Vitreous prolapse

 Vitreous prolapse, or the displacement of the vitreous gel into the anterior segment of the eye, can occur during or after eye surgery, particularly cataract surgery, and can lead to complications like corneal decompensation, glaucoma, and retinal detachment. 

Here's a more detailed explanation:

• What is vitreous prolapse?

  The vitreous gel, a jelly-like substance that fills the space between the lens and the retina, normally stays behind the posterior capsule of the eye. Vitreous prolapse occurs when this gel moves forward into the anterior chamber, the space between the cornea and the lens. 
• Causes:

  • Cataract surgery: During cataract surgery, a tear or rupture in the posterior capsule can allow the vitreous gel to leak into the anterior chamber. 
  • Trauma: Blunt ocular trauma can also cause vitreous prolapse. 
  • Nd:YAG laser capsulotomy: This procedure, used to treat posterior capsular opacification, can sometimes induce vitreous prolapse in pseudophakic eyes (eyes with an artificial lens). 
  • Pseudoexfoliation syndrome: This condition, characterized by the shedding of material from the lens and surrounding structures, is a known risk factor for vitreous prolapse during cataract surgery. 
• Complications:

  • Corneal decompensation: Vitreous in the anterior chamber can lead to corneal edema and bullous keratopathy. 
  • Glaucoma: Vitreous can obstruct the pupil and iridocorneal angle, leading to elevated intraocular pressure (IOP). 
  • Cystoid macular edema: Fluid buildup in the macula (central part of the retina) can occur. 
  • Uveitis: Inflammation of the middle layer of the eye can occur. 
  • Retinal detachment: Vitreous traction on the retina can cause retinal tears and detachment. 
• Diagnosis and Treatment:

  • Early detection is crucial: Subtle changes like a sudden deepening of the anterior chamber, abnormal pupillary movements, or an inability to rotate a previously mobile lens can indicate vitreous prolapse. 
  • Anterior vitrectomy: If vitreous prolapse occurs, surgical removal of the vitreous from the anterior chamber is often necessary. 
  • Mechanical vitrector: A mechanical vitrector is a specialized instrument used to remove vitreous gel. 
  • Visual aids: A light pipe, air bubble, or intracameral triamcinolone can be used to visualize the prolapsed vitreous. 
  • Preventing vitreous prolapse: During cataract surgery, surgeons take precautions to avoid posterior capsule rupture, such as using a phacoemulsification technique that minimizes trauma to the lens capsule. 
• Vitreous Wick Syndrome:

  This is a rare condition characterized by microscopic wound breakdown and vitreous prolapse that can develop into a vitreous wick, which can cause endophthalmitis (a serious eye infection).