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 Table of Contents    
CLINICAL IMAGE
Year : 2020  |  Volume : 13  |  Issue : 2  |  Page : 100-101  

Vitelliform Vitreoretinopathy: Clinical Implications of the Vitreomacular Interface


1 Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
2 Vitreoretinal Surgery, PA, Edina, MN, USA

Date of Submission18-Sep-2019
Date of Decision31-Jan-2020
Date of Acceptance08-Mar-2020
Date of Web Publication28-May-2020

Correspondence Address:
Giancarlo A Garcia
Department of Ophthalmology, Byers Eye Institute, Stanford University, 2452 Watson Court Palo Alto, CA 94303
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.OJO_214_2019

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   Abstract 


Pathologies of the vitreomacular interface are implicated in a variety of sight-threatening clinical entities. The authors present a photo essay of a case of Terson syndrome with a striking premacular dehemoglobinized hemorrhage with ovoid morphology. This unique “vitelliform” finding highlights the distinct structure of the premacular vitreous space and its important implications in both health and disease.

Keywords: Dehemoglobinized hemorrhage, premacular bursa, Terson syndrome, vitreomacular interface, vitreoretinopathy


How to cite this article:
Garcia GA, Tang PH, Pan CK, Mruthyunjaya P. Vitelliform Vitreoretinopathy: Clinical Implications of the Vitreomacular Interface. Oman J Ophthalmol 2020;13:100-1

How to cite this URL:
Garcia GA, Tang PH, Pan CK, Mruthyunjaya P. Vitelliform Vitreoretinopathy: Clinical Implications of the Vitreomacular Interface. Oman J Ophthalmol [serial online] 2020 [cited 2020 Oct 21];13:100-1. Available from: https://www.ojoonline.org/text.asp?2020/13/2/100/285296



A 53-year-old man noted vision loss in the left eye (OS) 2 weeks following a subarachnoid hemorrhage. Best-corrected visual acuity OS was counting fingers without pinhole improvement, and intraocular pressure was 14 mmHg by contact tonometry. Dilated fundus examination revealed a large, well-circumscribed, egg-shaped subhyaloid dehemoglobinized hemorrhage overlying the macula, consistent with Terson syndrome [Figure 1]a. No other vitreoretinal pathologies were noted on examination, and the evaluation of the fellow eye was unremarkable. Optical coherence tomography (OCT) confirmed the location of this “vitelliform” hemorrhage within the preretinal space [Figure 1]b. The hemorrhage resolved 5 weeks later, and the vision improved to 20/30.
Figure 1: Images depicting “vitelliform vitreoretinopathy.” (a) View of the left macula in a wide-field fundus photograph demonstrating a large, ovoid, preretinal dehemoglobinized hemorrhage. (b) Optical coherence tomography image of the left macula highlighting this preretinal hemorrhage with shadow obscuring underlying retinal architecture

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These images underscore the ability of the remarkable cavity confined between the posterior vitreous cortex and the macula – described by Worst as the bursa premacularis[1] – to allow for blood to adapt striking configurations that can impair vision. The clinical significance of this bursa and its potential role in the pathogenesis and treatment of various clinical entities have gained increased understanding. For example, swept-source OCT evidence indicates that this cavity fuses with Cloquet's canal in eyes before the onset of vitreous degeneration, suggesting the presence of a direct connection between the premacular, preoptic, and retrolental spaces and a route for aqueous humor to access the premacular bursa.[2] Other analyses have demonstrated the importance of this bursal space in the progression of proliferative diabetic retinopathy.[3] In addition, an understanding of mechanical forces exerted within this region may lend insight into the pathogenesis of vitreomaculopathies and other clinical phenomena, including macular hole, posterior vitreous detachment, and even abusive head trauma.[4] Further, given the increased heterogeneity of vitreous structure with age, diabetes, and myopia, this space has even been suggested as a potential site of targeted intraocular drug delivery, as it is conceivable that the pharmacokinetics of medications may vary substantially depending on location of injection within the vitreous body.[5]

The uniquely shaped hemorrhage observed in this case – which may, at first glance, be subtly reminiscent of other disease entities, such as vitelliform macular dystrophy – highlights the vitreomacular interface's distinct anatomy, which is of profound importance in both health and disease.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Department of Ophthalmology, Stanford University, is a recipient of an institutional Research to Prevent Blindness unrestricted grant and the National Eye Institute P30-EY026877.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Worst JG. The bursa intravitrealis premacularis: New developments in ophthalmology. Doc Ophth Proc Ser 1976;7:275-9.  Back to cited text no. 1
    
2.
Itakura H, Kishi S, Li D, Akiyama H. Observation of posterior precortical vitreous pocket using swept-source optical coherence tomography. Invest Ophthalmol Vis Sci 2013;54:3102-7.  Back to cited text no. 2
    
3.
Kishi S, Shimizu K. Clinical manifestations of posterior precortical vitreous pocket in proliferative diabetic retinopathy. Ophthalmology 1993;100:225-9.  Back to cited text no. 3
    
4.
Fine HF, Spaide RF. Visualization of the posterior precortical vitreous pocketin vivo with triamcinolone. Arch Ophthalmol 2006;124:1663.  Back to cited text no. 4
    
5.
Willekens K, Reyns G, Diricx M, Vanhove M, Noppen B, Coudyzer W, et al. Intravitreally injected fluid dispersion: importance of injection technique. Invest Ophthalmol Vis Sci 2017;58:1434-41.  Back to cited text no. 5
    


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