OSLI Retina

June 2020

Issue link: http://osliretina.healio.com/i/1260326

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June 2020 · Vol. 51, No. 6 313 Practical Retina that developed connections with other spaces only after a degenerative process of the vitreous. 8 To emphasize this, they changed the term premacular bursa to pos- terior precortical vitreous pocket (PPVP). With the de- velopment of vitrectomy and use of intraocular stains, these structures were later visualized using triamcino- lone intraoperatively. 9 THE VITREOUS IN THE OCT ERA With the advent of optical coherence tomog- raphy (OCT), our understanding of in vivo ocular anatomy, and pertinently, vitreous anatomy, has expanded dramatically. Many have utilized the en- hanced imaging capabilities of OCT to better under- stand the vitreous. 10,11 In 2014, we developed an im- aging protocol that allowed us to enlarge the size of the area scanned to 18 × 18 mm using swept-source OCT (SS-OCT). 12 This approach made it possible to demonstrate that the premacular bursa is limited in- feriorly, but contrary to what had been previously reported, continues superiorly beyond the reach of our instruments (Figures 1C and 1D). 13 This scan- Figure 1. The top left image depicts schematically how the premacular bursa and prepapil- lary gap fuse at a variable dis- tance from the optic nerve in the majority of adult eyes and is lim- ited inferiorly but extends superi- orly. These spaces can be readily seen on spectral-domain optical coherence tomography (OCT) and swept-source OCT. The hori- zontal B-scan below the optic nerve (A) shows how the area of Martegiani (the posterior portion of the prepapillary gap overlying the optic nerve head) is sepa- rated from the bursa (asterisk) by formed vitreous – the "septum interpapillomaculare" of Worst. The horizontal B-scan above the optic nerve (B) shows that the two spaces have fused, but a ridge persists as a legacy of the septum. The vertical B-scan in through the more central (C) and temporal macula (D) shows that the bursa (asterisk) is confined to the posterior pole inferiorly, but extends beyond the scan range superiorly. Adapted from: Engel- bert M. A new understanding of vitreous structure. Review of Ophthalmology. 2016;01:60-64.

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