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PURPOSE. To clarify the three-dimensional morphology of the vitreous pocket by direct injection of triamcinolone acetonide (TA) into the vitreous pocket. METHODS. Ten eyes of 10 subjects with incomplete posterior vitreous detachment (PVD) were studied. During vitreous surgery, TA was directly injected into the vitreous pocket. A 25-G cutter was then inserted into the vitreous pocket and TA was removed by aspiration. The anterior surface of the vitreous pocket was removed with the 25-G cutter, and the posterior side of the vitreous pocket was observed. RESULTS. Injecting TA allowed visualization of the circular vitreous pocket located anterior to the optic disk and macular area in all 10 eyes. The surface of the anterior border had a bright appearance. In 2 eyes without PVD, the posterior side of the vitreous pocket was depicted as a flat plate-like structure encompassing the macular region and the optic disc. In 8 eyes with partial PVD around the optic disc, a larger flat plate with the macula as the center and a smaller plate with the optic disc as the center were observed. CONCLUSIONS. The vitreous pocket is a disc-shaped liquefied lacuna spreading anterior to the optic disc and macular region, which is surrounded by a dense network of fibrils. In patients with partial PVD around the optic disc, the posterior wall was visualized as being composed of two plate-like structures with the macula and the optic disc at their centers.

Purpose To assess the usefulness of the method of oblique-parallel trocar insertion with conjunctival displacement to the corneal side in 25-gauge (G) transconjunctival vitrectomy. Methods 25-G vitrectomy was performed in 77 consecutive eyes. Before making oblique-parallel trocar insertions, the conjunctiva was conventionally displaced superiorly in 35 eyes, but was displaced toward the corneal side in 42 eyes. After surgery, the distance between the scleral and conjunctival wounds was measured with calipers. The frequency of scleral wound exposure was assessed. Results After cannula removal at the end of surgery, inferior repositioning of the superiorly displaced conjunctiva was observed, while marked posterior repositioning of the corneal side caused displacement of the conjunctiva due to gravity. The superior displacement distances between the sclera and conjunctival wounds were 2.4±0.3 mm at the infusion port, 2.0±0.4 mm at the superior temporal port, and 1.9±0.4 mm at the superior nasal port, while the corresponding distances for corneal side displacement were 3.6±0.5, 3.5±0.5, and 2.5±0.5 mm, and were all significantly (pConclusions In 25-G transconjunctival vitrectomy, using oblique-parallel trocar insertions with the conjunctiva displaced toward the corneal side results in marked posterior repositioning of the conjunctiva after cannula extraction. Corneal side conjunctival displacement is technically easy and completely covers the scleral wound. This method is expected to be effective in preventing endophthalmitis.

PURPOSE To demonstrate anterior vitreous incarceration in the cannulae at 3 ports during 25-gauge vitrectomy in eyes with asteroid hyalosis. METHODS In 6 eyes with asteroid hyalosis, 3-port 25-gauge pars plana vitrectomy was conducted using conventional 25-gauge cannula (4 eyes) or 25-gauge EdgePlusTM trocar/cannula system (2 eyes). The relationship between the cannulae and anterior vitreous was observed during surgery. RESULTS The 3 ports were observed at the beginning of vitrectomy. At the infusion port, incarceration of anterior vitreous containing asteroid bodies between the cannula and the infusion tip was clearly observed in all 6 eyes, irrespective of the cannula used. When the incarcerated vitreous fibers were excised using a vitreous cutter, the infusion fluid flowed toward the center of the vitreous. At both the left and right ports, anterior vitreous containing asteroid bodies was incarcerated into the cannulae in all 6 eyes irrespective of the cannula used. The incarcerated vitreous fibers were excised. At the end of surgery, no vitreous prolapse was found at the 3 ports in all eyes. CONCLUSIONS When using the 25-gauge cannula system, incarceration of anterior vitreous fibers into the cannulae of 3 ports from the beginning of surgery was clearly depicted in eyes with asteroid hyalosis. Excising the incarcerated anterior vitreous fibers is useful to ensure good perfusion and prevent vitreous prolapse.

PURPOSE. To report a case in which optical coherence tomography (OCT) showed needle-shaped deposits on the retinal surface oriented toward the vitreous cavity and immunohistochemical findings suggested light chain-related amyloidosis. METHODS. A 59-year-old man with no systemic complications had bilateral neovascular glaucoma and vitreous opacities in the right eye. Vitrectomy was conducted on the right eye and the excised vitreous was examined histopathologically. RESULTS. Glass wool-like opacities were observed during vitrectomy. Postoperative fundus examination of the right eye showed retinal hemorrhage and white deposits around blood vessels and on retinal surface. Fluorescein angiography revealed hyperfluorescence of the optic disc, non-perfusion areas, and vascular focal staining. OCT depicted needle-shaped deposits perpendicular to the retinal surface oriented toward the vitreous. Histologic examination of deposits revealed positive reaction for Congo red stain, and immunohistochemical examination demonstrated positive reactivities for anti-lambda and anti-kappa light chains (precursors of amyloid protein), suggesting a diagnosis of light chain-related amyloidosis. C ONCLUSIONS. In this case, OCT showed needle-shaped deposits perpendicular to the retinal surface. Special staining with Congo red revealed the deposit to be amyloid deposition. Immunohistochemical staining suggested light chain-related amyloidosis. Vascular obstructive lesions and neovascular glaucoma secondary to retinal vascular damage in amyloidosis warrant particular attention. (Eur J Ophthalmol 2008; 18: 473-5)