The posterior vitreous detachment clinic: do new retinal breaks develop in the six weeks following an isolated symptomatic posterior vitreous detachment?

Abstract

Symptomatic posterior vitreous detachment (PVD) is sometimes associated with sight-threatening retinal tears or retinal detachment. Patients are usually reviewed twice because it is believed that retinal breaks may develop within 6 weeks of a PVD and as such the management of a PVD consumes significant resources. The aim of this study was to find the frequency of retinal breaks developing within 6 weeks of an isolated PVD using the same experienced examiner at both visits. Patients presenting to the eye casualty with symptomatic PVD were examined by the casualty staff. Those with a retinal break or retinal detachment were referred directly for treatment and those with only a PVD were seen within 8 days in the PVD clinic. They were examined by a vitreo-retinal Fellow using indirect ophthalmoscopy and a 20 D lens with scleral indentation. The position and nature of any retinal abnormalities were noted and compared with those described in the casualty notes. Those with sight-threatening breaks were referred for treatment and the remainder were reviewed 5 weeks later when the presence of any new breaks was noted. One hundred and seven patients were referred to the PVD clinic over a 6-month period, of whom 2 did not have a PVD. At the first visit to the PVD clinic 6 patients had round holes anterior to the equator, 2 had equatorial horseshoe tears and 1 had lattice with holes. At the second visit, 2 additional patients had round holes anterior to the equator but in both the retina had been obscured by vitreous haemorrhage at the first visit. No patient in whom a full examination was possible at the first visit developed further retinal pathology. These results demonstrate the need to perform a full examination of the peripheral retina with scleral indentation at the time of presentation and emphasise the importance of finding a vitreous haemorrhage following a symptomatic PVD. If no retinal breaks are detected by thorough examination at presentation, further reviews, in the absence of increasing symptoms, may not be necessary.