Vitreous body damage

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Symptoms

Vitreous body damage is manifested as tiny dark spots, spot clusters, webs, or threads floating in front of the eye. They become more prominent when looking at light backgrounds. Their occurrence and intensity is variable, sometimes almost unperceivable, other times very annoying or even obstructing vision until the spots float away.

Causes

The causes are age-related or degenerative changes in the vitreous body. The vitreous body is a transparent colorless jelly mass comprising a thin fibrous structure that fills two thirds of the inner eyeball space behind the lens. It slightly defibrillates and squeezes with age, thus causing detachment of the vitreous body from the retina and forming tiny floating cataracts projecting shadows onto the retina. The patient senses them as floaters in front of his eye. Despite the fact that they are annoying, they do not usually mean any serious health problem. Only with the exception of cases when the floaters appear suddenly and massively. In that case, the cause might be slight bleeding into the vitreous body as a result of a tear in the retina.

Examination

A doctor examines the inner eye using a slit lamp. A slit lamp is a special microscope allowing to the eye to be seen and its parts to be examined in detail. It is a pain-free procedure. You will be seated in front of the device with your forehead and chin leaned against a special construction and the doctor will examine both of your eyes. Sometimes it is necessary to apply special drugs in the form of drops to dilate your pupil (artificial mydriasis). Shortly after the exam (a maximum of a few hours), you might experience worsening of your vision or higher light sensitivity due to the previous pupil dilatation. Therefore, we strongly recommend no driving immediately after the examination. However, the above mentioned symptoms will wear off when the drug effects disappear.

You will be examined by an ophthalmoscopy – directly or indirectly. In both cases, it is an examination that does not cause you any difficulties or discomfort. The direct ophthalmoscope is a handheld device that the doctor shines into your eyes by means of an inbuilt light. In indirect ophthalmoscopy, a doctor will wear a binocular device containing a light source as well. A special form of an indirect ophthalmoscopic exam is biomicroscopy, used for examining the eye background – the retina. It is done also pain-free using a slit lamp while a doctor holds an ophthalmoscopic lens in front of your eye. We use a Volk Macular 90 D or 78 D lens in our clinic.

Conservative treatment

For non-surgical treatment of the vitreous cataracts, a doctor can prescribe eye drops containing healing substance of potassium iodine, which stimulate and increase metabolic changes in the vitreous body, increase the solubility of blood clots and slightly decrease blood clotting. Thus, it inhibits the absorption of the vitreous cataracts. However, long-term usage of potassium iodine is essential in order to achieve lasting effects. Otherwise, it is not very effective.

Surgical treatment

Pars plana vitrectomy

Pars plana vitrectomy is a surgical procedure in which vitreous body or membrane opacification is cured together with bleeding into the vitreous body. It is done under a local anesthesia while a doctor observes the whole procedure under a microscope. The devices are inserted into the eye through the ciliary body, a circular structure at the front of the eye serving to maintain the proper position of the lens and for accommodation. Then the diseased vitreous body is removed and replaced by the infusion of a salty solution.

Two surgical procedures are used: stitch and non-stitch vitrectomy. The former includes a cut of 0.9–1 mm in the ciliary body area by using a special knife. The diseased vitreous body is cut off and sucked out. It lasts about 30 – 60 minutes. The wound is finally sewed up with self-dissolving sutures.

Non-stitch vitrectomy is an economical and unique method done only according to the preciously defined indications, e.g. in certain vitreous cataract types or in case of a macular hole. The procedure takes no longer than an hour. The advantage is non-complicated healing and due to the small cut, which is thinner than 0.8 mm, stitches are not needed. Therefore, the postoperative rehabilitation is much shorter.

Surgery is done on an outpatient basis. The pain is suppressed by analgesics. Irritation and eye reddening fade away a few days after the operation. Follow the doctor’s advice and apply into your eyes the prescribed drops or ointments.

YAG laser treatment of clouding in the vitreous body

Drops dilate the patient’s pupil and the eye is anesthetized. Consequently, a special lens is attached onto the eye and the doctor aims the laser on the vitreous cataracts and burns the cataract away. The surgery is done on an outpatient basis. The only condition is that the cataract must occur at least 3 mm away from the retina or lens.

 

Equipment/device used

Slit lamp

A slit lamp is a special binocular microscope that allows the inner eye and its part to be seen and examined in detail, mainly the cornea, anterior eye chamber, iris and lens. For better visualization, it is sometimes necessary to apply drops to dilate the pupil. In our clinic, we use a device from the Alcon and Rodenstock companies containing an inner digital camera that enables high quality images or video to be fed directly into the doctor’s PC.

Ophthalmoscope 

An ophthalmoscope ("eye-mirror") is a piece of equipment used to exam the inner eye structures, mainly the eye background, choroid, retina and optic nerve. A direct ophthalmoscope is a handheld device with a source of light that penetrates the eye through the retina and allows the inner eye to be examined (the examined visual field is around 5–8°). An indirect ophthalmoscope, on the other hand, is a binocular device that constitutes a light attached to a headband, in addition to a small handheld lens. This device uses a specially modified light source and an accessory lens that is held in front of the patient’s eye. The lens induces real but inverted images of the observed structures (the examined visual field is around 45°). We use a device from the Heine Company in our clinic.

OCT device (Optic Coherent Tomography)

This is a modern diagnostic device used for a detailed, pain-free examination of the eye background, individual retina layers, nerve fibers and the optic nerve without taking a surgical sample abstract and without direct eye contact. Sometimes drops are administered to dilate the pupil to enable better visualization. OCT is an optic device operated by a PC. It generates colorful, cross-sectional images with a very high resolution of the individual structures and layers (in micrometers) of the examined tissues by means of infrared (IR) radiation, which uses a short coherent wavelength. It even permits 3D images and spatial relevance of the examined eye to be evaluated. We use a device from the Carl Zeiss Company in our clinic.

YAG laser

It is currently the most common firm fiber laser type (the active crystal material is Yttrium Aluminium Granate) used in many medical fields. Concerning ophthalmology, it is used mainly to remove secondary cataracts. A small opening is made by a laser in the posterior lens capsule, which allows sharp vision to be regained. Furthermore, the laser can be used to create an opening in the iris while decreasing the inner eye pressure. In our clinic, we use a Carl Zeiss YAG laser.

Vitrectom

This is a device used for operating on the posterior segment of the eye. It is a high-frequency mini-knife that serves for removal of the vitreous body and other damaged tissue. It is not necessary to sew up the wound afterwards. Vitrectom is operated by a PC, which provides the maximum amount of safety throughout the procedure.

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