**5.1 Macroscopic examination by the technique of preparation with staining of structures**


## **5.2 Microscopic examination by light (electronic) microscopy of each isolated VB structure**


#### **5.3 Making an individual map of VB macromicroscopic topographic anatomy**

This algorithm is characterized by the ability to distinguish any VB structure in isolation and to distinguish each cortical layer with the possibility to study its anatomo-topographic features and relations with the underlying tissues (retinal ILM, ciliary body, lens capsule).

The size of intravitreal structures was determined during the study (average size of retrociliary cisterns was 10–12 mm, equatorial cisterns were 15–17 mm, petal-like cisterns were 8–10 mm). Besides, it was revealed for the first time that the anterior cortical layers consistently line the pars plana, the posterior surface of the lens, the ciliary zone fibers and can laminate. Closer to the posterior surface of the lens, a tendency for gradual thinning and lamination of the detected VB layers came into being. For the first time, a separate anatomical structure in the Berger's space projection zone was revealed, making us suggest the possibility of the existence of a retrolenticular bursa not previously described in literature, its anterior multilamellar wall was tightly fixed to the posterior lens capsule and inseparable from it mechanically. It is also important to mention that in the course of the preparation during the formation and cutting off retinal petals, cortex delamination was detected, which could serve as an adaptive mechanism to prevent retinal detachment. It was revealed by modern diagnostic techniques and interpreted as PVD. In addition, after the separation of cortical layers, a defect was formed in the area of the preoptic cistern or premacular bursa, with the subsequent separation of the posterior pole sclera section from the cortical layers and the development of vitreous herniation. In such

a case, the VB structure was disturbed, Vitreocontrast suspension stains altered and elongated VB cisterns, and exited through the cortex defect. We noted that when the intraocular pressure increased, the cortex rupture occurred in the defect area with emptying of intravitreal structures and subsequent contraction of the cortical layers. This mechanism can serve as one of the links in the pathogenesis of regmatogenic retinal detachment.

Scientific substantiation of the complex technique of vitreous body imaging (CTVBI, original Vitreocontrastography method in combination with the developed step-by-step algorithm of macroscopic and microscopic examination) for the diagnosis and the surgical treatment of vitreoretinal pathology was based on the efficiency criteria that were developed using the following four groups of imaging methodological principles tested in literature:


Comparative analytical evaluation of the developed technique with the approved methods of VB imaging according to the first three groups of efficiency criteria was performed in scores from 0 (no efficiency) to 3 (high efficiency). The results of the analytical evaluation revealed that the mean score of complex technique of VB imaging (CTVBI) was 2.8; CV -1.9; OCT - 1.4; ultrasound - 1.3 and CLSO - 1.2, respectively. Thus, the data obtained indicate the undoubted advantages of CTVBI where the level of VB imaging efficiency is 93% of the required one.

It is also important to note that our proposed system of the complex technique fully complies with the following basic principles of vitreoretinal interface imaging systems tested in clinical practice.

*Universality principle* was implemented in the possibility of imaging (based on the vitreocontrastography method) both in experimental (on donor eyes) and in real (intraoperatively during vitrectomy) conditions.

*Principle of staging* was characterized by our step-by-step technique of VB preparation.

*Perspective Chapter: The Vitreous Body Visualization Technique in Diagnosis… DOI: http://dx.doi.org/10.5772/intechopen.109264*

*Structuredness principle* providing VB macroscopic and microscopic analysis from the position of the system of interconnected structures that in general allowed for the analysis of the internal structure and activating and regulating mechanisms.

*Stability principle* was characterized by the pronounced stability of the vitreocontrastography to adhesion throughout the surgical intervention.

*Realism and controllability principles* reflected the possibility of applying the developed VB imaging system in real time and in the required for each specific case duration and volume that is especially important in the process of surgical intervention.

*Obtained image segmentation principle* was characterized by the possibility of the isolated identification of each of the VB layers and structural elements (cisterns, canals).

*Pathological process modeling principal* lied in the effectiveness of the developed imaging system in detecting VB defects (hernias) as a pathogenetic risk factor of retinal detachment development.

The studies of the third stage of the work addressed the evaluation of clinical and diagnostic efficiency of the developed complex technology of VB imaging in MH.

The following anatomo-morphological classification criteria were determined for the diagnosis of MH of different sizes (143 patients, 143 eyes): elongation of VB cisterns in anteroposterior direction, disruption of the wall integrity of VB cisterns and exit of the staining composition beyond stained cavities, destruction (disruption of structural integrity) of VB, degree of VB adhesion to the ILM surface, degree of VB layer adhesion in the macular zone.

Our analysis testified to a fundamentally higher level of anatomical and morphological diagnosis of different stages of MH using the developed VB imaging technique that, in our opinion, was associated with the following general drawbacks of the traditional classification:


of ERM that has a tangential traction effect on the retinal ILM, but the ERM anatomo-topographic characteristics are not provided for in the classification. Summarizing the above clinical data, it should be noted that in the present study the classification anatomo-morphological criteria established on the basis of the developed technique of vitreous body imaging allowed (taking into account the presented clinical examples) us to formulate a number of general and specific practical recommendations for the improvement of surgical treatment.

Thus, on the basis of the studies performed, theoretical provisions were developed. Accumulatively, they ensured an increase in clinical efficiency of vitreoretinal surgical intervention based on the application of the proposed complex system of VB imaging.

The practical application of the developed system of VB imaging is possible in the following areas:

