Development Of Posterior Vitreous Detachment Research Articles

Fellow-Eye Retinal Detachment Risk as Stratified by Hyaloid Status on OCT

To evaluate the risk of a rhegmatogenous retinal detachment (RRD) in the fellow eye utilizing posterior hyaloid status as determined by optical coherence tomography (OCT) at the time of initial RRD. Retrospective chart review. Patients diagnosed with an RRD. Posterior hyaloid status-presence or absence of a posterior vitreous detachment-in both eyes at the time of initial RRD was determined by OCT imaging. Baseline characteristics including lattice degeneration, refractive error, prior ocular laser procedures, lens status and family history of RRD. Development of fellow eye RRD along with time to fellow eye RRD. In addition, OCT imaging was utilized in those fellow eyes with a visible posterior hyaloid to document whether a posterior vitreous detachment (PVD) developed during follow-up and time to such an event. A total of 1049 patients with an RRD were followed for an average of 5.7 ± 0.3 years. Overall, 153 (14.6%) patients were diagnosed with bilateral sequential RRDs during this follow-up period. There were OCT images available for 582 fellow eyes: PVD noted in 229 (39.3%) and an attached hyaloid in 353 (51.7%) fellow eyes. An RRD occurred in 7 (3.1%) fellow eyes with a PVD at presentation. Within the cohort of fellow eyes with an attached hyaloid, 29 (8.2%) developed an RRD during follow-up; however, when evaluating only those that developed a PVD during follow-up 24.6% of such eyes were found to have an RRD as well. At the time of PVD development in the fellow eye an additional 21 (17.8%) eyes were noted to have a retinal tear that was treated without progression to RRD. Optical coherence tomography imaging of the fellow eye at time of presentation with an RRD offers a significant amount of information regarding risk stratification for RRD in this eye. Patients noted to have a completely detached posterior hyaloid are at a significantly lower risk of RRD than those with a visible posterior hyaloid-who need to be monitored closely at the time of PVD development.

WF SS-OCTA for detecting diabetic retinopathy and evaluating the effect of photocoagulation on posterior vitreous detachment.

This study aimed to assess the clinical usefulness of widefield swept source optical coherence tomography angiography (WF SS-OCTA) for detecting microvasculature lesions in diabetic retinopathy (DR) by comparing it with ultra-widefield fluorescein angiography (UWFFA) and to investigate the effect of panretinal photocoagulation (PRP) on posterior vitreous detachment (PVD) status. Patients with severe non-proliferative DR (NPDR) or proliferative DR (PDR) who were initially treated with PRP were enrolled. They underwent WF SS-OCTA with a 12×12-mm scan pattern of five visual fixations at baseline and at least a 3-month follow-up after PRP treatment. Patients with no contraindications underwent imaging with UWFFA within a week. Images were evaluated using two methods for the areas of the visible field of view (FOV), non-perfusion area (NPA), presence of neovascularization of the disc (NVD), neovascularization elsewhere (NVE), and PVD status. In total, 44 eyes of 28 patients with DR that were initially treated with PRP were analyzed. The FOV of the UWFFA was significantly wider than that of the WF SS-OCTA. The quantitative measurement of the NPAs was consistent between the two methods. NPAs more than 5DA outside the panoramic OCTA imaging area were detected in 1 eye with NPDR (8.3%) and in 10 eyes with PDR (47.8%). WF SS-OCTA had high detection rates for NVDs and NVEs, with a low rate of false positives. After PRP treatment, no eyes indicated progression in the PVD stages around the macula, optical disc, or NVEs at the short follow-up. WF SS-OCTA is clinically useful for evaluating NPAs and neovascularization in DR. PRP treatment does not induce PVD development in the short term.

Retinal Shape-Based Classification of Retinal Detachment and Posterior Vitreous Detachment Eyes.

