Modern Possibilities for the Vireoretinal Interface Contrasting (Experimental Study)

The contrast agents in vitreoretinal surgery are necessary to ensure the visualization of translucent and ultra-thin membranes and vitreoretinal interface (VRI) structures, but the ideal staining agent has not been found yet.Purpose. To investigate and compare staining properties of two vital dyes for vitreous body (VB) and vitreoretinal interface visualization: “Kenalog-40” and “Vitreocontrast”.Patients and methods. The study was performed on 20 cadaveric eyes. After eyeball dissection with the original technology, we carried out posterior vitreous cortex separation and comparative staining of retinal fragments on the side of VB and corresponding section of the VB by “Kenalog-40” and “Vitreokontrast”. Vitreo-retinal interface samples underwent morphological analysis.Results. In contrast to «Kenalog-40», «Vitreocontrast» enables the visualization of thin layer of VB on retina surface after splitting of cortical layers during posterior vitreous detachment induction. Upon that, the adherent particles of the “Vitreocontrast” suspension remained on the corresponding splitted fragment of the VB. After staining with “Kenalog-40”, the VB surface remained smooth, shiny, with no visible changes. The results of histological examination of the obtained retinal and VB samples confirmed the presence of VB layer on the retina surface at the site of vitreoshisis formation during the induction of posterior vitreous detachment.Conclutions. Received data confirm the possibility of vitreoshisis formation during posterior vitreous body detachment, and demonstrate the advantages of the staining properties of the “Vitreokontrast” suspension for visualization of fine structures of vitreoretinal interface.

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The Pathophysiology of Vitreomacular Interface Disease

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0097 ◽

2018 ◽

pp. 224-230

Keyword(s):

Surgical Treatment ◽

Posterior Vitreous Detachment ◽

Vitreous Body ◽

Treatment Modalities ◽

Clear Understanding ◽

Vitreoretinal Interface ◽

Vitreous Detachment ◽

Vitreomacular Interface ◽

Anomalous Posterior Vitreous Detachment

Anomalous posterior vitreous detachment is an important step in the pathogenesis of vitreoretinal interface diseases. In order to understand the pathophysiology of vitreoretinal interface diseases, the structure and biochemistry of the vitreous body, and its relation with the retina should be investigated. Having a clear understanding of the pathophysiology of these diseases may help to develop new pharmacologic or surgical treatment modalities.

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Anatomic and Topographic Vitreous and Vitreoretinal Interface Features in Proliferative Diabetic Vitreoretinopathy

Ophthalmology in Russia ◽

10.18008/1816-5095-2020-2-249-257 ◽

2020 ◽

Vol 17 (2) ◽

pp. 249-257

Author(s):

