The vitreous is the transparent gel that fills the space between the lens and retina. It provides structural support to the eye and allows for a clear optical path. The vitreous can develop various lesions over time, which may be signs of vitreous degeneration or detachment from the retina. Vitreous hemorrhage occurs when blood leaks into the vitreous cavity, which can diminish vision depending on density and requires treatment if non-resolving.

1. Vitreous
Mohamed Abdelzaher MD, FRCS

2. • The posterior segment of the eye between Lens & Retina.

3. • Transparent extracellular gel consisting of
collagen, soluble proteins, hyaluronic acid and
water.
• Some cells are present; Hyalocytes, Astrocytes
& Glial cellss.
• Its total volume is approximately 4.0 ml.

4. 1. Structural support to the eye
2. Allow clear & uniform optical path to the retina
• Vitreous base: 3-4 mm
across ora serrata
• annular attachment
to posterior lens
surface

5. • Weiss ring: around the
edges of optic disc

6. • e.g. lattice degeneration

7. • Fly, cobweb or thread-like lesions best seen against a pale background.
1. Embryological remnants of vitreous cells
2. Vitreous haemorrhage
3. Vitreous degeneration
• If associated with photopsia,
Posterior vitreous detachment
(PVD) or Retinal break is
suspected.

9. 1. Reassurance & observation
2. Vitrectomy: in severe visually disabling cases
3. YAG vitreolysis (Debatable): the laser energy evaporates the collagen
and hyaluronic molecules to form a gas

10. 1. Acute PVD (due to attachment of the vitreous to retinal vascular arcades)
2. Proliferative retinopathy (VEGF) e.g. diabetic retinopathy, Retinal vein occlusion, …
3. CNV: AMD, Myopia, trauma, uveitis, …
4. Trauma
5. Bleeding Disorder

11. 1. Mild haemorrhage; sudden onset of floaters
2. Severe haemorrhage; sudden painless diminution of vision

12. 1. Visual Acuity; diminished according to the
density of haemorrhage
2. Red reflex: dark red or dim
3. Fundus: Vitreous Haemorrhage might
preclude good retinal view

13. • Retinal Detachment
• Retinal edema
• Central Retinal Artery occlusion
• Central Retinal Vein occlusion
• B scan Ultrasound (to exclude
retinal detachment)

14. • Proliferative
Vitreoretinopathy
(PVR)
• Tractional Retinal
Detachment

15. • Treat the cause
• Alpha chymotrypsin
• Vitrectomy, When;
1. Non resolving vitreous
haemorrhage for 3 - 6 months
2. Pre macular haemorrhage
3. Vitreous haemorrhage combined
with retinal detachment

16. Separation of the posterior hyaloid membrane from the retina anywhere
posterior to the vitreous base.
1. Senility
2. High myopia
3. Trauma

17. • Photopsia (flashes of light)
• Floaters
• Ring floater to the temporal side of central vision (Weiss ring)

18. • Retinal break
• Retinal Detachment

19. • Not required in
non complicated
cases
• Retinal Tear >>>
Argon laser
retinopexy
• Retinal
detachment >>>
Vitrectomy

20. • A common degenerative process in which calcium pyrophosphate particles collect
within the vitreous gel
• Commonly Unilateral
• Asymptomatic (do not affect the
vision)
• Numerous tiny round yellow–white
opacities of varying size and density
• Moves with vitreous during eye
movement
• Do not sediment when the eye is
immobile

21. •Occurs as a consequence of chronic vitreous haemorrhage, often in a blind eye
•Crystals are composed of cholesterol and are derived from plasma cells or degraded
products of erythrocytes
• Often blind eye
• Numerous Golden brown refractile
particles of varying size and density
• Anterior chamber may be involved
• Tend to sediment inferiorly when the
eye is immobile

22. Asteroid Hyalosis Synchysis Scintillans
Vision Not affected Often blind
Nature Calcium Cholesterol
Clinically
tiny round yellow–white
opacities
Golden brown refractile
particles
Anterior chamber Not affected May be affected
Sedimentation No Yes