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Cisternal Anatomy of the Vitreous.

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Cisternal Anatomy of the Vitreous.By JGF Worst, LI Los. Pp 148; $156, Dutch guilder 250. Amsterdam/New York: Kugler Publications, 1995. ISBN 90 6299 110 6.

The first author of this interesting volume is renowned within the ophthalmological community for his unique approach to ophthalmology. He was a pioneer in the early days of intraocular lens implantation with the development of the first lens, but more importantly he is widely known for his studies of the anatomy of the vitreous gel, particularly what he terms the “cisternal anatomy”. Most vitreoretinal surgeons will appreciate that the elusive gel does indeed have particular anatomical structure and indeed older anatomists describe a variety of spaces such as Berger’s space, the canal of Pettit, and other features of the vitreous gel. Jan Worst has added further to this knowledge. His work has been founded on the use of coloured dyes injected into the various compartments of the vitreous to identify their features. Some of the spaces have been named after him, such as the Worst premacular bursa.

This volume is a culmination of many years of work and contains a remarkable set of data which will not be repeated elsewhere. Vitreoretinal surgeons, and indeed all of those interested in the ocular physiology and anatomy and, in particular, vitreous pathology should read this book. It is organised in a series of chapters detailing the cisternal anatomy, functional anatomy, and the traditional view of anatomy of the vitreous. This is followed by an interesting chapter on the decompartmentalisation concept in relation to cataract surgery which is written in the context of intracapsular and extracapsular cataract extraction. This particular chapter would have benefited from an evaluation of the compartments of the vitreous in relation to phacoemulsification techniques for cataract extraction since the special forces induced on the vitreous structure during phacoemulsification within a closed compartment are likely to have major significance.

The last three chapters deal with aspects of vitreous pathology in relation to cystoid macular oedema, rhegmatogenous retinal detachment, and the vitreous in diabetic retinopathy; these are interesting review chapters but are somewhat out of date.

The most interesting feature of the book is a false compartment at the end which contains a stereo viewing set and series of superb slides which are taken from Jan Worst’s personal collection. These slides beautifully illustrate all the aspects of the anatomy and pathology of the vitreous which Dr Worst and his co-author Dr Los wish to draw to our attention. In this respect they have been outstandingly successful and more often than not they have been quite convincing.

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