Vitreous Humor

 Today I'm going to talk about vitreous

opacities and vitreous floaters so I

wanted to express some gratitude for a

couple people one is Lilian in our

office who has helped us extensively

with our presentations and I'm really

grateful to her for that and this is a

picture of her here and also I'd like to

express gratitude to Geri seabag who is

a virtual retinal surgeon in California

who has been a pioneer in vitreous

opacities and floaters  and not only

is he a a very erudite and sophisticated

person but he is he has been

consistently and politely pushing this

field forward for many decades

particularly given the attitude that

many of us have towards patients with

floaters and dismissing their symptoms

and he's been very gently and

persistently moving the field in the

right direction so first we'll start

with vitreous Anatomy and over here on

on the Left panel you can see a autopsy

eye in which the choroid the sclera was

removed and the choroid was detected

anteriorly and then the vitreous base

was the second off of the retina and you

could see that early in life the

vitreous gel is firm it's very clear and

and it's it has a structure.

It doesn't

just collapse when you set it on a on a

surgical cloth and if we look at the

iron cross section we can see that the

the vitreous emanates from the aura

sirata and it's always connected to this

space during life there's a little space

right here and then the vitreous is

connected to the lens and this space

here behind the lens that posterior

capsule is called Berger space or the

retro mental space of galette

there are fibers that extend up to the

pars plana and even the pars Picatta and

these aren't shown on this diagram but

we know that those exists because when

we're opera

patients with proliferative retinal

diseases we can see contraction with the

retina actually gets pulled from here up

onto the ciliary body and by coming

across with a cutter in shaving those

vitreous bands we can release that

traction

there's cloak haze canal which emanates

from the disk and if we blow the space

up here we can see this this area a

little better there's this little space

here a little space behind the capsule

and then this type adhesion between the

anterior vitreous face and the posterior

capsule and this is why cataract

surgeons get vitreous loss when they

break the posterior capsule it isn't

because they're you know going crazy

back here it's it's because whenever the

capsule is torn it often actually

breaches the vitreous phase right here

if we look during development at a

neonatal or our embryonic eye we see the

the lens with the embryonic nucleus and

the fetal nucleus and then we see the

tunic of a skull osa lentes which is

contiguous with cloakers canal and this

branch of vessels and this regress is

overtime and forms a a little tuft in

adults this is a a embryonic or neonatal

lens and when we do retinopathy

prematurity exams which I don't do

anymore but I did when I ran the

neonatal intensive care unit service at

Parkland Memorial Hospital in Dallas we

can see these these lenses these blood

vessels on the lense in fact when we're

doing laser for retinopathy prematurity

we try to avoid the bigger lenses into

order to avoid causing a sub capsular

cataract and here is an example of a

incompletely regressed Bergmeister is

patella the remnant of the Clos case

canal and this is a picture from dr.

Henry Kaplan who is a famous

ophthalmologist in Louisville

specializes specialists and many things

including you be honest so here are some

some work where we're comparing an

embryonic vitreous

to a middle-aged vitreous to an aged

vitreous and one of the problems we have

with examination of the vitreous is that

the optics aren't ideal we're unable to

get the slit arm far enough over to

examine the posterior vitreous

effectively because of the optics of the

pupil and if we take the vitreous out

and then look at it with these effects

we can create what's called a Tyndall

effect and we can see that in the

e