Vitreous Detachment Definition

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Complete or partial detachment of the vitreous body from its underlying tissue. The most common form is posterior vitreous detachment (see Fig. 11.3a); anterior or basal vitreous detachment is much rarer.

Epidemiology: Six percent of patients between the ages of 54 and 65 and 65 % of all patients between the ages of 65 and 85 have posterior vitreous detachment. Patients with axial myopia have a predisposition to early vitreous detachment. Presumably the vitreous body collapses earlier in these patients because it must fill a "longer" eye with a larger volume.

Etiology: Liquefaction causes collapse of the vitreous body. This usually begins posteriorly where the attachments to the underlying tissue are least well developed. Detachment in the anterior region (anterior vitreous detachment) or in the region of the vitreous base (basal vitreous detachment) usually only occurs where strong forces act on the globe as in ocular trauma.

Symptoms and findings: Collapse of the vitreous body leads to vitreous densities that the patient perceives as mobile opacities. These floaters (also known as flies or cobwebs) may take the form of circular or serpentine lines or points. The vitreous body may detach partially or completely from the retina. An increased risk of retinal detachment is present only with partial vitreous detachment. In this case, the vitreous body and retina remain attached, with the result that eye movements in this region will place traction on the retina. The patient perceives this phenomenon as flashes of light. If the traction on the retina becomes too strong, it can tear (see retinal tears in posterior vitreous detachment, Fig. 11.3 b - c).This increases the risk of retinal detachment and vitreous bleeding from injured vessels.

H Floaters and especially flashes of light require thorough examination of the ocular fundus to exclude a retinal tear.

11.3 Aging Changes 283 Retinal tears in posterior vitreous detachment. -

Vitreous Body

Attachment of vitreous body to retina

Round or oval hole in the retina

Attachment of vitreous body to retina

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Fig. 11.3 a Complete posterior vitreous detachment (arrows). b This can produce traction at the posterior attachment of the base of the vitreous body to the retina, causing retinal tears. c Autopsy finding of a manifest retinal tear with traction of the vitreous body at the edge of the opening (arrow).

Horseshoe tear b

Fig. 11.3 a Complete posterior vitreous detachment (arrows). b This can produce traction at the posterior attachment of the base of the vitreous body to the retina, causing retinal tears. c Autopsy finding of a manifest retinal tear with traction of the vitreous body at the edge of the opening (arrow).

Diagnostic considerations: The symptoms of vitreous detachment require examination of the entire fundus of the eye to exclude a retinal defect. In cases such as lens opacification or vitreous hemorrhage where visualization is not possible, an ultrasound examination is required to evaluate the vitreous body and retina.

H Vitreous detachment in the region of the attachment at the optic disk (funnel of Martegiani) will appear as a smokey ring (Weiss' ring) under ophthalmoscopy.

Martegiani Ring
Fig. 11.4 The smokey ring appears when the vitreous body detaches from its attachment at the optic disk at the funnel of Martegiani (arrow).

Treatment: The symptoms of vitreous detachment resolve spontaneously once the vitreous body is completely detached. However, the complications that can accompany partial vitreous detachment require treatment. These include retinal tears, retinal detachment (for treatment see Chapter 12, Retina), and vitreous hemorrhage.

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