Vitreous Touch Syndrome

Overview

Vitreous touch syndrome is a rare postoperative complication that can occur following cataract surgery, particularly after intracapsular cataract extraction (ICCE) or complicated extracapsular cataract extraction (ECCE). The condition arises when the vitreous humor, the gel-like substance filling the eye's posterior chamber, prolapses into the anterior chamber and comes into direct contact with the corneal endothelium or surgical wound. This abnormal contact can lead to progressive corneal decompensation, inflammation, and visual deterioration if not recognized and managed promptly.

Causes

Vitreous touch syndrome occurs when the anterior hyaloid face of the vitreous body is disrupted during surgery, allowing the vitreous gel to move forward into the anterior chamber. Common causes and risk factors include:

• Intracapsular cataract extraction (ICCE): Older surgical method with a higher risk of vitreous prolapse

• Posterior capsule rupture: A complication during phacoemulsification or ECCE

• Zonular dialysis or weakness: Leading to vitreous instability

• Lack of anterior vitrectomy: After vitreous prolapse during surgery

• Absence of an intraocular lens (aphakia): Which can allow vitreous migration

Symptoms

Symptoms of vitreous touch syndrome may develop gradually or acutely, depending on the extent of vitreous prolapse and corneal involvement. Common symptoms include:

• Progressive decrease in visual acuity

• Glare or halos around lights

• Corneal edema (clouding of the cornea)

• Photophobia (light sensitivity)

• Foreign body sensation if corneal damage occurs

In many cases, the condition may initially be asymptomatic and only detected through follow-up examinations.

Diagnosis

Diagnosis of vitreous touch syndrome is based on clinical evaluation and slit-lamp examination. Key diagnostic findings and tools include:

• Slit-lamp biomicroscopy: Reveals vitreous strands in the anterior chamber and signs of corneal endothelial touch or damage

• Specular microscopy: Used to assess corneal endothelial cell density

• Anterior segment optical coherence tomography (AS-OCT): Helps visualize the relationship between vitreous and corneal structures

• Intraocular pressure (IOP) monitoring: May be elevated due to angle compromise or inflammation

Treatment

The primary goal of treatment is to prevent ongoing corneal damage and restore normal ocular anatomy. Treatment options include:

• Anterior vitrectomy: Surgical removal of prolapsed vitreous from the anterior chamber, often the definitive treatment

• Topical corticosteroids: To reduce inflammation

• Hypertonic saline drops: To reduce corneal edema temporarily

• Intraocular pressure management: Use of antiglaucoma medications if needed

• Corneal transplantation: In severe cases where corneal decompensation is advanced and irreversible

Prognosis

The prognosis for vitreous touch syndrome depends on how quickly the condition is diagnosed and treated. Early intervention, particularly with anterior vitrectomy, can lead to stabilization and preservation of visual function. However, prolonged vitreous contact with the corneal endothelium can lead to irreversible endothelial cell loss, resulting in chronic corneal edema and vision loss. Regular postoperative monitoring is essential to detect and manage this complication promptly.