By Lisa B. Arbisser, MD
The authors describe the anterior vitreous face during pediatric cataract surgery as a bulging structure; a homogenous staining pattern of three buttonholes, suggesting a tabletop configuration with its three subramifications; and a concentric pattern with a lamellar or fibrillar variant as radial septa. They present three cases to illustrate this, describing the intraoperative morphology of the intact anterior vitreous face with the aid of triamcinolone acetonide. This should help surgeons correctly recognize the intact anterior vitreous face, which they say is vital for all ophthalmologists and for cataract surgeons in particular.
This is another subtle useful observation by Abhay R. Vasavada, MS, FRCS, and his colleagues, although I still don't understand why he hasn't adopted optic capture into Berger's space.
The authors say that the status of the anterior vitreous face, whether intact or disturbed, is important since vitrectomy can be avoided in such eyes. They say that there is little information on the intraoperative morphology of the anterior vitreous pertinent to pediatric cataract surgery.
Information in this study is of value for the treatment of older children and young adults in whom posterior continuous curvilinear capsulorhexis (PCCC) without vitrectomy is often performed, which can lead to anterior vitreous face disturbance. In children between two and six years of age in whom PCCC is performed without vitrectomy, information on the presence or absence of anterior vitreous face disturbance also is important, as it suggests the need for vitrectomy. In addition, knowledge of the normal anterior vitreous face contour and its variations can serve as a guide to uneventful cataract surgery.
The authors say the pattern of the three buttonholes with three subramifications could be due to the presence of Wieger ligament in which the vitreous is attached to the posterior surface of the lens, classically described as having three ramifications of the ligament head. The presence of the buttonhole could be due to adhesions between the posterior capsule and the anterior vitreous face.
The other diagnostic sign of an intact anterior vitreous face, a concentric pattern with a fibrillar or lamellar variant as radial septa, could be due to compression of a number of cisterns by filling of adjacent cisterns or a vertical overlap (interdigitation) between the various layers of cisterns, creating multiple tracts in a radial fashion. The authors think this pattern represents the vitreous tracts created by the lamellae that traverse in the anteroposterior direction in the vitreous cavity.