N. M. Kislitsyna ◽

S. V. Novikov ◽

S. V. Kolesnik ◽

A. I. Kolesnik ◽

M. P. Veselkova

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Imaging Techniques ◽

Posterior Vitreous Detachment ◽

Vitreous Body ◽

Diabetic Patients ◽

Vitreoretinal Interface ◽

Posterior Cortex ◽

Vitreous Cortex

The role of the vitreous body and vitreomacular interface (VMI) is key in many processes including proliferative diabetic retinopathy (PDR). In PDR patients, the VMI changes can significantly influence the emergence and progression of the disease. There are multiple factors at work in the VMI including taut posterior cortical layers, vitreoschisis, posterior vitreous detachment (PVD), and vitreous adhesions. But there is no general consensus about their role in proliferative complications. Further understanding the VMI relationship in a case of PDR is warranted in order to design better treatments, to arrest and possibly even reverse progression of PDR. Today there is no imaging techniques to determine normal vitreous and VMI interactions in different PDR stages intraoperatively. Purpose: to analyze intraoperative vitreous and vitreoretinal interface features during chromovitrectomy in patients with A-C stages of PDR. Patients and methods. Seventy-four diabetic patients (74 eyes) were included. We performed standard 25 Gauge pars plana vitrectomy using Vitreocontrast for vitreous and vitreoretinal interface (VRI) visualization. Intravitreal “Vitreocontrast” suspension is the most favored agent of those studied and it is increasingly used as an adjunct during surgery to delaminate fine tissue planes and pockets of formed vitreous and VRI structures that may not be visible with routine operative illumination systems, or using modern vital dyes. Results. “Vitreocontrast” suspension allows to visualize posterior cortex changes during different stages of PDR. We investigated vitreous and VRI anatomy, topography and structure and determined safety of retrociliary and equatorial cisterns walls in 97 % in stage A of PDR, 95 % in stage B and in 82 % of stage C. In 3–5–18 % cases, correspondently, we determined disorganization of some vitreous cisterns. In 94 % cases of PDR A and 96 % cases of PDR B we visualized preretinal vitreous layer in a central macular zone, within the boundaries of vascular arcades. It has specific topography and strong adhesion to the internal retinal membrane. It’s the first time when this new vitreous cortex layer was revealed. The presence of this layer is the result of a strong vitreomacular adhesion that causes the posterior vitreous cortex split as it attempts to detach from the inner retinal surface. Such outermost layer remains attached to the macula and can induce further proliferation process. On a stage B of PDR this area correspond with multiple vitreoschisis, on a stage C of PDR — with fibrovascular membrane. The complete PVD was revealed in 61 cases. Conclusion. In this article we analyze the results of surgical treatment in 74 patients with A-C stages of proliferative diabetic retinopathy. Newer imaging technique with new dye — suspension “Vitreocontrast” allows to detect sensitive relationships of vitreous and VRI in each stage of the disease. The role of vitreous body in this process gives us a reason to consider it as an important object for further research. Moreover, the understanding of their relations in different stages of PDR enables to develop optimal surgical approach on each stage of PDR.

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Macro-Microscopic Study of Posterior Vitreous Detachment Variants in an Ex Vivo Experiment

Fyodorov journal of ophthalmic surgery ◽

10.25276/0235-4160-2020-4-50-55 ◽

2020 ◽

pp. 50-55

Author(s):

N.M. Kislitsyna ◽

◽

A.V. Shatskikh ◽

S.M. Dibirova ◽

D.M. Sultanova ◽

...

Keyword(s):

Ex Vivo ◽

Posterior Vitreous Detachment ◽

Vitreous Body ◽

Internal Limiting Membrane ◽

Original Method ◽

Layer By Layer ◽

Cortical Layers ◽

Vitreoretinal Interface ◽

Boundary Area ◽

Vitreous Detachment

Purpose. The key to understanding the development of any vitreoretinal pathology is a presence of a clear conception to possible variants of changes in the anatomical and topographic relationships of the posterior cortical layers of the vitreous body and the retinal internal limiting membrane (ILM) in a formation of posterior vitreous detachment (PVD). An original method of macro-microscopic examinations of anatomical objects proposed by professor V.P. Vorobyov, which includes investigations of morphological objects whose dimensions lie in the boundary area between macroscopic parameters studied by anatomists and microstructures studied by histologists, discover a new boundary area for the study of anatomical structures. However, it has not been practically used in ophthalmology until now. The study of a process for changes in the vitreoretinal interface during the PVD occurrence is difficult due to a complexity of simulation, a possibility of visualization, and an absence of approved protocols for macro-microscopic research. Purpose. To study variants of anatomical and topographical changes in the vitreoretinal interface during the formation of induced PVD in ex vivo experiments using the method of macro-microscopic examination. Material and methods. The study was performed in 24 eyeballs of cadaver donors. To assess changes in the vitreoretinal interface in the process of PVD induction, an original method of dissection was used, that allows to isolate layer-by-layer the cortical layers of the vitreous body and the retinal ILM, with a possibility of further evaluation of changes in the vitreoretinal interface by the macro-microscopic examination. Salt barium sulfate suspension Video-contrast was used with the purpose to contrast vitreous fibers. Macroscopic investigation was carried out using the Topcon OMS-800 operating microscope with an indication from x8 to x21 magnification, microscopic changes were evaluated by the light microscopy method with x50, x100, x200, x400 x630 magnification using the Leica DM LB2 microscope with the subsequent photo registration. Results. During the macro-microscopic study, three variants of possible changes in the vitreoretinal interface during the development of induced PVD were revealed, which were interpreted as the normal (true) PVD and abnormal PVD, which occurred both with the formation (the variant A) of vitreoschisis zones (exfoliation of the cortical layers of the vitreous body) and with the zones of retinal ILM exfoliation (the variant B). Conclusion. The proposed method of macro-microscopic investigation of the vitreoretinal interface allows to dissect isolated sequentially layer-by-layer the cortical layers of the vitreous body and the retinal ILM with subsequent fixation on a special substrate according to the original method and the possibility to carry out a histological section and its evaluation by the light microscopy method. The application of the developed method allows to accurately assess changes in the vitreoretinal interface on any isolated site of the vitreoretinal surface. The presented work demonstrates possibilities for the application of the method to detect variants of changes in the vitreoretinal interface within the formation of induced PVD. Keywords: posterior vitreous detachment, internal limiting membrane, dissection of the vitreous body, vitreoretinal interface.

