Diagnostic pearls in the management of vitreomacular disorders

The posterior precortical vitreous pocket is a premacular liquefied lacuna that is physiologically present in adult eyes. The posterior wall of the pocket consists of a thin layer of the vitreous, and its anterior border is delineated by vitreous gel. This peculiar structure of the premacular vitreous cortex plays a key role in the development of various vitreomacular disorders. In diabetic retinopathy, fibrovascular tissue tends to develop along the outer margin of the pocket, resulting in a ring- or c-shaped structure. Tangential contraction of the posterior wall of the pocket or premacular cortex causes the formation of macular holes. The posterior wall of the pocket serves as a major structural component of idiopathic premacular fibrosis. The concept of the posterior precortical vitreous pocket provides a guideline to manage vitreoretinal disorders occurring in the macular area.