Abstract
Vitreoretinal interface diseases commonly occur in the macula. However, the mechanism of this preferential distribution was not known for many years. We used scanning electron microscopy to examine postmortem eyes with posterior vitreous detachment, and found vitreous cortex remnants at the macula with high frequency. We discovered the "posterior precortical vitreous pocket" when we observed the three-dimensional structure of the vitreous in postmortem eyes with fluorescein staining technique. Based on this anatomical finding, we explained the clinical mechanism of macular hole, premacular membrane, and ring shaped proliferation in diabetic retinopathy. Optical coherence tomography (OCT), introduced in 1997, enabled visualization of the premacular vitreous cortex, i.e. the posterior wall of the "pocket", proving our hypothesis. The swept source OCT, which became commercially available in 2012, enabled visualization of the entire "pocket". It also showed the "pocket" was connected to Cloquet's canal (Cloquet's canal traverses the vitreous from the optic nerve disc to the lens). This anatomical finding suggests that aqueous humor may flow into the premacular pocket.