Retinal detachment is a sight-threatening emergency, with more than half of those affected suffering permanent visual impairment. A diagnostic test to identify eyes at risk before vision is threatened would enable exploration of prophylactic treatment. This report presents the use of irregularities in retinal shape, quantified from optical coherence tomography (OCT) images, as a biomarker for retinal detachment. OCT images were taken from posterior and mid-peripheral retina of 264 individuals [97 after a posterior vitreous detachment (PVD), 99 after vitrectomy for retinal detachment and 68 after laser for a retinal tear]. Diagnoses were taken from history, examination and OCT. Retinal irregularity was quantified in the frequency domain, and the distribution of irregularity across the regions of the eye was explored to identify features exhibiting the greatest difference between retinal detachment and PVD eyes. Two of these features plus axial length were used to train a quadratic discriminant analysis classifier. Classifier performance was assessed by its sensitivity and specificity in identifying retinal detachment eyes and visualised with a receiver operating characteristic (ROC) curve. Validation set specificity was 84% (44/52 PVD eyes correctly labelled) and sensitivity 35% (23/64 retinal detachment eyes identified, p = 0.02). Area under the ROC curve was 0.75 (95% confidence intervals 0.58-0.85). Retinal detachment eyes were significantly more irregular than PVD eyes in the superior retina (0.70mm versus 0.49mm, p < 0.05) and supero-temporal retina (1.12mm versus 0.80mm, p < 0.05). Lower sensitivity (16/68, 24%) was seen for eyes with a retinal tear without detachment, that were intermediate in size between retinal detachment and PVD eyes. Axial length on its own was a poor classifier. Neither irregularity nor classification were affected by surgery for retinal detachment or the development of PVD. The classifier identified 1/3 of retinal detachment eyes in this sample. In future work, these features can be evaluated as a test for retinal detachment prior to PVD.

Clinical findings in acute posterior vitreous detachment.

To analyze the typical presentation of acute posterior vitreous detachment (PVD), including demographics and prevalence of various treatable findings in the same and fellow eye. Retrospective analysis of medical records from 2346 patients with acute PVD. Descriptive statistics were generated on age, sex, contact date, visual acuity, and slit lamp, and fundoscopy findings. Multivariate regressions were used to generate odds ratios with 95% confidence intervals (CI) to quantify associations between variables. A total of 4692 eyes from 2346 patients were analyzed. Most patients were female (60.5%) with an average age of 62.8years old. Overall, 605 patients (25.8%) had any additional ocular finding on fundus exam, including pigmentation (N = 184, 7.8%), lattice degeneration (N = 158, 6.7%), tear (N = 131, 5.6%), and hole (N = 131, 5.2%). Unilateral retinal detachment was present in 26 patients (1.1%), and these patients demonstrated a similar rate (26.9%) of additional ocular findings compared to the entire sample size. Female sex (OR 1.21, 95% CI 1.03-1.43, p = 0.020) was independently associated with presentation during spring or summer. Acute PVD is associated with a number of risk factors and peripheral lesions. These findings may be useful in treating and predicting the course and development of PVD.

Specific Features of the Course of Toxocariasis Chorioretinitis

Toxacariasis is a parasitic disease from the group of nematodoses, the causative agents of which are toxocaras of dogs and cats (Toxocara canis and Toxocara mystax). Most often, the source of human invasion is dog — the main host of the parasite. Invasion occurs when helminth's eggs are ingested by means contaminated food, water, accidental geophagy, and direct contact with a dog. In the human gut, the larva releases from the egg and migrates, causing a general parasitic infestation known as “visceral migrating larvae” (Visceral larval migrans). Toxocara settles in various organs (lungs, spleen, liver, eyes, brain), which causes the local inflammatory and allergic reactions. The incidence of toxocariasis is a serious problem in recent years, especially in large cities. Each year, relatively low rates of toxocariasis and sporadic ocular infestations are recorded. This situation does not indicate stability of the situation, but rather may be due to insufficient alertness of ophthalmologists in relation to the toxacarous etiology of the inflammatory process in the eye, which leads to incomplete examination of patients and diagnostic errors. An ocular form of toxocariasis may manifest as granulomatous choroiditis, chorioretinitis and parsplanitis with the formation of peripheral granulomas and vasculitis. Complications of these inflammatory diseases are traction retinal detachment, and with a long course, chronic endophthalmitis which develops with the outcome in subatrophy and atrophy of the eye-globe, leading to its death. The disease occurs in children and adult patients. The ophthalmologists should be on the alert to the toxacariasis etiology of the inflammatory process in the choroid and retina. The article cites two case reports of toxacarous chorioretinitis (females of 53 and 57 y.o.) with development of posterior vitreous detachment and hemophthalmos. The dynamics of the pathological process, diagnostic approaches and treatment tactics are described.

