Real-Time Intraoperative Optical Coherence Tomography Imaging Confirms Older Concepts About the Berger Space

Abstract

Background: The presence of a space between the posterior capsule and the anterior vitreous was first reported in 1887, but difficulties inherent in examining this structure made it impossible to visualize this area in vivo until now. Estimation of the size of this space was considered to be impossible. Materials and Methods: We utilized an optical coherence tomography (OCT) system attached to the Zeiss Opmi Lumera 700/Rescan microscope (Zeiss Ltd., Jena, Germany) to provide real-time images of the Berger space, the anterior hyaloid and the ligament of Wieger. Results: Imaging in 3 patients provided beautiful, real-time OCT images of the Berger space and of the ligament of Wieger. In one highly myopic eye, there was even evidence of anterior vitreous detachment. Conclusion: Previously unseen transparent structures of the eye can now be imaged intraoperatively using real-time OCT. This new technology seems very promising in achieving a better understanding of the anterior vitreous interface, more specifically of the anterior hyaloid and its posterior capsule attachment by the ligament of Wieger. Changes in the anterior hyaloid and its capsular attachment may contribute to a better understanding of the posterior segment complications after cataract surgery.

Impact of fluidic parameters during phacoemulsification on the anterior vitreous face behavior: Experimental study

“…Recently, with the introduction of real-time intraoperative optical coherence tomography (OCT) attached to the operating microscope[19] as well as that attached with femtosecond laser cataract systems[2021] there is promise that surgeons may be able to explore better the anatomy of the anterior vitreous and Berger's space.…”

The Emerging Role of Anterior Segment Optical Coherence Tomography in Cataract Surgery: Current Role and Future Perspectives

“…provide greater anatomical detail of the tissues, which was previously often thought to be difficult. The realtime in vivo changes along the lens, 8,9 laser dissection depths and paths, 10 laser parameter variations with lens thickness and density, 11 identification of Berger space, laser capsulotomy details 12,13 and others have been observed more pragmatically until now. 14 Thus, these constructive observations broaden the scope of ASOCT in lenticular diseases.…”

Detection of Anterior Hyaloid Membrane Detachment Using Deep-Range Anterior Segment Optical Coherence Tomography

“…In most adults, this is a potential rather than a true space [ 3 ], with the posterior capsule and anterior hyaloid face directly apposed in normal eyes. When there is fluid in Berger’s space, it is thought to be due to an age-related or pathological degeneration of the ligament of Wieger that connects the space with Petit’s canal, allowing aqueous to enter [ 4 , 5 ].…”

“…In contrast to the posterior hyaloid membrane that can be easily visualized with optical coherence tomography (OCT), however, AHM and Berger’s space in normal human eyes are rarely seen in vivo. Several attempts have been reported to visualize AHM during surgery using a fiberoptic endoscope [ 7 ] and intraoperative OCT attached to surgical microscope [ 4 , 6 ]. Berger’s space was visualized in eyes with pathological conditions such as trauma and pigment dispersion syndrome [ 8 , 9 , 10 , 11 ], or after the capsulo-hyaloidal hydroseparation procedure with the aid of triamcinolone enhancement [ 12 ].…”