Age-dependent changes in the basal retinovitreous adhesion

PURPOSE. To determine the width of the posterior vitreous base in human eyes of different ages and to clarify the nature of the postoral retinovitreous adhesion that underlies the development of juxtabasal retinal tears and retinal detachment after posterior vitreous detachment (PVD). METHODS. The posterior limit of the vitreous base was delineated with indocyanine green after mechanical peeling of the postbasal vitreous cortex from the retina in 58 pairs of donor eyes. The area of residual retinovitreous adhesion was measured by image analysis. Scanning electron microscopy was performed on the undersurface (or retinal aspect) of the inner limiting lamina (ILL) after trypsin digestion of the peripheral retina. RESULTS. An age-dependent increase in the anteroposterior dimension of the posterior vitreous base was revealed that became progressively wider in eyes of male donors than in those of female donors and in the nasal half compared with the temporal half of the globe. Ultrastructural studies showed progressive invasion of the innermost peripheral retina by bundles of collagen fibrils, initially in the form of characteristic braids splaying out beneath the ILL and eventually as a dense sublaminar mat in the elderly. The collagen fibrils penetrated the ILL through localized defects and intertwined with those in the basal gel. CONCLUSIONS. With aging, the posterior border of the vitreous base migrates posteriorly so that an annular band of firm adhesion eventually straddles the ora serrata eccentrically. Intraretinal synthesis of collagen fibrils, their penetration of the ILL, and their splicing with cortical vitreous fibrils, underlie the slowly evolving retinovitreous adhesion.