Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Punctate hyperreflective vitreous opacities: a ubiquitous finding in healthy children beyond infancy

Eye volume 39, pages 337–344 (2025)Cite this article

Subjects

Abstract

Background

The vitreous evolves from birth over lifetime. Little is known about the appearance of the healthy vitreous during childhood. We aimed to characterise posterior vitreous features in healthy children using spectral domain optical coherence tomography (SD-OCT).

Methods

Retrospective cohort study including healthy eyes of 78 children aged 2–12 years and 39 healthy adults. Patients diagnosed with intraocular inflammation or vitreoretinal pathology were excluded.

Main Outcome: Proportion of eyes with presence of punctate hyperreflective vitreous opacities (PHVO). Percentage of B-scans demonstrating PHVO within an OCT volume scan, correlation between presence of PHVO and patients’ age group, retinal measurements, and presence of premacular bursa were analysed.

Results

154 paediatric eyes (median age 9.08 (IQR 5.17–9.75) years) and 76 adult eyes (30.75 (IQR 26.42–38.08) years) were included; 12244 OCT images were reviewed. All eyes (100%) in the paediatric group and 73% in the adult group presented PHVO. The median percentage of OCT images showing PHVO was 77.05% (IQR 51.23–88.52) in children and 8.0% (IQR 0–16.03) in adults (p < 0.001). Separate analysis of right and left eyes confirmed the results (p < 0001). Premacular bursa appeared in 20.5% of paediatric and 31.6% of adult eyes (p = 0.103). Mean central subfield thickness was significantly lower in children (257 ± 21 µm vs. 276 ± 18 µm, p < 0.001), while median total macular volume was similar (8.59 (IQR 8.25–8.86) mm3 vs. 8.62 (IQR 8.39–8.96) mm3, p = 0.145).

Conclusions

This study demonstrates that PHVO are ubiquitous physiologic vitreous findings in healthy children beyond infancy. These findings enhance the understanding of the development of the posterior segment of the eye and might improve paediatric OCT interpretation, potentially avoiding misdiagnoses and unnecessary interventions in children.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Macular OCT demonstrating multiple punctate hyperreflective vitreous opacities.
Fig. 2: Macular OCT demonstrating premacular bursa.
Fig. 3: Distribution of punctate hyperreflective vitreous opacities in paediatric and adult groups.

Similar content being viewed by others

Data availability

All data generated or analysed during this study are included in this article or its supplementary material files. Further enquiries can be directed to the corresponding author.

References

  1. Tozer KR, Kenneth Y, Sebag J. Vitreous and developmental vitreoretinopathies. Hartnett ME: Pediatric Retina, ed. 2004;2.

  2. Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel E, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology 2013;120:2611–9.

    Article  PubMed  Google Scholar 

  3. Wang R, Lovenberg C, Hess O, Todorich B. Role of optical coherence tomography in management of acute posterior vitreous detachment and its complications. Retina. 2023;43:371–8.

    Article  PubMed  Google Scholar 

  4. Pichi F, Carreño E. The vitreous in uveitis: characterizing the invisible with optical coherence tomography. Ocul Immunol Inflamm 2022;30:690–6.

    Article  PubMed  Google Scholar 

  5. Liu X, Kale AU, Ometto G, Montesano G, Sitch AJ, Capewell N, et al. OCT assisted quantification of vitreous inflammation in uveitis. Transl Vis Sci Technol 2022;11:3.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Saito M, Barbazetto IA, Spaide RF. Intravitreal cellular infiltrate imaged as punctate spots by spectral-domain optical coherence tomography in eyes with posterior segment inflammatory disease. Retina. 2013;33:559–65.

    Article  PubMed  Google Scholar 

  7. Mehrotra N, Nagpal M, Vishnoi A, Mehta R, Jain H. Vitreous punctate spots in eyes with intermediate and posterior uveitis using spectral domain optical coherence tomography. DJO. 2017;28:16–19.

  8. Maccora KA, Sheth S, Ruddle JB. Optical coherence tomography in paediatric clinical practice. Clin Exp Optom 2019;102:300–8.

    Article  PubMed  Google Scholar 

  9. Gürağaç FB, Totan Y, Güler E, Tenlik A, Ertuğrul İG. Normative spectral domain optical coherence tomography data in healthy turkish children. Semin Ophthalmol 2017;32:216–22.

    Article  PubMed  Google Scholar 

  10. El-Dairi MA, Asrani SG, Enyedi LB, Freedman SF. Optical coherence tomography in the eyes of normal children. Arch Ophthalmol 2009;127:50–58.

    Article  PubMed  Google Scholar 

  11. Al-Haddad C, Barikian A, Jaroudi M, Massoud V, Tamim H, Noureddin B. Spectral domain optical coherence tomography in children: normative data and biometric correlations. BMC Ophthalmol. 2014;14:53.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lee YP, Ju Y-S, Choi DG. Ganglion cell-inner plexiform layer thickness by swept-source optical coherence tomography in healthy Korean children: Normative data and biometric correlations. Sci Rep. 2018;8:10605.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Zepeda EM, Shariff A, Gillette TB, Grant L, Ding L, Tarczy-Hornoch K, et al. Vitreous bands identified by handheld spectral-domain optical coherence tomography among premature infants. JAMA Ophthalmol. 2018;136:753–8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Schaal KB, Pang CE, Pozzoni MC, Engelbert M. The premacular bursa’s shape revealed in vivo by swept-source optical coherence tomography. Ophthalmology 2014;121:1020–8.