Incidence and Risk Factors of Epiretinal Membrane after Cataract Surgery

Purpose: To investigate the incidence and risk factors of epiretinal membrane (ERM) after cataract surgery.Methods: We reviewed the medical records of patients who underwent cataract surgery between January 2016 and December 2018. Eyes with ERM, as observed by optical coherence tomography performed 1-2 months after surgery, were excluded from the study. ERM was diagnosed by fundus photography. The incidence rate was determined 2-6, 6-12, and 12-24 months after surgery. The cumulative incidence rate of ERM was calculated by Kaplan-Meier analysis. Data were analyzed using logistic regression to determine the associations between ERM development and various factors.Results: The study included 218 eyes of 161 patients with a mean age of 66.6 ± 9.7 years at the time of surgery. ERM was observed in 3 of 218 eyes (1.4%) between 2 and 6 months, 15 of 176 eyes (8.3%) between 6 and 12 months, and 14 of 150 eyes (10.3%) between 12 and 24 months after surgery. The cumulative incidence rate of ERM was 11.7% over the 24-month period after surgery. In multivariate logistic regression analysis, older age (≥65 years; odds ratio [OR], 8.59, 95% confidence interval [CI], 1.43-51.49), fellow eye with ERM (OR, 3.63; 95% CI, 1.04-12.73), longer axial length (≥26 mm; OR, 8.02; 95% CI, 1.08-59.66), and complete posterior vitreous detachment development (OR, 7.48; 95% CI, 1.64-34.14) were significantly associated with ERM development.Conclusions: ERM is not rare after cataract surgery. Long-term retinal examination should be required after cataract surgery.

Epiretinal membrane appearance or progression after intravitreal injection in age-related macular degeneration

BackgroundThe purpose of this study is to evaluate the influence of anti-vascular endothelial growth factor (VEGF) in the appearance or progression of epiretinal membranes (ERMs) in age-related macular degeneration (ARMD) and investigate confounding factors causing ERMs.MethodsSeventy-six eyes that were treated for more than 36 months from the first anti-VEGF injection were assessed. Binary logistic regression analysis was performed between smoking, lens status, subretinal hemorrhage, posterior vitreous detachment (PVD) status, peripheral retinal degeneration, type of AMD, conditions of contralateral eye, and the number of injections as independent variables and appearance or progression of ERMs during 36 months as dependent variables.ResultsThe presence of vitreomacular adhesion (VMA) or development of PVD during the observation period was significantly associated (Odds ratio [OR]: 5.77; 95% confidence interval [CI], 1.72–19.4; p = 0.005) with the appearance or progression of ERMs. Moreover, peripheral retinal degeneration was significantly associated (OR: 3.87; 95% CI, 1.15–13.0; p = 0.029). Injection number of anti-VEGF was not significantly associated (OR: 1.02; 95% CI, 0.90–1.16; p = 0.72).ConclusionThis study suggests possibilities that anti-VEGF injections alone are unable to cause the development of ERMs, that VMA or developing PVD has a prior impact on the developing ERMs in ARMD similar to that of idiopathic ERMs, and that peripheral retinal degenerations and vitreomacular adhesion were both related to ERMs development and pathogenesis of ARMD.

