|Year : 1984 | Volume
| Issue : 1 | Page : 5-7
Structural changes in vitreous in aphakic eye
VN Prasad, KP Sarabhai, HK Bist
Department of Ophthalmology, B.RD. Medical College, Gorakhpur, India
V N Prasad
Deptt. of Opthalmology, Medical Collage Gorakhpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Prasad V N, Sarabhai K P, Bist H K. Structural changes in vitreous in aphakic eye. Indian J Ophthalmol 1984;32:5-7
The vitreous is recognised from the time of Sushruta, a great Indian surgeon. Sushruta described fluid element as `Jala' in 3,000 years B.C. Hippocrates described it as essential organ for the sight.
Normally in old age (after 60 years), a majority of the patients have some shrinkage and posterior detachment of the vitreous and the eye is able to adjust these changes of vitreous without any visual disturbances. The same changes can be found after Intraocular surgery (Cataract and glaucoma Surgery) but in these operations the shrinkage of vitreous develops rapidly and the structures of the eye may not be able to adjust with these rapid changes leading to vitreous degeneration.
The causal relationship of vitreous with aphakia is likely to be inaccurate for the reason that the presence of cataract prevents preoperative evaluation of the vitreous body. Despite this, the present study was undertaken to evaluate the various vitreous changes in Intracapsular cataract surgery.
| Materials and methods|| |
One hundred and forty six cases of Aphakia (Intracapsular cataract extraction by Smith method) were studied. Diabetic and hypertensive patients were excluded from this study.
The vitreous changes have been studied at the time of discharge of patient (average 15 days) and then alter 8 weeks, 2 months, 6 months on slitlamp using Hruby lens and three mirror contact lens.
| Observations|| |
The observations made are shown in [Table 4]. In some cases more than one structural changes were noted in the same eye.
| Discussion|| |
Besides the vitreous changes the retinal. and choroidal changes noted were macular oedema, degeneration, retinal detachment and arteriosclerotic changes of retinal vessels.. It was noticed that after intracapsular extraction, some degenerative changes in Vitreous were bound to occur.
Syneresis was found in most of the cases in present series. This was commonly seen in anterior central portion of the Vitreous. Syneresis of the vitreous gel is considered as a part of aging process because it is observed more frequently in old than in young individuals,. Fibrous destruction were found in 19.1% of the operated cases in our series. While Goswami etal in their study recorded abnormal condensation membrane and deposits on the anterior vitreous face in 10% of eyes which have undergone uncomplicated intracapsular cataract extraction.
Shrinkage of Vitreous which was much less common condition and described as the absence of normal mobility of its component part was found only in 1.4% cases in present series.
Deposition of pigments over the anterior surface of the vitreous face was seen as a common change in our series of cases studied. It has been observed that pigment deposition was more common in cases where complete iridectomy was done. It appears that pigments released from the cut margin of the iris were deposited over the vitreous anteriorly. The other causes found were operative trauma to iris or post operative iridocyclitis. A comparatively low vision were found in cases where the deposition of the pigments were in large quantity.
Asteroid bodies were observed only in 4.6% case's which were proved nondiabetic cases, occupying the anterior and central position of the vitreous body. Its association with diabetes mellitus and hypercholesterolemia has been emphasized,, but it has been questioned by others. As many as 27 percent of patients with asteroid hyalitis were reported diabetic.
As the vitreous has not support anteriorly after intracapsular cataract extraction, the concavity of the vitreous evert and protrude through the pupil. The herniation of the vitreous in the anterior chamber depends on the size of the pupil. In complete iridectomy, the herniation of the vitreous was less common because the whole surface is slightly tense than that of a round pupil with less area in peripheral iridectomy. So less vitreous herniation took place in complete iridectomy cases during surgical manipulation for delivery of lens.
The herniation of vitreous into the anterior chamber was found in 9.5% of cases, while the corneal opacities were found in 5.4% cases where the vitreous was adherent to the posterior surface of cornea. It gave rise to corneal dystrophy though the incidence was very low, (0.6%). In other studies it was found that 10 percent of eyes show a permanent vitro corneal contact after intracapsular cataract extraction, but only 0.5 percent of these eyes develop corneal oedema and bullous Keratopathy,
Vitreous detachment was seen in 13.7% cases. In most of cases they were associated with syneresis. Several authors have reported inconsistent incidence presumably because different examination techniques were employed. The various incidence reported are 20%, 100%,66%,93%.
| Summary|| |
Various structural changes in vitreous in aphakic eyes have been studied.
| References|| |
Goldman, H., 1964, Amer. J. Ophthalmol, 57:1.
Pischel, D.K, 1953, Amer. J. Ophthalmol, 36: 1497.
Goswami, A.P., Mathur, K.N. and Raizada, I., 1967, Orient Arch. Ophthalmol. 5:42.
Smith, J.L., 1958, J.A.M.A., 168:891.
Hatfield, RE. Gastineau, C.F. and Rucker, C.W., 1962., Proc. Mayo. Clin., 37:513.
Agarwal, L.P., Mohan, M., Khosla, P.K and Gupat, A.K, 1963. Orient. Arch. Ophthalmol, 1:167.
Luxeberg, M., and Sime, D. 1969, Amer. J. Ophthalmol, 67:406.
Bard. L.A. 1964, Amer. J. Ophthalmol, 58;239.
Reese, AB., 1949, Amer. J. Ophthalmol, 32:933.
Leahey, B.D., 1951, Arch. Ophthalmol, 46:22-32.
Harrington, D.O., 1952, Amer. J. Ophthalmol, 35:1177.
Huber, Y. and Barkay, S. 1964, Brit. J. Ophthalmol 48:341.
Friedman, Z., Neumann, E. and Hagams, S., 1973, Brit. J. Ophthalmol, 57:52.
Foos, KY., 1972, Trans. Amer. Acad. Ophthalmol, Otolaryngaol, 76:480.
[Table - 1]