vitreous cell

[switchwithme]

first year resident here. The peripheral exam thread was super helpful and we need more threads like it to help out the greenhorns such as myself.

Its always difficult for me when seeing a patient with lots of AC reaction to know if superimposed vitritis is present. Looking at the anterior vitreous using a slit beam is pretty simple but how can you tell if there are posterior vitreous cells floating around? What are you techniques and how can you tell if your view on indirect is ****ty from the AC reaction or vitritis? Appreciate any tips

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[RestoreSight]

Sometimes its hard to tell if A/C cell is just spilling over into the anterior vitreous. Its helpful to take a careful history, full review of systems, and consider your differential carefully. Sometimes there is obvious retinitis like from ARN or toxo, but it can be subtle like pars planitis snowbanks or intraocular lymphoma. Vitreous cell usually has a source, but not always. Is the patient s/p intraocular surgery of some kind that makes you consider endophthalmitis? Do they have pain? Does their review of systems make you consider sarcoid, syphilis, TB, etc?

There is no one easy answer, but cells confined to the anterior vitreous with an obvious anterior uveitis is probably spillover. Vitritis usually has a source which you often (but not always) see on exam or determine by history.

 

[MstaKing10]

It can be difficult to identify posterior cell, especially if subtle. Few tricks: anterior cell can be looked at through a slit lamp without a lens (90D, 78D etc) simply by focusing the slit beam just posterior to the crystalline lens or PCIOL. If you focus slightly more posterior than this your are in the mid vitreous and may be able to see cells. With a bio lens, if your view to the fundus is hazy this is most likely due to vitreous cells (in the right clinical scenario, can be other things too). Same goes for indirect ophthalmoscopy. A very thin beam with a bio lens can sometimes show cells throughout its course if you focus on the retina. Similar to finding a PVD, pull back a little and you should be able to visualize cells. Other methods include seeing vitreous opacities on B scan ultrasound or OCT. Look for vitreous oparities (ie snowballs) or pars planitis as well. Retinal findings such as active chrioretinitis or vasculitis are typically associated with vitreous cells.

 

[pianist]

Cells can also be trapped and immobile in the anterior vitreous, suggesting that they are old. If you see circulating cells up and down in the anterior vitreous, that suggests the inflammation is active.