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Ophthalmology at your fingertips!

A Virtual Ophthalmology Atlas!


‘Ocular curiosities!’⁣

Vitreous Cysts⁣

Tansley, 1899 - irregular spherical cyst that showed lines of pigment on its surface⁣

Congenital Cysts⁣

Remnants of the hyaloid vascular system⁣

Located at hyaloid canal & found in conjunction with Mittendorf's dot or⁣

Bergmeister's papillae⁣

Stable, do not progress and rarely interfere with vision⁣

Non-pigmented pearl-gray cysts with a smooth surface, sessile or pedunculated⁣

Located anterior to optic disc⁣

Can be limited in movement due to vitreous strands attaching cyst to optic⁣


Acquired Cysts⁣

Ocular trauma⁣

Intraocular inflammation/infection/ uveitis eg. Intermediate Uveitis, Toxoplasmosis⁣

Retinal diseases such as Retinitis pigmentosa, Choroidal atrophy, Retinoschisis, High myopia with uveal coloboma etc⁣

Retinal detachment surgeries⁣

Usually symptomatic -reduced vision⁣



From pigment epithelium of iris or ciliary body later become detached into the vitreous, Brown colour⁣


From hyaloidal vascular system⁣

Translucent, mobile, yellow-gray⁣


Congenital cysts are choristomas of primary hyaloidal system⁣

Derived from pigment epithelium of iris or ciliary body⁣

Contains immature melanosomes⁣

Pathophysiology of Acquired Cysts⁣

Trauma can cause damage to pigment epithelium of ciliary body and create pigment cysts⁣

Other theories: Vitreous reaction to underlying retinal degeneration can causes cysts, Ciliary adenoma breaking into the vitreous, cystic growths that occur at site of coloboma that enter the vitreous⁣


Pigmented cysts mimic pigmented ocular tumors such as malignant melanoma Nonpigmented cysts mimic parasitic cysts such as Cysticercosis, Echinococcus etc.⁣

Ocular Investigations:⁣

B Scan to look for scolex in case of cysticercosis⁣

OCT - characterize the cyst⁣

UBM - rule out anomalies of ciliary body or posterior iris⁣

FFA - characterization of intra and extra cystic vascularisation ⁣


Asymptomatic cysts⁣

Observation and follow-up ⁣

Symptomatic cysts⁣

Laser cystotomy by Argon laser/Nd:Yag laser⁣

Pars plana vitrectomy with cyst excision⁣


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Link to article: https://eyewiki.aao.org/Vitreous_Cysts⁣

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Epiretinal Membrane ⁣

An avascular fibrocellular membrane that proliferates on the inner surface of the⁣

retina and produces visual impairment⁣


Idiopathic ERMs is the most common presentation. ⁣

Secondary ERMs: retinal vascular diseases including diabetic retinopathy, retinal vein occlusion, ocular inflammatory disease, trauma, intraocular surgery, intraocular tumors, and retinal tear or detachment.⁣

Symptoms: Gradual painless loss of vision, Metamorphopsia, Micropsia⁣

Pathology: Fibrous proliferative membrane like structure consisting of cells interspersed with an extracellular matrix.⁣

Fundus examination: ⁣

Thin sheen like membrane to a thick opaque membrane, associated with vascular tortuosity, straightening and dragging of vessel toward the fovea. ⁣

Associated intraretinal hemorrhage, cystic changes in macula, cotton wool spots, macular edema, macular hole or pseudohole. ⁣

Gass classification of ERM :⁣

Grade 0 – Cellophane maculopathy⁣

● Completely translucent membrane barely visible clinically. There is no foveal distortion and retinal traction ⁣

Grade 1 – Crippled cellophane maculopathy⁣

● Contraction of ERM⁣

● Membrane causes an irregular wrinkling of inner retinal surface.⁣

● If wrinkling is severe enough, para macular vessels may be pulled towards the fovea⁣

in a corkscrew formation (seen on FFA) ⁣

Grade 2 – Macular pucker⁣

● Membrane is thick and opaque.⁣

● Full thickness puckering of macula may be present along with edema, small⁣

hemorrhages, cotton wool spots and sometimes localized RD⁣

● Severe visual loss⁣

Cause of vision loss in ERM:⁣

● Contraction of ERM causes elevation of macula⁣

● Retinal distortion and traction⁣

● Macular edema⁣

Investigations :⁣

● Amsler grid⁣

● FFA - can show retinal vascular tortuosity, straightening and leakage, as well as⁣

CME, also helps in excluding the other retinal pathologies that may cause ERM formation ⁣

● OCT- To see CME,VMT,Localizing the edge and thickest part of ERM and to⁣

differentiate lamellar macular hole from pseudohole⁣

● Multifocal ERG⁣

Management :⁣

● ERM removal with/without ILM peeling


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Sashwanthi & Madhuvanthi Mohan

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