The effect of posterior vitreous detachment on aflibercept response in diabetic macular oedema

PurposeTo investigate the effect of posterior vitreous detachment (PVD) on aflibercept response in treatment-naïve diabetic macular oedema (DME).DesignA retrospective cohort study.MethodsOne hundred and fifty eyes of 150 treatment-naïve patients with...

Risk Factors for Onset or Progression of Posterior Vitreous Detachment at the Vitreomacular Interface after Cataract Surgery

To study the incidence and risk factors for onset or progression of posterior vitreous detachment (PVD) at the vitreomacular interface (VMI) after cataract surgery. Retrospective case series. Patients with a history of phacoemulsification from April 2018 through April 2019 at the Keye Eye Center, Seoul, Korea, and postoperative monitoring for more than 2 months. Cox proportional hazard ratios for the onset or development of PVD after cataract surgery in the presence of selected risk factors and demographic data were calculated. To evaluate the ocular risk factors, various ocular metrics, including spherical equivalent (SE), axial length (AL), anterior chamber depth, lens thickness, central subfield thickness, PVD status at macula and optic nerve head (ONH), peripapillary retinal nerve fiber layer thickness, and ONH parameters from OCT scans, were used for the analysis. Onset or development of PVD at the VMI. Among 988 eyes without PVD at baseline, 174 eyes (17.6%) showed changes in the VMI. Univariate analysis showed that age, SE, AL, PVD status at macula and ONH, and average and vertical cup-to-disc ratios (CDRs) were associated significantly with PVD onset or development (P= 0.046, P= 0.004, P= 0.040, P < 0.001, P < 0.001, P= 0.008, and P= 0.042, respectively). In a multivariate analysis, PVD status at the macula and ONH and smaller CDR were associated with PVD onset or progression after cataract surgery after adjustment for age, SE, and AL (P < 0.001, P < 0.001, and P= 0.005, respectively). The risk of PVD onset or progression was dependent on PVD status and the CDR detected on OCT scans, not on age or AL, in a large patient cohort. Patients who show risk factors on OCT should be monitored carefully during the postoperative period.

Posterior vitreous detachment rate following intravitreal dexamethasone injection.

To determine whether intravitreal dexamethasone (DEX) implant induces posterior vitreous detachment or not. We retrospectively reviewed 810 eyes of 405 patients who underwent intravitreal DEX implantation due to macular edema caused by diabetic and retinal venous occlusion in our clinic. The eyes having no injection were determined as the control group. The examination findings of the patients before the injection and 3mo after the injection and optical coherence tomography (OCT) images were scanned. The pre-injection OCT findings and OCT findings of the patients having no posterior vitreous detachment (PVD) and determined to have partial PVD were compared. The separation in vitreoretinal adhesion and total PVD development of DEX-injected 56/208 (26.9%) eyes were statistically greater in comparison with the 12/129 (9.3%) eyes that had not been injected (P=0.001). PVD development was observed more in the patients that were younger, had larger macula thickness and lower visual acuity. It can be stated that intravitreal DEX implant induces PVD development. Prospective, controlled studies are required in order to determine prognosis of vitreoretinal disease in PVD-developed patients and in non-PVD-developed patients.

Effect of vitreomacular adhesion on the treatment outcomes in the STOP-Uveitis clinical trial for non-infectious uveitis

