Lecture 1

Question 1

The vitreous makes up how much of the ocular volume

Answer 1

75%

Question 2

Is the vitreous considered a CT

Answer 2

Yes

Question 3

Make up of the vitreous

Answer 3

1. 99% water
2. Collagen, type 2. AKA Vitrosin.
3. GAGs, help keep spacing
   - Hyaluronic acid (gel)
   - Chrondroitin sulfate
4. A few cells, inorganic salts, and soluble proteins.

Question 4

Another name for collagen

Answer 4

Vitrosin

Question 5

Attachment of the vitreous to the back of the lens

Answer 5

Weigers adhesion/ligament is the attachment at the back of the lens in a circle. Creates eggers line on the posterior capsule.
Directly behind the lens, in front of the vitreous, is bergers space

Question 6

Strong to weak attachemnts

Answer 6

1. Vitreous base
2. Posterior lens
3. Optic disc
4. Macula
5. Vessels

Question 7

The vitreous is __x as viscous as water

Answer 7

4

Question 8

Combination of which 2 things causes elasticity in the vitreous

Answer 8

Collagen and Hyaluronic acid

Question 9

Vitreous liquefaction/synchysis seniles occurs when what happens ?

Answer 9

Hyaluronic acid depolymerizes- less gel, more water (lacunae) uneven spacing between collage – > aggregation makes visible bundles of fibers

Begins in the center.

Question 10

Vitreous liquefaction/synchysis seniles before age 50 and after age 80. How much liquid?

Answer 10

Before age 50, 25% liquid

After age 80, 62% liquid

Question 11

Syneresis

Answer 11

Shrinkage of the vitreous as solids and liquids separate

Question 12

Fibriliary degeneration

Answer 12

Liquefaction and syneresis

Question 13

Vitreous condensation

Answer 13

collagen fibers are drawn together

Question 14

Essention phenom of coloquets

Answer 14

Dynamic. Have pt look up and then down. Can see it moving due to liquefaction.

Question 15

Liquefaction starts earlier in what type of patients

Answer 15

Myopes and those with thin retinas

Question 16

PVD commonly occurs in what age and gender

Answer 16

Females older than 45

Question 17

Causes of PVD

Answer 17

Age
High myopia
Trauma
Inflammation - speeds up fibrillation process
Aphakia - no more anterior attachment to lens
Cataract surgery
Vitreoretinal degeneration

Question 18

How to differentiate complete and incomplete PVD

Answer 18

Complete- presence of weiss ring

Question 19

Tobacco dust/Schafers sign

Answer 19

RPE pigment due to liquefied vitreous disrupting bonds. Know there was a retinal break. 
Should not occur with PVD unless there is a break 
Always document (-) in chart 

When present, 52x more likely to have retinal break

Question 20

Complications of PVD

Answer 20

1. VMT–> Edema –> Hole
2. Vitreous hemorrhage
   - If a PVD causes a vitreous hemorrhage, there is 75% chance it also caused a retinal break
3. Retinal break
   - Tobacco dust/shafers (when present, 52x more likely to have a retinal break)
   - 1/3 of symptomatic retinal breaks progress to RD
4. Retinal hemorrhage

Question 21

What causes flashes and how many people report this when they have a PVD?

Answer 21

Traction causes physical stimulation of the photoreceptors.

Question 22

If a PVD causes a vitreous hemorrhage, there is 75% chance it also caused

Answer 22

a retinal break

Question 23

___ of symptomatic retinal breaks progress to RD

Answer 23

1/3

Question 24

f/u schedule

1. No retinal break or heme?
2. No break but mild vitreous heme or peripheral hemes are present
3. No break but significant vitreous heme or tobacco dust present

Answer 24

1. See back in 3 weeks, 3 months, 6 months
2. Repeat in 1 week, 3 weeks, 3 months, 6 months
3. Refer to retina

Question 25

marfan syndrome ocular findings

Answer 25

``` ST subluxation Axial myopia Small k diameter Increased risk of retinal detachment Vit degen ```

Question 26

Syndrome that has a mutation in the fibrillan genes

Answer 26

Marfans

Question 27

Ehlers Danlos ocular findings

Answer 27

``` High myopia Micro K --> Glaucoma Angiod streaks Lattice (vitreoretinal degeneration) Ptosis Strab ```

Question 28

Anterior vitreous detachment is usually due to? Associated with what else? How to manage?

Answer 28

- Trauma or lens dislocation. - Associated with retinal break due to high degree of trauma - Look for tears or dialysis. If no break, follow up in 1 year.

Question 29

Asteroid hyalosis incidence in the pop? | What is it?

Answer 29

1% Calcium, phosphorous, oxygen, and lipid suspensions- adherent to the vitreous framework. Suspended throughout the collagen fibrils.

Question 30

Asteroid hyalosis differential

Answer 30

Synchysis Scintillans - cholesterol crystals. Occurs in severely blind eye. Settles after movement, reflective, may cause pseudo hypopyon.