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Risk Factors for Residual Vitreous Cortex at the Fovea after Posterior Vitreous Detachment during Vitrectomy in Ocular Trauma

Journal of Ophthalmology ◽

10.1155/2019/4312958 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Anan Wang ◽

Zhenquan Zhao ◽

Qihua Xu ◽

Yaohua Wang ◽

Hongfei Liao

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Ocular Trauma ◽

Posterior Vitreous Detachment ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Vitreous Detachment ◽

Vitreous Cortex

Purpose. To investigate the frequency and patterns of the residual vitreous cortex (RVC) at the fovea after posterior vitreous detachment (PVD) during vitrectomy after ocular trauma and the risk factors associated with its occurrence. Methods. A cross-sectional, multicenter, and observational study was conducted in 72 consecutive patients who underwent pars plana vitrectomy after ocular trauma. In patients with PVD after vitrectomy, RVC patterns were visualized using triamcinolone acetonide staining and were classified as diffuse or focal. A multivariate logistic regression analysis was performed to evaluate the association between RVC and various factors, such as the patient’s age, preoperative visual acuity, days after injury, the existence of spontaneous PVD, and the type of injury prior to vitrectomy. Results. Of the 72 eyes with trauma, 35 eyes (48.6%) showed RVC on the macula, of which 19 (54.3%) were of the diffuse type and 16 (45.7%) were of the focal type. A multivariate logistic regression analysis showed that age (OR = 0.933, P=0.025) and days after injury (OR = 0.862, P=0.013) had a significant impact on RVC. Conclusions. RVC at the fovea is very common after spontaneous or surgical PVD during vitrectomy. Younger patients are more likely to show RVC if vitrectomy is performed soon after injury.

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Age-related changes of the vitreous body

Kazan medical journal ◽

10.17816/kmj2018-170 ◽

2019 ◽

Vol 100 (1) ◽

pp. 170-174

Author(s):

S D Stebnev ◽

V S Stebnev ◽

I V Malov ◽

V M Malov ◽

E B Eroshevskaya

Keyword(s):

Posterior Vitreous Detachment ◽

Vitreous Body ◽

Vitreous Detachment ◽

Age Related ◽

Macular Holes ◽

Retinal Disorders ◽

Viscoelastic Structure ◽

Idiopathic Macular Holes ◽

Strength And Plasticity ◽

Age Related Changes

Innovative advances in recent years in the study of pathological changes of the posterior segment of the eye including the use of optical coherence tomography which is considered the gold standard for diagnosing vitreoretinal interface pathology, not only significantly expanded the idea of the most prevalent lesions of the structure of posterior eye segment but also discovered absolutely new aspects of their pathology. The review emphasizes the spreading understanding of vitreous body, its age-related changes in the pathology of the posterior eye segment. Two main interrelated processes occurring in the vitreous body - synchysis and syneresis, gradually increasing with age, are considered. Synchysis process begins at the early age and by the age of 70 reaches 50% of the volume of the vitreous body in 70% of the population. Parallelly, syneresis provides strength and plasticity of the entire vitreous volume due to collagen involved in formation of fibrillar frame. An important role in maintaining a stable and viscoelastic structure of the vitreous body, belonging to hyaluronic acid, is discussed, the level of which remains relatively stable at any age due to its constant synthesis. The accumulated data on the structure of age-related and pathological biodegradation of the vitreous body demonstrates inevitable progression of this process leading to age-related posterior vitreous detachment, which is a detachment of the posterior cortical layers of the vitreous body from subjacent retina. Posterior detachment under the influence of age-related changes in the vitreous body has certain stages - from incomplete juxtafoveolar detachment to complete posterior vitreous detachment with clinical retinal changes corresponding to each stage (idiopathic macular holes, lamellar macular tears, macular fibrosis, vitreomacular traction syndrome, myopic foveoschisis). Complete posterior vitreous detachment usually does not cause anatomical retinal disorders and any clinical forms of its diseases, thus, it can be considered as a natural favorable outcome.

