Abnormal traction of the vitreous detected by swept-source optical coherence tomography is related to the maculopathy associated with optic disc pits.

BACKGROUND: Maculopathy associated with optic disc pits (ODP), which sometimes causes severe visual loss, usually appears in late childhood or early adulthood. However, it has long been unclear how the disease begins to develop at these ages. We evaluated the relationship between vitreous structure and maculopathy associated with ODP. METHODS: Six patients (seven eyes) with ODP were diagnosed between July 1990 and May 2013. Fundus photographs and swept-source optical coherence tomography (SS-OCT) images were evaluated retrospectively, and the vitreous at the vitreoretinal interface was visualized by reconstructing three-dimensional SS-OCT images. Vitrectomy was performed in the eyes with maculopathy. RESULTS: Among the six patients, five had ODP in one eye each and one patient had bilateral ODP. The pits were mainly located in the temporal quadrant, and maculopathy, including retinoschisis and retinal detachment, was detected in five eyes associated only with the temporal pits. A flat retinal detachment was observed in four eyes and identified within the vascular arcade except in one eye. A posterior precortical vitreous pocket (PPVP) was observed in all eyes except in one eye without maculopathy. Reconstructing images from SS-OCT showed the vitreoretinal interface abnormalities around the optic disc and the macular area in all eyes, which was completely different from the vitreoretinal interface in the normal pediatric eye. Vitrectomy was performed in four eyes with retinal detachment to resect the abnormal vitreous traction. Posterior vitreous detachment was created in two eyes. Retinal reattachment was achieved in three eyes, and subretinal fluid receded in one eye. The visual acuity improved in all four eyes. CONCLUSIONS: Abnormal traction of the vitreous due to an abnormality of the vitreoretinal interface, which may be strengthened by the development of a PPVP, generates the maculopathy associated with ODP.

Posterior Precortical Vitreous Pocket in Stickler Syndrome: A Report of Two Cases.

Stickler syndrome is a genetic disorder characterized by collagen abnormalities leading to various ocular manifestations, such as retinal detachment. We present two cases of siblings clinically diagnosed with Stickler syndrome who exhibited retinal detachment. Case 1, a seven-year-old girl, and case 2, her 14-year-old brother, both displayed severe myopia and other clinical signs consistent with Stickler syndrome. Despite their ages, neither case showed evidence of posterior precortical vitreous pocket (PPVP) on imaging or during surgical intervention. These findings suggest a potential relationship between collagen abnormalities and PPVP dysplasia in Stickler syndrome.

Hemorrhagic Macular Cysts in Patients with Terson's Syndrome Observed through an Ophthalmic Surgical Microscope.

The characteristics of hemorrhagic macular cysts (HMCs) in patients with Terson's syndrome, focusing on the vitreoretinal interface observed through an ophthalmic surgical microscope, are described. Between May 2015 and February 2022, 19 eyes (17 patients) with vitreous hemorrhage (VH) occurring after subarachnoid hemorrhage underwent pars plana vitrectomy. After removing dense VH, 2 of 19 eyes had HMCs. In both cases with HMCs, they formed a dome-like shape and were located beneath the internal limiting membrane (ILM), lying beyond the clean posterior precortical vitreous pocket (PPVP) without hemorrhage despite the severe VH. Based on the microsurgical findings, it appears that two types of HMCs consisting of subhyaloid and sub-ILM hemorrhages in Terson's syndrome may be involved in the impairment of adhesion of the posterior border of the PPVP and the ILM surface of the macula due to micro bleeding, and that the PPVP may prevent the sub-ILM type of HMC from breaking into the subhyaloid space and transforming into the subhyaloid type. In conclusion, the PPVP may play an important role in the formation of HMCs in Terson's syndrome.

Microsurgical observation of the posterior vitreous in patients with vitreous hemorrhage caused by Terson syndrome.

PURPOSE: To describe features characteristic of vitreous hemorrhage in patients with Terson syndrome observed through a microsurgical scope. METHODS: Between May 2015 and February 2019, 12 eyes of 10 patients with vitreous hemorrhage occurring after subarachnoid hemorrhage (SAH) underwent pars plana vitrectomy. RESULTS: During vitreous surgery, we found 10 of 12 eyes did not have posterior vitreous detachment (PVD). Furthermore, we observed in 9 of the 10 eyes without PVD (90.0%) that there was no hemorrhage in the posterior vitreous cavity at the posterior pole while we removed vitreous hemorrhage. We confirmed that this clean space could be the posterior precortical vitreous pocket (PPVP). CONCLUSION AND IMPORTANCE: Terson syndrome may have no hemorrhage in the PPVP regardless of the presence of severe vitreous hemorrhage. The cases presented in our study may suggest one of the mechanisms of Terson syndrome.