    Article  PubMed  Google Scholar 

  15. Gal-Or O, Ghadiali Q, Dolz-Marco R, Engelbert M. In vivo imaging of the fibrillar architecture of the posterior vitreous and its relationship to the premacular bursa, Cloquet’s canal, prevascular vitreous fissures, and cisterns. Graefes Arch Clin Exp Ophthalmol. 2019;257:709–14.

    Article  PubMed  Google Scholar 

  16. Cabrera MT, Legocki AT, Zepeda E, Gillette TB, Touch P, Lee AY, et al. Vitreous findings quantified by handheld spectral domain optical coherence tomography correlate with retinopathy of prematurity severity. J Am Assoc Pediatr Ophthalmol Strabismus. 2021;25:e3.

    Article  Google Scholar 

  17. Scoville NM, Legocki AT, Touch P, Ding L, Moshiri Y, Bays-Muchmore C, et al. Vitreous opacities in infants born full-term and preterm by handheld swept-source optical coherence tomography. J AAPOS. 2022;26:20.e1–20.e7.

    Article  PubMed  Google Scholar 

  18. Moshiri Y, Legocki AT, Zhou K, Cabrera MT, Rezaei KA, Tarczy-Hornoch K, et al. Handheld swept-source optical coherence tomography with angiography in awake premature neonates. Quant Imaging Med Surg 2019;9:1495–502.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Allingham MJ, Cabrera MT, O’Connell RV, Maldonado RS, Tran-Viet D, Toth CA, et al. Racial variation in optic nerve head parameters quantified in healthy newborns by handheld spectral domain optical coherence tomography. J Aapos 2013;17:501–6.

    Article  PubMed  Google Scholar 

  20. Sugioka K, Saito A, Kusaka S, Kuniyoshi K, Shimomura Y. Identification of vitreous proteins in retinopathy of prematurity. Biochem Biophys Res Commun 2017;488:483–8.

    Article  PubMed  CAS  Google Scholar 

  21. Qiao H, Hisatomi T, Sonoda KH, Kura S, Sassa Y, Kinoshita S, et al. The characterisation of hyalocytes: the origin, phenotype, and turnover. Br J Ophthalmol. 2005;89:513–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Lund‐Andersen H, Sebag J, Sander B, La Cour M. The Vitreous. In: The biology of the eye.Vol 10. Advances in organ biology. Elsevier; 2005. 181–94.

  23. Leong BCS, Fragiotta S, Kaden TR, Freund KB, Zweifel S, Engelbert M. OCT En face analysis of the posterior vitreous reveals topographic relationships among premacular bursa, prevascular fissures, and cisterns. Ophthalmol Retina. 2020;4:84–89.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Mrs. Ilana Gelernter for her support with the statistical analysis.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Ophthalmology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    May Cohen, Omer Dor, Daphna Mezad-Koursh, Anat Loewenstein & Dinah Zur

  2. Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv-Yafo, Israel

    May Cohen, Omer Dor, Daphna Mezad-Koursh, Anat Loewenstein & Dinah Zur

  3. Edmond J Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv, Israel

    Omer Dor

Authors
  1. May Cohen
    View author publications

    Search author on:PubMed Google Scholar

  2. Omer Dor
    View author publications

    Search author on:PubMed Google Scholar

  3. Daphna Mezad-Koursh
    View author publications

    Search author on:PubMed Google Scholar

  4. Anat Loewenstein
    View author publications

    Search author on:PubMed Google Scholar

  5. Dinah Zur
    View author publications

    Search author on:PubMed Google Scholar

Contributions

May Cohen, Omer Dor, Dinah Zur: - Substantial contributions to the conception or design of the work; the acquisition, analysis, and interpretation of data for the work. - Drafting the work or revising it critically for important intellectual content. - Final approval of the version to be published. - Ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Daphna Mezad-Koursh and Anat Loewenstein: - Drafting the work or revising it critically for important intellectual content - Final approval of the version to be published - Ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Dinah Zur.

Ethics declarations

Competing interests

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submit- ted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Ethics

As this was a retrospective study, participants’ informed consent was not needed, in compliance with the Institutional review board (IRB) approval. This study protocol was reviewed and approved by the IRB at Tel Aviv Medical Centre. The research adhered to the tenets of the Declaration of Helsinki.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cohen, M., Dor, O., Mezad-Koursh, D. et al. Punctate hyperreflective vitreous opacities: a ubiquitous finding in healthy children beyond infancy. Eye 39, 337–344 (2025). https://doi.org/10.1038/s41433-024-03434-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41433-024-03434-1

This article is cited by

Search

Advanced search

Quick links