ANTERIOR

    VITREOUS DETACHMENT

    occurs following blunt trauma

    may be associated with

    vitreous hemorrhage

    retinal hemorrhage

    anterior retinal dialysis

    dislocation of crystalline lens

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    VITREOUS OPACITIES

    vitreous is a transparent structure

    any non-transparent structure present in it will

    form an opacity and cause symptoms of

    9L310

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    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

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    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

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    VITREOUS OPACITIES

    )ERSISTENT HY)ER)LASTIC )RIMARY

    VITREOUS

    .ifferentials

    retinoblastoma, congenital cataract and 2

    (3 0can helps in diagnosis

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    VITREOUS OPACITIES

    )ERSISTENT HY)ER)LASTIC )RIMARY

    VITREOUS

    3reatment

    pars plana lensectomy

    e

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    VITREOUS OPACITIES

    INFLAMMATORY VITREOUS O)ACITIES

    e

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    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

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    VITREOUS OPACITIES

    AMYLOID DE*ENERATION

    rare condition

    amorphous amyloid material is deposited in thevitreous

    part of generalied amyloidosis

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    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

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    VITREOUS OPACITIES

    ASTEROID HYALOSIS

    genetic relationship between this condition,

    diabetes and hypercholesterolemia genesis is unknown

    effective treatment

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    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

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    VITREOUS OPACITIES

    SYNCHYSIS SCINTILLANS

    =beautiful shower of golden rain> on

    ophthalmoscopy symptomless

    untreatable

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    VITREOUS OPACITIES

    RED O)ACITIES

    caused by small vitreous hemorrhages or left-

    outs of the massive vitreous hemorrhage

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    VITREOUS OPACITIES

    TUMOR CELLS O)ACITIES

    maybe seen as free-floating opacities in some

    patients with retinoblastoma, and reticulum cellsarcoma

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    VITREOUS HEMORRHAGE

    usually occurs from the retinal vessels

    may present as pre-retinal "sub-hyaloid# or an

    intrage

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