Vitreous anatomy and the vitreomacular correlation.

The presence of a posterior precortical vitreous pocket, referred to as a precortical pocket, implies that the vitreous cortex is formed into a collagen sheet separated from the gel in the macula. Along with strong vitreoretinal attachment at the fovea, the precortical pocket plays a role in perifoveal posterior vitreous detachments, which may lead to macular holes, premacular membranes, and ring-shaped proliferation in diabetic retinopathy. I and my colleagues published pioneer studies of the vitreous in postmortem eyes. Here, the role of the precortical pocket in various vitreoretinal interface diseases is discussed. Swept-source optical coherence tomography showed development of the precortical pocket, the connecting channel, and Cloquet's canal during early childhood. These findings raised the possibility that aqueous humor may drain into the precortical pocket. The physiologic role of the drainage route is also discussed. Crosstalk between the anterior chamber and macula is an attractive hypothesis and remains to be elucidated.

Impact of swept source optical coherence tomography on ophthalmology.

Swept source optical coherence tomography (SS-OCT) was introduced in clinical practice in 2012. Because of its deeper penetration and faster acquisition time, SS-OCT has the ability to visualize choroid, vitreous, and retinal structures behind dense preretinal hemorrhages. Swept source optical coherence tomography has positively influenced and hugely contributed to the research of the vitreous body. It is the first ophthalmic diagnostic technology to demonstrate the entire structure of the posterior precortical vitreous pocket (PPVP) in vivo. The roles of the PPVP in physiological posterior vitreous detachment and vitreoretinal interface disorders have now been elucidated. The presence of a connecting channel between the PPVP and Cloquet's canal suggests that the aqueous humor drains into the premacular space. Deeper penetration of SS-OCT has made it possible to view the choroid. It also has an important role in central serous chorioretinopathy and uveitis. We have also been able to treat Harada disease by monitoring the choroidal thickness by SS-OCT.

Posterior Precortical Vitreous Pocket in Children.

PURPOSE: The purpose of the present study was to investigate the profile of posterior precortical vitreous pocket (PPVP) in children using spectral-domain optical coherence tomography (OCT) and to compare the profile with that of adults. MATERIALS AND METHODS: In this retrospective comparative study, the height at the fovea and the horizontal diameter of PPVP in healthy children and adults in the upright position were measured based on OCT (Spectralis, Heidelberg Engineering GmbH, Heidelberg, Germany) images. PPVP diameter was divided into nasal length and temporal length based on the center of the fovea. The proportion of temporal length to the entire horizontal diameter was calculated as temporal length/horizontal diameter of PPVP. The association of age with the height and the proportion of temporal length to the entire horizontal diameter were evaluated in each group. The two values were also compared between the two groups. RESULTS: Sixty-three eyes of 63 children (mean age: 6.9 ± 1.8 years) and 44 eyes of 44 young adults (mean age: 32.1 ± 5.3 years) were included. The height of PPVP at the fovea was 355.3 ± 80.3 µm in children and 367.8 ± 75.6 µm in adults. The proportion of temporal length to the entire horizontal diameter was 0.45 ± 0.05 and 0.50 ± 0.03. The proportion was significantly greater in adults than in children (p < 0.001), whereas the height (p = 0.349) was not different between the two groups. In children, there was a positive association between the age and the proportion of temporal length to the entire horizontal diameter (p = 0.001). CONCLUSION: The results suggest a progressive temporal extension of PPVP during childhood.

Vitreous changes in high myopia observed by swept-source optical coherence tomography.

