Timing of Delayed Retinal Pathology in Patients Presenting with Acute Posterior Vitreous Detachment in the IRIS® Registry (Intelligent Research in Sight)

Abstract

To determine the timing to delayed retinal pathology in eyes presenting with acute posterior vitreous detachment (PVD). Retrospective database study. Patients in the IRIS registry found to have acute posterior vitreous detachment based on International Classification of Diseases (ICD), Ninth and Tenth Revision, codes were followed. Patients coded to have a PVD from 2013 to 2018 along with CPT coding of extended ophthalmoscopy were included. Ocular baseline characteristics included visual acuity, lens status, presence or absence of vitreous hemorrhage, myopia, lattice degeneration and sub-specialty training of the treating physician. Timing (days) to delayed retinal break or detachment RESULTS: A total of 434,046 eyes met inclusion/exclusion criteria and 10,518 eyes (2.42%) presented with a delayed retinal break or detachment after initial PVD. The median time to retinal break and detachment after initial PVD was 42 (range 1-365) days and 51 (range 1-365) days, respectively. Eyes with vitreous hemorrhage (HR: 9.30, 95% CI [8.50-10.2], history of RB/RD in the fellow eye (HR: 3.91, 95% CI [3.64-4.20]), lattice degeneration (HR: 2.61, 95% CI [2.35-2.90]), and myopia (HR: 1.42, 95% CI [1.33-1.53]) were found to be at a higher risk of developing delayed break or detachment. Follow up examination after initial PVD is necessary to diagnose delayed or missed retinal pathology. In eyes with no initial pathology, providers should consider repeat examination at least once within six weeks, and within 1 month for eyes with higher risk features.