Research progress in Berger's space: An interesting retrolenticular space

Abstract

Purpose of the review: In recent years, Berger's space (BS), the potential space between the posterior lens capsule and the anterior hyaloid membrane, has received little attention from the ophthalmic clinical community. This is primarily due to the limited documentation, with only a few isolated case reports detailing foreign bodies in this area.

Recent findings: Recent advances in medical imaging technology have enabled the visualization of the BS under various circumstances. This progress has deepened clinicians' understanding of this elusive structure, allowing ophthalmic surgeons to utilize this space better and enhancing the safety and efficacy of relevant surgical procedures. This study explored the discovery, anatomical features, and clinical significance of the BS through anatomical and clinical studies.

Summary: This review emphasizes the observation of the BS via different imaging methods, the changes in the BS following the entry of abnormal substances, and its application in specific intraocular surgical procedures.

Keywords: Anterior segment; Berger's space; Ophthalmic surgical procedures; Ophthalmological imaging techniques.

Fig. 1

Schematic of BS. A: Sagittal view of the BS; B: coronal view at the plane of the ciliary sulcus; C: ciliary sulcus plane view after the lens was concealed; D: 1/4 partial magnification of (C). Keywords: 1. lens; 2. ciliary body; 3. zonula fibers; 4. WL; 5. PLC; 6. BS; 7. AHM. Abbreviations: WL, Wieger's ligament; PLC, posterior lens capsule; BS, Berger's space; AHM, anterior hyaloid membrane.

Fig. 2

A: In the normal physiological state, the posterior lens capsule (PLC) and anterior hyaloid membrane (AHM) are closely apposed; B: Irregular retrolenticular space is depicted after Wieger's ligament (WL) detachment, which is commonly observed in pathological states such as trauma or intraocular surgery; C: Localized magnification showing the WL detachment.

Fig. 3

The retrolenticular space observed using a slit lamp after cataract surgery. A and B: Photographs of slit lamp images showing retroillumination (A) and direct focal illumination (B) after routine ultrasound emulsification cataract surgery. In direct focal illumination, the anterior and posterior surfaces of the IOL (red and green arrows), the PLC (white arrow) with the AHM (yellow arrow), and the irregular retrolenticular space (white star) between the PLC and AHM are visible. Abbreviations: IOL, intraocular lens; PLC, posterior lens capsule; AHM, anterior hyaloid membrane.

Fig. 4

Clear OCT images of BS before and after cataract surgery. A: Preoperatively, BS results in a uniformly consistent dark area in the OCT image. B: Localized enlargement of (A). C: Postoperatively, BS demonstrated as wavy and inconsistent retrolenticular space in the OCT image. D, Local enlargement of (C). Abbreviations: BS, Berger's space; OCT, optical coherence tomography.

Fig. 5

Schematic diagram of a foreign body protruding into the BS. A: Pigment particles in the BS; B: The top half of the image depicts blood accumulation outside the BS, while the bottom half illustrates a small amount of blood infiltrating the BS.; C: Triamcinolone particles entering the BS; D: Trypan blue infiltrating the BS; E: Diagram of the BS in a normal human eye; F: Lens fragment traversing into the BS (the white arrows point to the lens fragment that enters the BS); G: Air bubbles entering the BS; H: Silicon oil entering the BS; I: ICL migrating into the BS due to ocular trauma. Abbreviations: BS, Berger's space; ICL, implantable collamer lens.

Fig. 6

Schematic diagram of surgical methods related to the BS. Operations by the cataract surgeon: A: After phacoemulsification cataract surgery, the OVD was injected into the BS by gently elevating the PLC with the tip of the syringe; B: After phacoemulsification cataract surgery, the PLC was localized with a femtosecond laser to assist with the PCCC procedure; C: After phacoemulsification cataract surgery, fluid was injected through the zonular fibers via a syringe to induce WL detachment. Operations by the vitreoretinal surgeon: D: Direct suction method; E: After the fluid is injected into the anterior chamber, it passes through the zonular fibers into the posterior chamber, where the tension of the fluid acts on the AHM; F: Bubbles are injected into the anterior vitreous cavity after core vitrectomy; G: The retrolenticular space is expanded by injecting OVD/bubbles between the PLC and AHM.