vitreous body: 3-D anatomical beauty
Body in 3-D
Jan G.F. Worst
Jan Worst Research Group, Groningen, 2001
Text and Viewer with 18 3-D images
of the Vitreous
Jan G.F. Worst and Leonoor I. Los
Kugler Publications, Amsterdam, 1995
143 pages of Text and Viewer with 80 3-D slides
you know somebody who thinks that eyeballs are disgusting, you should
show them The Vitreous Body in 3-D. This little booklet conjures
up images of creatures floating undersea or unknown planets and
moons spinning in outer space.
It is beautiful. It is also real human vitreous. The fact that structures
with the consistency of cobwebs have been stained and captured in
a photograph with stunning visual effects in three dimensions does
not make them less real. And that is why this work deserves wider
The Vitreous Body in 3-D consists of 18 pairs of images. But when
seen through the viewer inserted in the back cover of the booklet,
the images are transformed into in life-sized 3-D images of ocular
globes - denuded of the sclera - at different stages of dissection
and stained with different dyes.
Each image has a brief explanatory note of what you see, with a
few numbers labelling particular structures. There are no comments
or explanations of the implications of what you see, just a little
assistance to help you interpret the images.
For information on dissection techniques and the importance of vitreous
anatomy, the booklet refers you to the companion textbook, The Cisternal
Anatomy of the Vitreous, also by Jan Worst MD, with co-author Leonoor
Although these two books were published six years apart, the ideas
they contain are basically the same; it makes sense to review them
Both reflect the ideas and lifework of Prof Worst. Born in 1928,
this Dutch ophthalmologist has been an active member of the international
ophthalmic community for nearly half a century.
Although often controversial, there is no doubt that he is the proud
owner of an extremely fruitful mind and many innovative ideas, many
of them extremely successful. Prof Worst recruited Ms Los into the
project to help write and compose The Cisternal Anatomy of the Vitreous.
The book looks like a solid textbook. But perhaps as the first hint
that things may not be as they appear at first sight, and that you
should not take initial impressions for granted, this book has a
trick. It is only half a book.
After some 140 pages of regular text, with the occasional line drawing,
the book's second half is like no other ophthalmic textbook. It
has a recess cut out of its middle to carry - or hide -things, like
the hollowed-out Bible in Western movies that hides a pistol or
flask of whiskey.
It's the type of book that explains why people without much love
of reading spend some time on their own in the study room.
The secret compartment contains a viewer. It's a flat-packed plastic
device with two little lenses and a slot for micro-stereo slides.
It is almost like a traditional slide viewer - easy to use, just
by holding it up at a short distance from your eyes.
The micro-stereo slides consist of 80 pairs of high quality slides;
through the viewer, each pair of images becomes a single, 3-D globe
in full colour.
The book begins with an illustrated description of how Prof Worst
obtained the images. With line diagrams, the book shows, step-by-step,
how Prof Worst prepared and dissected the specimens. The chapter
also describes in some detail the intravitreal structures.
The second chapter reviews the literature on the anatomy of the
vitreous, structured according to the different vitreal structures.
Line diagrams and histological illustrations, many borrowed from
other sources, help present a comprehensive overview.
A chapter on the functional anatomy of the vitreous follows. ProfWorst
bases this chapter on his conviction that an ophthalmologist cannot
understand the physiological functions of the vitreous body without
knowledge of its microscopic structures and biochemical properties.
Some beautiful electron microscope images help make the point.
The book next explores the so-called "compartmentalisation
concept" as it relates to cataract surgery.
Here we get into Worst's own concept - introduced in 1975 - as a
unifying theory which proposes that the disruption of the biochemical
barrier of anterior and posterior compartments of the eye can explain
the development macular oedema and retinal detachment following
cataract surgery. You will find here a detailed explanation of the
theory, and its clinical relevance.
The book next discusses aphakic cystoid macular oedema (CMO). The
pathological effects of inflammatory mediators, the prophylactic
effects of non-steroid anti-inflammatory drugs and possible reasons
for the variable interval between cataract surgery and CMO are all
Rhegmatogenous retinal detachment - including a good discussion
of existing theories - and diabetic retinopathies are the subjects
of the last two chapters. The book approaches both conditions from
a vitreous-centric point of view.
The book finishes with a figure-by-figure guide to the micro-stereo
slides contained in the secret pocket, a list of abbreviations and
an index. This is a book full of science, presented in the most
professional and methodical way.
The basic idea of both books is that the highly complex structures
of the vitreous body are difficult to study and have no easy correlation
with functional aspects of the eye.
The implication of both works is that a mental switch is necessary
in current clinical ophthalmology: the vitreous is not a fluid medium;
it is an organ. It has its own structures and peculiarities that
must have an impact on its function.
In some ways, these books are written for the future by somebody
who would like to be proven right now rather than later, but who
is not, in fact, in a hurry.
Whether or not you agree with Prof Worst's interpretation of the
meaning and importance of the vitreous structures, seeing is a good
first step towards understanding. See and judge for yourself.
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