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Vitreous Substitutes: The Present and the Future

BioMed Research International ◽

10.1155/2014/351804 ◽

2014 ◽

Vol 2014 ◽

pp. 1-12 ◽

Cited By ~ 38

Author(s):

Simone Donati ◽

Simona Maria Caprani ◽

Giulia Airaghi ◽

Riccardo Vinciguerra ◽

Luigi Bartalena ◽

...

Keyword(s):

Adverse Effects ◽

Vitreous Body ◽

Vitreoretinal Surgery ◽

Inflammatory Reactions ◽

Vitreous Substitute ◽

The Past ◽

The Future ◽

Vitreous Substitutes ◽

The Ideal

Vitreoretinal surgery has advanced in numerous directions during recent years. The removal of the vitreous body is one of the main characteristics of this surgical procedure. Several molecules have been tested in the past to fill the vitreous cavity and to mimic its functions. We here review the currently available vitreous substitutes, focusing on their molecular properties and functions, together with their adverse effects. Afterwards we describe the characteristics of the ideal vitreous substitute. The challenges facing every ophthalmology researcher are to reach a long-term intraocular permanence of vitreous substitute with total inertness of the molecule injected and the control of inflammatory reactions. We report new polymers with gelification characteristics and smart hydrogels representing the future of vitreoretinal surgery. Finally, we describe the current studies on vitreous regeneration and cell cultures to create new intraocular gels with optimal biocompatibility and rheological properties.

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Negative staining of the vitreous with the use of vital dyes

European Journal of Ophthalmology ◽

10.5301/ejo.5000968 ◽

2017 ◽

Vol 28 (1) ◽

pp. 117-118 ◽

Cited By ~ 2

Author(s):

Cesare Mariotti ◽

Michele Nicolai ◽

Simone Donati ◽

Michele Reibaldi

Keyword(s):

The Netherlands ◽

Salt Solution ◽

Epiretinal Membrane ◽

Posterior Vitreous Detachment ◽

Posterior Hyaloid ◽

Vitreous Detachment ◽

Vital Dye ◽

Inner Limiting Membrane ◽

Vitreous Cortex ◽

Light Probe

Purpose: The vitreous cortex, epiretinal membrane (ERM), and inner limiting membrane (ILM) are transparent tissues and are thus difficult to visualize. Staining these structures can increase the efficiency of a nontraumatic removal. Methods: The surgeon performs a partial core vitrectomy and induces a posterior vitreous detachment. The vital dye is then injected into the retrohyaloid space in balanced salt solution (BSS). The dyes used are TWIN (Alchimia srl, Padova, Italy), MembraneBlue-Dual (DORC International, Zuidland, the Netherlands), and Doubledyne (Alfa Intes, Casoria, Italy). The surgeon can complete the vitrectomy and gradually aspirate the dye with the probe. Once the vitrectomy is complete, the surgeon can perform the peeling of the ERM without the need to reinject the vital dye over the macula. Results: The presence of the dye over the macula facilitates visualization of the vitreous cortex by blocking the red reflex and increasing the contrast power of the coaxial light probe during the vitrectomy. This allows a negative coloration of the vitreous because the dye acts by increasing the visibility of the surrounding BSS and not the vitreous itself. Conclusions: We describe a new chromovitrectomy technique using the same dye to increase the visualization of the vitreous, posterior hyaloid, ERM, and ILM.

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