What Is Vitreous Wick Syndrome?
Vitreous Wick syndrome (VWS), also known as the vitreous touch syndrome or the vitreous tug syndrome, occurs after eye surgery or trauma. It is described by the breakdown of the corneal wounds and prolapse of the vitreous humor. Vitreous prolapse is a condition where the vitreous humor bulges anteriorly, thus violating the corneal and scleral envelope. It was thought to be more common in anterior segment procedures; however, posterior segment involvement with vitreous entrapment is seen.
What Is Vitreous Humor?
Vitreous humor is a transparent gelatinous mass between the lens and the eyeball. It plays a crucial role in providing nourishment to the lens, coordinating eye growth, and providing sustenance to the eye's retina.
What Is Vitreous Humor Prolapse and How Is It Caused?
Vitreous prolapse is the bulging of the vitreous humor into the anterior chamber of the eye following surgical procedures of the eye. It can cause macular edema, corneal decompensation, detachment of the retina, and glaucoma. It is mainly caused due to the rupture of the posterior capsule of the lens.
What Are the Causes of Vitreous-Wick Syndrome?
The various factors that are responsible for the development of VWS are:
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Routine cataract surgical procedure with unidentified rupture of the posterior capsular segment.
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Vitreous prolapse with adhesion to the wound.
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Complicated cataract surgery with posterior capsule collapse or rupture.
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Delivery of the drugs into the conjunctiva.
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Sutureless vitrectomy.
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Inadequate removal of the prolapsed vitreous.
Is It Common to Get Vitreous-Wick Syndrome?
VWS is a rare surgical complication. Therefore, there is no sexual, age, or racial preference noted.
How Does Vitreous-Wick Syndrome Develop?
VWS develops after eye surgery or trauma. Breaking the wound remains the most prominent process for developing VWS. The practitioner can induce trauma during the surgery. In the case of anterior segment surgeries, there might be perforation of the sclera, which leads to the microscopic breakdown of the wound. Imperfect suturing in corneal wounds also leads to the breakdown of the injury. The gap developed between the anterior and posterior segments of the wounds leads to outward movement of the aqueous fluid, ultimately forming the vitreous wick.
What Are the Clinical Signs and Symptoms Presented by a Patient Suffering From Vitreous-Wick Syndrome?
Patients suffering from VWS present with the following symptoms:
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Pain.
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The blurring of vision.
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Itching.
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Foreign body sensation.
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Redness of the eye.
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Discharge from the eyes.
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Excessive gushing of the warm fluid inside the eyes.
The ocular signs that are prevalent in patients suffering from VWS are:
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Haze in the cornea.
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Mucous thread in the surgical site.
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Presence of yellowish exudate in the lower part of the anterior chamber (hypopyon).
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Peaked pupil.
How Is Vitreous-Wick Syndrome Diagnosed?
VWS is diagnosed by taking a complete history from the patient regarding their past eye surgery or trauma.
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History taking is followed by clinical diagnosis and laboratory tests.
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Clinical diagnosis of VWS is made by slit-lamp examination and fluorescein dye. The presence of leakage changes the dye color to produce a waterfall-like effect in the leaking zone. Physical analysis of the eye with slit-lamp technique shows corneal haze, presence or absence of cells, and necrotic area in the wick region.
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Confirmatory laboratory tests that are performed depend on the type of the VWS specimen. The tests include:
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Gram stain.
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Culture sensitivity test.
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Calcofluor white test.
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How Is the Vitreous-Wick Syndrome Managed?
Vitreous-touch syndrome can be managed by both medical therapy and surgery. Patients with VWS should avoid strenuous sports activities.
1) Medical Management of the Syndrome:
The administration of antibiotics does medical management of the syndrome. Systemic drugs and topical (subconjunctival and intravitreal) injections are given after testing for the specific organism based on the culture sensitivity tests.
2) Surgical Management of the Syndrome:
The syndrome can be managed surgically based on the condition's clinical presentation.
There are three surgical options for managing VWS are:
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Laser application helps convert the discrete bands into an amorphous gelatinous substance by releasing the tension.
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After eye surgeries, the surgeon can remove the vitreous strands at risk of developing into the vitreous wick.
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Surgery. Conventional surgical cutting of the bands or vitrectomy (removal of the vitreous and its replacement with normal saline solution) can be performed depending upon the circumstances.
What Are the Postoperative Measures Followed After Surgery?
The following postoperative measures are followed after VWS surgery:
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After both laser and conventional surgical procedures, patients are maintained under topical nonsteroidal antiinflammatory drugs, steroids, or in combination to reduce pain and inflammation.
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Broad-spectrum antibiotic drops are administered for a few weeks.
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Pilocarpine ophthalmic solutions are given to prevent migration of the anterior segment.
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Eyeshields are recommended, especially at night, to avoid trauma to the globe of the eye.
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Patients are kept at regular follow-up immediately after the surgery.
What Are the Conditions That Are Similar to Vitreous-Wick Syndrome?
The conditions that show similarities with VWS are:
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Postoperative endophthalmitis.
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Intraocular foreign body.
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Iris prolapse.
What Are the Complications Associated With Vitreous-Wick Syndrome?
There are several complications associated with vitreous wicking. The difficulties linked to vitreous wicking include:
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Endophthalmitis (posterior displacement of the globe).
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Cystoid macular edema (presence of multiple cysts in the macula of the retina).
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Pupillary block glaucoma (presence of an obstruction to aqueous humor flow in the pupillary portion of the eye leading to open angle-closure glaucoma).
What Is the Overall Outlook of Vitreous-Wick Syndrome?
The condition's prognosis mainly depends on the presence of cystic macular edema. Patients suffering from cystic macular edema have a poor prognosis.
Conclusion
Vitreous-Wick syndrome is a rare surgical complication of ocular surgeries like cataracts. The syndrome is caused due to the prolapse of the vitreous humor and breakdown of the cornea, and it can be diagnosed based on the patient's history, clinical picture, and lab tests. The condition can be treated by antibiotics or by surgical procedures. The overall prognosis of the disease is based on the presence of cystic macular edema. If left untreated, it can lead to severe damage to the vision.
