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5/28/2018 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


VITREOUS

.ifferentials

retinoblastoma, congenital cataract and 2

(3 0can helps in diagnosis


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VITREOUS OPACITIES


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

intragel hemorrhage

intragel hemorrhage may involve anterior,middle, posterior or the whole vitreous body


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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


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VITREOUS HEMORRHAGE

CAUSES

leeding disorders

8eoplasms

7diopathic


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VITREOUS HEMORRHAGE

CLINICAL FEATURES

sudden development of floaters small

hemorrhage

painless loss of vision massive vitreous

hemorrhage


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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


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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


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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


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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*


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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


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thank you!