Vitreous Causes Most Retinal Disease

Part 2: Stem Cells to be Safe, Too
February 8, 2012
New Drug Induces Posterior Vitreous Detachment (PVD)
February 23, 2012
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Vitreous Causes Most Retinal Disease

The vitreous is the culprit in just about every surgical retinal disease. A PVD is sometimes dangerous, but may prevent many retinal diseases.

The vitreous causes most diseases of the retina.

Retinal tears, retinal detachments, macular holes, epiretinal membranes, macular edema, vitreomacular traction, diabetic retinopathy, diabetic macular edema and diabetic retinal detachments are all related to the vitreous.

We suspect even wet macular degeneration may play a role as well, but there is no conclusive evidence.

Even floaters, though not necessarily a disease, can be caused by abnormal optical properties of the vitreous.

Retinal Tears and Retinal Detachments

The vitreous is physically attached to the retina.  If you divide the eyeball into a front half and back half while looking straight at the eye, the vitreous and retina are most adherent in the front half.

A PVD, or posterior vitreous detachment, means that the watery gel has separated from the retina in the back half of the eye, or, the “posterior vitreous.”

Rhegmatogenous Retinal Detachment with Retinal Tears or Holes

Front Half (Grey Ring), "Posterior" Half (Central Grey Ring)

 

The anterior half remains adherent to the retina.

Hence, if enough force is generated through the vitreous and pulls on the retina, a retinal tear develops and is almost always in the front of the eye.

Retinal tears can cause retinal detachments.  This is why I often recommend a vitrectomy in patients with multiple tears.  By removing the vitreous, I am removing the causative agent.

Epiretinal Membranes and Macular Holes

In most cases of epiretinal membranes, a PVD has occurred.  In most cases of macular holes, a posterior vitreous detachment has not occurred.

Macular Edema

Swelling of the macula from various causes, but including diabetic retinopathy, usually occurs before a PVD occurs, that is, the vitreous is still adherent to the macular region.

What Does this Mean?

In many cases,  a posterior vitreous detachment can be dangerous, as in the case of a retinal detachment or retinal tear.

In many more cases, a PVD might be “therapeutic.”

There is no conclusive proof, but separation of the vitreous interface can sometimes prevent macular edema, is probably going to be shown to reduce diabetic macular edema, may prevent retinal detachment from proliferative disease and may prevent two other conditions called vitreomacular traction (VMT) and macular holes.

Presently, a posterior vitreous detachment is a purely natural event, that is, it happens to everyone.  Surgically, a posterior vitreous detachment can be induced, or caused, at the time of vitrectomy surgery.  This can be a risky part of the procedure as inadvertent retinal tears may develop.

In theory, however,  many of the aforementioned conditions might be avoided altogether or at least improved…leading to better vision or preventing further loss.

On the horizon, an enzyme, given as an injection that might chemically cause a PVD.

 

Comments
  • Michael N. Martino February 18, 2012 at 10:40 pm

    Dear Dr. Wong,
    I am trying to send you photos, drawings, and specifications of the face brace that I made for my wife, Mary Butler, to help her recover from retinal detachment surgery. Please provide your email.
    Best Regards,
    Mike Martino

  • Liz February 22, 2012 at 6:43 am

    Hi there! My 16 yr old son was born with a congenital cataract in his right eye. His left eye, however, had excellent vision. We made the agonising decision not to remove the cataract as we did not wish to run the risk of any other complications this would bring. Rather we patched his ‘good’ eye and tried to encourage some sight with a contact lens inserted daily until he was 7. Unfortunately his vision in this eye has never really improved beyond light and dark shade but he has managed to lead a normal life with his vision in the other eye. Recently he has become short sighted however and on routine check up, an ultrasound revealed a probable RD. One retinal surgeon has stated he is keen to attempt to rectify this ASAP in order to save the eye not his vision, another of his colleagues disagrees and says we run more of a risk interfering with the eye and the risk outweighs the benefits in this case. He says that it is not definite that he may even lose the eye. This puts us in a dreadful position as you can imagine. I would be interested in your thought. Thank you

    • Randall V. Wong, M.D. February 22, 2012 at 12:44 pm

      Dear Liz,

      I am assuming that the bad, right eye, now has the retinal detachment?

      My understanding is that the right eye has low visual potential. Regardless, I think I’d vote for fixing the retinal detachment to save the eye. I also agree it won’t improve the vision.

      Randy

  • John Shybeck February 22, 2012 at 2:23 pm

    Hello Randall,

    I have floaters in my eye that are semi-transparent. They are super abundant in my left eye and I want to get rid of them because they are just a pain. I have had them for about 4 years now and they have just gotten worse. Is there any chance that they will go away on there own?

    Thanks,
    John

    • Randall V. Wong, M.D. February 23, 2012 at 9:15 am

      Dear John,

      If they have been there for 4 years, most likely they are staying.

      Randy

  • milos April 5, 2012 at 7:57 pm

    I have fresh retinal bleeding after cataract extraction.- previously dry mac degen now defect at 9.
    I like your mental speed-attitude – however you frawn on PDT treatment.
    Would it not (logically) be bertter for acute cases? – or why not ?
    Thanks for your hint. Depressed Milos .

    • Randall V. Wong, M.D. April 8, 2012 at 5:49 pm

      Dear Depressed Milos,

      Don’t be depressed. Depending upon the location of the bleed (actually the location of the blood vessels causing the bleed), Avastin is probably the preferred method. PDT might be useful, too. Not really comparing the two.

      Randy

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