PurposeTo evaluate the role of vitreomacular adhesion (VMA) in visual and anatomic outcomes in patients with non-infectious uveitis.DesignPhase 2 clinical trialParticipantsData from the Safety, Tolerability, and Efficacy of Tocilizumab in Patients with Non-infectious Uveitis (STOP-Uveitis) study was analyzed.MethodsIn the STOP-Uveitis study, patients with non-infectious uveitis (NIU) received monthly intravenous infusions of either 4 or 8 mg/kg tocilizumab until month 6 (M6). Spectral domain optical coherence tomography (SD-OCT) images of patients that completed M6 of the study were analyzed at baseline to stratify the patients by the presence (VMA+) or absence (VMA−) of VMA. Patients with vitreomacular traction (VMT) or epiretinal membrane causing structural abnormalities within center 1 mm were excluded. All images were graded by two independent graders.Main outcome measuresMean change in best-corrected visual acuity (BCVA), central retinal thickness (CRT), and vitreous haze (VH) at M6.ResultsOut of 37 patients randomized in the STOP-Uveitis study, 48 eyes (27 patients) were eligible based on the study criteria. At baseline, 19 eyes were classified as VMA+, and 32 eyes were classified as VMA−. The distribution of two doses of TCZ (4 mg/kg and 8 mg/kg) were similar between the two groups. At M6, the mean improvement in BCVA was 2.00 ± 5.3 and 6.50 ± 7.98 letters in the VMA+ and VMA− groups, respectively (p = 0.02). The mean improvement in CRT was 34.85 ± 72.36 and 80.37 ± 157.21 μm in the VMA+ and VMA− groups, respectively (p = 0.18). Similarly, the mean change in VH was − 0.65 ± 0.47 and − 0.76 ± 0.71 in the VMA+ and VMA− groups, respectively (p = 0.32). Out of 16 eyes with VMA at baseline, 3 eyes developed posterior vitreous detachment (PVD) at M6. The mean change in BCVA was significantly higher (p = 0.02), while CRT and VH score were similar (p > 0.05) in eyes with PVD compared to eyes with persistent VMA.ConclusionsThe absence of VMA or development of PVD in eyes with VMA seems to have a beneficial effect on the vision of subjects receiving treatment for uveitis. Therefore, patients with uveitis should be assessed using SD-OCT for the presence of vitreomacular interface abnormalities.

Outcome and Predictors for 2-Year Visual Acuity in Eyes with Diabetic Macular Edema Treated with Ranibizumab

Purpose: To determine the role of baseline characteristics in predicting visual outcome in patients with diabetic macular edema (DME) treated with ranibizumab. Methods: A review was carried out of the charts of 97 eyes that received pro re nata (PRN) intravitreal ranibizumab (IR) 0.5 mg treatment for DME. The change in the mean best-corrected visual acuity (BCVA) was analyzed. The baseline demographics and ocular and optic coherence tomography findings were analyzed to determine the association with the 2-year visual acuity (VA). Results: BCVA increased from 0.54 ± 0.2 (0.05-1.0) to 0.41 ± 0.3 (0.0-1.0) log of the minimum angle of resolution (P < 0.001). Age (P = 0.012), gender (P = 0.018), baseline BCVA (P < 0.001), presence of leaking microaneurysms (MA) (P = 0.018), development of vitreomacular traction (VMT) (P = 0.001), development of posterior vitreous detachment (PVD) (P = 0.040), and disruption of ellipsoid zone (EZ) (P = 0.007) were found as predictors of 2-year VA. There was no association between visual outcome and the other characteristics. Conclusions: PRN treatment of IR provides significant benefits in VA gain and anatomic improvement in eyes with DME. Older age, female sex, lower baseline VA, VMT development, and EZ disruption are predictors for the poor final VA. Development of PVD and leaking MA are predictors for the good final VA.

Scleral buckling in the management of rhegmatogenous retinal detachment: patient selection and perspectives.

Although the technique of pars plana vitrectomy (PPV) develops rapidly, scleral buckling (SB) has several advantages over PPV for rhegmatogenous retinal detachment (RRD), including early visual rehabilitation and prevention of cataract progression. It is recommended to select the primary procedure for RRD by considering the advantages and disadvantages of each procedure based on the patient status. The vitreous body status affects the features of RRD. Vitreous liquefaction is an age-dependent process, resulting in the development of posterior vitreous detachment (PVD). RRD is usually associated with PVD, typically presenting with a retinal tear, strong vitreoretinal traction, and bullous detachment. In contrast, RRD may develop without PVD, and typically presents with a small atrophic hole, shallow detachment, and slow progression. RRD with less liquefied vitreous and no PVD can be managed successfully with SB alone even in the presence of subretinal strand as less liquefied vitreous acts as bio-tamponade blocking fluid passage. The strong traction induced by PVD and bullous detachment in an eye with extensively liquefied vitreous reduces the success rate of SB. PPV is gaining popularity as the primary procedure for RRD, especially in eyes with retinal tears, PVD, or pseudophakia. Nevertheless, SB remains the preferred procedure in young phakic patients without PVD.