PURPOSE: To observe vitreous changes in high myopia using swept-source optical coherence tomography (SS-OCT). METHODS: We performed slit-lamp biomicroscopy and SS-OCT in the highly myopic right eyes of 151 patients (mean age, 52.7 years; mean refraction, -11.4 diopters [D]) and the right eyes with no myopia of 363 healthy control volunteers (mean age, 52.8 years; mean refraction, -1.4 D). To estimate the sizes of the posterior precortical vitreous pockets (PPVPs), we measured the height between the fovea and the anterior border of the PPVPs. RESULTS: Patients with partial posterior vitreous detachments (PVDs) around the macula and complete PVDs in high myopia were significantly (P < 0.0001) younger (47.1 ± 14.1 and 61.2 ± 12.0 years, respectively) than controls (59.0 ± 9.6 and 69.7 ± 6.6 years). The PPVPs with no PVDs were significantly (P < 0.001) higher in 32 eyes with high myopia (984 ± 292 µm) than 164 controls (553 ± 166 µm). After a complete PVD with a Weiss ring developed, the vitreous cortex was on the macula in 40.5% of the eyes with high myopia, which differed significantly (P < 0.0001) from the 8.7% of the controls. Myopic foveoschisis was present in 14 (9.3%) of 151 eyes. In eyes with foveoschisis, three (21.4%) eyes had partial PVDs and 11 (78.6%) eyes had complete PVDs; there was no residual cortex in 8 (72.7%) of 11 eyes with complete PVDs. CONCLUSIONS: Highly myopic eyes may have larger PPVPs than normal eyes. Partial PVDs around the macula and complete PVDs occur at younger ages. The vitreous cortex more frequently remains on the macula after development of complete PVDs in highly myopic eyes.

Posterior precortical vitreous pockets and connecting channels in children on swept-source optical coherence tomography.

PURPOSE: We observed the posterior vitreous in children using swept-source optical coherence tomography (SS-OCT). METHODS: The normal right eyes of 73 children (ages, 3-11 years) were studied using SS-OCT with 12-mm horizontal and vertical scans in the posterior fundus. RESULTS: Posterior precortical vitreous pockets (PPVPs), narrow liquefied spaces along the vitreoretinal interface in the macula (mean, 165.4 ± 35.2 µm [depth] × 3327 ± 615.7 µm [width]), were observed at age 3 in horizontal scans. The PPVPs enlarged to 382.9 ± 51.8 × 4486.5 ± 342.3 from ages 4 to 6 (P < 0.01) and 524.9 ± 60.3 × 5485.9 ± 307.5 after age 7 (P < 0.01). In all subjects, the depth and width were means of 426.4 ± 38.2 and 4834.4 ± 228.1 µm, respectively. There were significant correlations between the PPVP size and age (PPVP depth, r = 0.42, P < 0.001; PPVP width, r = 0.42, P < 0.001), but not refractive error. The PPVP posterior wall was not visible in all eyes. The PPVP and Cloquet's canal appeared as separate spaces at ages 3 and 4 years. The connecting channel between the PPVPs and Cloquet's developed in 7.7%, 11.1%, 12.5%, 27.3%, 40%, 37.5%, and 50% at ages 5, 6, 7, 8, 9, 10, and 11, respectively. CONCLUSIONS: The PPVPs emerged in front of the macula as a solitary space in early childhood. They first were narrow liquefied spaces anterior to the macula at age 3 and evolved to small boat-shaped spaces that gradually enlarged with age. The channels connecting the PPVPs and Cloquet's canal begin to form after age 5. Their presence suggests a physiologic role of the PPVPs.

Observation of posterior precortical vitreous pocket using swept-source optical coherence tomography.

PURPOSE: To observe posterior precortical vitreous pockets (PPVPs) using swept-source optical coherence tomography (SS-OCT). METHODS: We performed SS-OCT in both eyes of 58 volunteers (36 men, 22 women) using 12-mm horizontal vertical scans through the macula and optic disc. To minimize age-related changes (liquefaction or posterior vitreous detachment), all subjects were a mean of 26.2 years (range, 22-40 years). The refractive errors ranged from -9.5 diopters (D) to +3.0 D. To estimate the PPVP size, we measured the height between the fovea and the anterior border of the PPVP and the maximal width in the 12-mm horizontal scan through the fovea and disc. RESULTS: SS-OCT visualized the PPVPs as boat-shaped lacunae in the macular area bilaterally in all subjects (maximal width, 3114-9887 µm; mean width, 6420.6; central height, 208-1877 µm; mean height, 708.1 in the right eyes, with no significant difference in the left eyes). There was a significant correlation between the PPVP height and myopic refractive error. The posterior wall of the PPVP was a thin vitreous cortex, thinnest at the fovea. The septum was between the nasal border of the pocket and Cloquet's canal, which extended forward and tilted superiorly in all cases. A channel connected Cloquet's canal and the PPVPs bilaterally in 54 (93.1%) of 58 cases. CONCLUSIONS: SS-OCT clarified the boat-shaped PPVP structure in vivo. Although the central height increased with the myopic refractive error, the width was unchanged. A channel connecting Cloquet's canal and PPVP suggested the route of aqueous humor into the PPVP.