Vitreous

Chapter 14 Vitreous





ANATOMY AND PHYSIOLOGY



Anatomy


The vitreous is a transparent elastic hydrogel (Figure 14-1). It occupies about 80% of the volume of the eye (Figure 14-2). During embryonic development, primary, secondary, and tertiary vitreous are formed and laid down (Figure 14-3). Their genesis is described in detail in Chapter 2. Briefly, the primary vitreous is associated with the hyaloid vascular supply system, which nourishes the lens during development. The secondary vitreous is laid down around the primary vitreous and forms the definitive (adult) vitreous, whereas the tertiary vitreous contributes to the formation of the lens zonules.





The vitreous body is divided into the following zones (Figure 14-4):





4. Central vitreous, including Cloquet’s canal (see Figures 14-3 and 14-4, area 13). Cloquet’s canal, which is a cleft in the vitreous where the hyaloid vasculature passed during embryonic development, is visible with the biomicroscope (see Figure 14-3, B and C).



Composition


Vitreous is a complex gel with the following constituents:






Collagen fibrils form a meshwork internal to the retina (the vitreous cortex) and intermingle with the fibers of the internal limiting membrane of the retina, thus forming a firm attachment between the vitreous cortex and the retina (Figure 14-5). Therefore anterior movement of the vitreous (such as occurs after lens luxation) may pull the retina off the retinal pigment epithelium (RPE) and cause traction retinal detachment. A potential space exists between the vitreous and the inner surface of the retina. Blood and exudates may accumulate in this space if the vitreous and retina separate, resulting in subhyaloid hemorrhage.



The collagen fibrils are also responsible for the numerous attachments of the vitreous to the adjacent structures—the posterior lens capsule, the ora ciliaris retinae (the vitreous base), and the optic nerve head (see Figure 14-4). Collagen fibrils are present in greater concentrations at the vitreous bases and around the optic disc, where attachment is the strongest.


The lens sits in a depression in the anterior face of the vitreous cortex, the hyaloid fossa (patella fossa). Collagen fibrils form attachments between the posterior lens capsule and the anterior vitreous. These attachments are especially significant in dogs. Removal of the posterior lens capsule, as in intracapsular lens extraction, results in loss of vitreous.


Hyalocytes are numerous within the vitreous and are more numerous near the cortex. The functions of these cells are unclear, but they may possess secretory and phagocytic capabilities as well as the potential for reversion to primitive fibroblasts able to form scar tissue. Mucopolysaccharides, containing a high proportion of hyaluronic acid, are intimately related to the collagen fibrils and hyalocytes and are present in higher concentration where hyalocytes are common. Hyaluronic acid provides the viscoelasticity of the vitreous body.


With the exception of collagen and hyaluronic acid, aqueous humor and vitreous are similar in composition, with free movement of many substances between them. The principles that govern entry of substances, including drugs, from the vascular circulation into the aqueous humor generally apply to the vitreous as well.




PATHOLOGIC REACTIONS


Because of its simple structure and lack of vascular and lymphatic supply, the vitreous has a limited range of pathologic reactions, as follows:









Congenital and Developmental Abnormalities



Persistent Hyaloid Artery


The hyaloid artery is part of the embryonic vascular supply of the lens, which is described in Chapter 2. In most species, the hyaloid artery atrophies within a few weeks after birth (see Figure 14-3). An exception is ruminants, in which remains of the artery may be observed in a significant number of adults. However, persistent remnants of varying extent may be found in any species. The remnants of the artery origins on the surface of optic disc, which are surrounded by glial tissue, are called Bergmeister’s papilla (see Figure 14-4, area 11). These appear ophthalmoscopically, end-on, as red to white tufts originating from the optic disc and extending anteriorly a variable distance into the vitreous (see Figure 2-10, B, in Chapter 2). Similarly, at the distal end of the artery, remains of its attachment to the posterior lens capsule may be seen. The remains are known as Mittendorf’s dot (see Figure 14-4, area 4). It does not interfere with vision, except for rare occasions when it induces focal, posterior cataracts. A persistent artery, however, may extend from the disc all the way to the posterior lens. Persistence of the hyaloid artery may be hereditary in the Doberman pinscher and Sussex spaniel. In rats, the hyaloid artery may bleed into the vitreous during normal atrophy.


A persistent hyaloid artery and its attachment to the posterior lens capsule must be differentiated from the following conditions by the following means:








Persistent Hyperplastic Primary Vitreous


Unlike the former two disorders, which involve failure of the hyaloid artery and TVL to regress postnatally, this disorder involves fetal and postnatal hyperplasia of the hyaloid system, TVL, and primary vitreous. Therefore the resulting opacity (which varies in size) is usually more severe. The disorder may occur in cats and in most dog breeds, and it has been demonstrated to be hereditary in the Bouvier des Flandres, Staffordshire bull terrier, and Doberman pinscher. Extensive studies of PHPV in the Doberman pinscher in The Netherlands have shown it to be an autosomal incompletely dominant trait with variable expression.


Clinically PHPV appears as a white or fibrovascular plaque in the posterior pupil near the posterior lens capsule and anterior vitreous (Figure 14-6). Vessel ingrowth and frank hemorrhage into the vitreous and lens substance, calcium deposits, posterior lenticonus, microphakia, lens coloboma, intralental pigmentation, progressive cataracts, and elongated ciliary processes may also be present. Surgery of cataracts associated with PHPV carries a guarded prognosis due to opacification of the posterior lens capsule, the possibility of a patent blood vessel, and the need to combine the surgery with anterior vitrectomy.


Aug 11, 2016 | Posted by in INTERNAL MEDICINE | Comments Off on Vitreous
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