ROLE OF POSTERIOR VITREOUS DETACHMENT ON OUTCOME OF ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT IN AGE-RELATED MACULAR DEGENERATION

The aim of this study was to determine the effect of posterior vitreous detachment on outcome of anti-vascular endothelial growth factor injection. Sixty-one eyes with age-related macular degeneration that had received intravitreal bevacizumab or ranibizumab injections were retrospectively reviewed. The vitreomacular interface was evaluated, and eyes were grouped according to the presence of posterior vitreous detachment (Group 1, n = 25) or vitreomacular adhesion (Group 2, n = 36). All patients received three loading doses of intravitreal anti-vascular endothelial growth factor injections at monthly intervals, and subsequently, pro re nata regimen was performed. Best-corrected visual acuity and central foveal thickness measurement at follow-up were evaluated. The development of posterior vitreous detachment during the follow-up was also reported. The best-corrected visual acuity changes at each visit compared with baseline were significantly better in Group 1 (P = 0.01, 0.02, 0.02, 0.009, 0.009, respectively at third, sixth, ninth, 12th month, and last visit). When best-corrected visual acuity was classified according to the change in visual acuity of 10 letters or more, the rate of improved or stable best-corrected visual acuity was greater in Group 1 (P = 0.02). During the follow-up, 5 eyes (14.3%) developed posterior vitreous detachment. Vitreomacular adhesion seems to have an adverse effect on the visual prognosis of anti-vascular endothelial growth factor treatment for age-related macular degeneration.

Evolution of Vitreomacular Detachment in Healthy Subjects

Development of posterior vitreous detachment (PVD) plays an important role in vitreomacular diseases. Spectral-domain optical coherence tomography (SD-OCT) with noise reduction can visualize a posterior precortical vitreous pocket (PPVP) and classify PVD stages according to the state of the posterior wall of the PPVP. To describe the role of the PPVP in early-stage PVDs in healthy individuals. We performed biomicroscopy and SD-OCT in the right eyes of 368 healthy volunteers (188 males and 180 females; mean [SD] age, 57.1 [19.4] years; range, 12-89 years). The condition of the posterior wall of the PPVP was classified into stages according to the biomicroscopic findings and SD-OCT images: stage 0, no PVD with PPVP (134 eyes; mean [SD] subject age, 38.7 [16.5] years; range, 12-76 years); stage 1, paramacular PVD with PPVP (47 eyes; mean age, 55.2 [10.3] years; range, 36-77 years); stage 2, perifoveal PVD with PPVP (27 eyes; mean age, 62.0 [8.7] years; range, 46-81 years); stage 3, vitreofoveal separation with persistent attachment to the optic disc (19 eyes; mean age, 65.8 [6.2] years; range, 55-80 years; stage 3a, vitreofoveal separation with an intact posterior wall of the PPVP in 12 eyes; stage 3b, vitreofoveal separation with a defect in the posterior wall of the PPVP in 7 eyes; and stage 4, complete PVD (141 eyes; mean age, 73.2 [8.3] years; range, 48-89 years). Ages in each PVD stage. The posterior wall of the PPVP initially detaches at the paramacular area and extends to the perifoveal area, which results in a perifoveal PVD. A vitreofoveal detachment may develop with or without a defect in the PPVP. When the vitreous detaches from the optic disc, a complete PVD develops. An anatomical feature of the PPVP may play a role in the development of a perifoveal PVD.

