Vitreous prolapse describes a condition where the vitreous gel, a clear, jelly-like substance that fills the back two-thirds of the eye, shifts forward into the front part of the eye. This gel provides the eye with its shape and allows light to pass through to the retina. When this gel moves out of its normal position, it can interfere with vision and eye function.
Causes of Vitreous Prolapse
The most frequent cause of vitreous prolapse is a complication during intraocular surgery, particularly cataract surgery. During this procedure, the eye’s natural lens is removed, and an artificial intraocular lens (IOL) is implanted. If the posterior capsule, a delicate membrane behind the lens, tears or ruptures, the vitreous gel can move forward into the anterior chamber. Vitreous prolapse can also occur due to severe eye trauma, which can disrupt the eye’s internal structures. Risk factors include pre-existing eye conditions that weaken internal structures, such as pseudoexfoliation syndrome, which can make the zonules (fibers holding the lens in place) more fragile. Other factors like high myopia (severe nearsightedness), connective tissue disorders, or a history of prior eye surgery can also increase risk.
Symptoms and Diagnosis
Individuals experiencing vitreous prolapse may notice several symptoms. Common complaints include blurred vision, which can range from a slight haziness to a significant reduction in clarity. Many people also report a sudden onset or increase in “floaters,” which appear as small, dark spots or squiggly lines drifting across their field of vision. Eye pain or a feeling of pressure within the eye can also occur. An ophthalmologist diagnoses vitreous prolapse through a comprehensive eye examination, with the slit-lamp examination being the primary method. During this examination, the doctor uses a specialized microscope with a bright light to inspect the front and back structures of the eye. A key clinical sign is a distorted or “peaked pupil,” where the pupil appears stretched or pulled in one direction due to vitreous strands adhering to the iris or surgical wound. The presence of visible vitreous strands in the anterior chamber further confirms the diagnosis.
Medical and Surgical Treatments
The primary treatment for vitreous prolapse involves an anterior vitrectomy, a surgical procedure to remove the displaced vitreous gel from the front part of the eye. A specialized instrument, a vitrector, is used to precisely cut and aspirate the vitreous strands that have moved forward. The goal is to remove all vitreous from the anterior chamber.
This surgical intervention is often performed immediately during the initial surgery where the complication occurred, such as during cataract extraction. If not addressed at that time, a separate procedure may be scheduled later. To aid in visualization, a diluted triamcinolone acetonide solution may be instilled to stain the vitreous, making the clear gel more visible to the surgeon.
Supportive medications are also frequently used alongside surgical treatment. Anti-inflammatory eye drops, such as NSAIDs or steroids, are often prescribed to reduce swelling and inflammation within the eye. Other eye drops may be administered to manage intraocular pressure, especially if the prolapse leads to an increase in eye pressure. These medications help to support the eye’s healing process and minimize potential complications after the procedure.
Potential Long-Term Consequences
Untreated vitreous prolapse can lead to several long-term complications that may affect vision. These include:
Retinal detachment, where the light-sensitive tissue at the back of the eye pulls away from its underlying support layers, potentially causing significant vision loss.
Cystoid macular edema, which involves swelling in the macula, the central part of the retina responsible for sharp, detailed vision. This swelling can lead to blurred or distorted central vision.
Glaucoma, a condition characterized by elevated pressure within the eye, can develop if the displaced vitreous obstructs the natural fluid drainage pathways. This increased pressure can damage the optic nerve, leading to irreversible vision loss.
Corneal decompensation, or clouding of the cornea, if vitreous strands remain in contact with the corneal endothelium.
With prompt and effective treatment, the outlook for preserving vision and managing these complications is positive.