TMOD (Vitreous)

Posterior Vitreous Detachment (PVD)

Liquefaction of vitreous gel (collagen clumping) that cause dehiscence of posterior hyaloid from retina

Risk factors: high myopia, old age

New PVD may be accompanied by retinal break or detachment

May complain of flashes, floaters, blur associated with eye movement

Usually temporal VF and sudden onset

Shafer’s sign is sometimes present

Weiss Ring is diagnostic

Posterior Vitreous Detachment (PVD) Treatment/Manageme

No tx if isolated

NdYAG for chronic bothersome floaters

If new, could be a precursor for a RD

• FU in 1,3,6 months after onset

Educate on symptoms of RD

If no retinal breaks but a mild vitreous heme is present, FU in 1 week, 1,3,6 months

If no retinal breaks but significant vitreous heme is present, urgent referral to retinal specialist within 24 hours

Asteroid Hyalosis

Calcium-phosphate soaps within vitreous associated with aging >60

Presents as yellow-white “asteroids” in vitreous

Moves with eye movement but stays suspended (does not settle inferiorly)

Astroid Hyalosis Treatment/Management

No tx

Vitrectomy in severe cases

Synchysis Scintillians

Rare, usually occurs in a blind eye after chronic vitreous hemorrhage, trauma, or uveitis

Cholesterol crystal

Brownish-yellow refractile crystals

Settles inferiorly (“snow globe effect”)

Synchysis Scintillians Treatment/Management

Observation and possible vitrectomy

Manage high cholesterol

Vitreous Hemorrhage

Occurs when retinal neo grows into the vitreous

Painless vision loss, flashes, floaters

Vitreous Hemorrhage Treatment/Management

If retinal tear or break is present, tx it immediately

Observe bedrest for 2-3 days with head elevated

Avoid anticlotting agents (aspirin and NSAID)

If hemorrhage persist >3 months, tx with vitrectomy