The vitreomacular interface in retinal vein occlusion

To evaluate the posterior vitreous adhesion status in patients with a history of central or branch retinal vein occlusion and to compare the results with the natural time-course of posterior vitreous detachment in healthy age-related controls. A retrospective chart review in terms of the posterior vitreous adhesion status was performed in 132 patients (133 eyes) with a history of a central (CRVO) or branch (BRVO) retinal vein occlusion. All patients underwent vitrectomy. Based on the operation reports, the vitreous adhesion status was classified as attached, partially detached or completely detached. The results were compared to the natural time-course of posterior vitreous detachment development in healthy age-related controls. Eighty-one eyes met the inclusion and exclusion criteria. Fifty-two eyes (64%) had a history of CRVO and 29 eyes (36%) a history of BRVO, respectively. In the CRVO group, the posterior vitreous was attached in 47 eyes (90%) and completely detached in five eyes (10%). In the BRVO group, the posterior vitreous was attached in 27 eyes (93%), partially detached in 1 eye (3%) and completely detached in another eye (3%). A subdivision into age classes and a comparison with healthy age-related controls [data by Weber-Krause & Eckardt (1997) Ophthalmologe, 94, 619-623] showed in patients between 65 and 69 years of age an attached posterior vitreous cortex in 72% in healthy eyes, in 100% in CRVO (p = 0.109) and in 89% in BRVO (p = 0.440), in patients between 70 and 79 years of age an attached posterior vitreous cortex in 56% in healthy eyes, in 86% in CRVO (p = 0.010) and in 100% in BRVO (p = 0.038) and in patients between 80 and 89 years of age an attached posterior vitreous cortex in 43% in healthy eyes, in 100% in CRVO (p = 0.191) and in 67% in BRVO (p = 0.582) (Fisher's exact t-test). In patients with a history of CRVO or BRVO, the posterior vitreous cortex stays attached more frequently in all age groups in comparison with the healthy age-related controls.

Cataract-Related Acute Vitreomacular Traction Syndrome

To report the acute and transient (within 10 days) presentation of vitreomacular traction following routine cataract surgery. This is a case series of 5 patients with no evidence of posterior vitreous detachment preoperatively who presented with acute vitreomacular traction following routine cataract surgery. All patients presented the first postoperative day with dramatically reduced visual acuity. The patients underwent optical coherence tomography and if necessary fundus fluorescein angiography. Images were suggestive of vitreomacular syndrome. In all 5 cases, there was spontaneous resolution of the traction within 10 days. The latter was probably related to the development of posterior vitreous detachment due to the uncomplicated cataract surgery. In 2 cases there were significant retinal pigment epithelium changes and decreased retinal thickness following the resolution of the traction leaving permanent metamorphopsia and slightly decreased visual acuity. Cataract-related acute vitreomacular traction is a rare phenomenon and not well-recognized; however, it resolves spontaneously within 10 days.

Peripapillary serous retinal detachment preceding complete posterior vitreous detachment

To report on a case of peripapillary serous detachment due to vitreopapillary traction during the development of posterior vitreous detachment. A 63-year-old female presented with acute decreased viual acuity and peripapillary serous retinal detachment extending to the macula in her left eye. Visual acuity was 20/200 in left eye and 20/20 in right eye. Optical coherence tomography confirmed the clinical findings. Peripapillary serous detachment resolved spontaneously 1 week after presentation with the complete development of posterior vitreous detachment. Visual acuity improved to 20/20. Posterior vitreous detachment may cause peripapillary and macular serous detachment during the development.

ROLE OF POSTERIOR VITREOUS DETACHMENT INDUCED BY INTRAVITREAL TISSUE PLASMINOGEN ACTIVATOR IN MACULAR EDEMA WITH CENTRAL RETINAL VEIN OCCLUSION

To evaluate the effects of posterior vitreous detachment (PVD) in macular edema associated with central retinal vein occlusion (CRVO) treated with intravitreal tissue plasminogen activator (tPA). The authors conducted a retrospective study of 36 eyes of 36 patients with macular edema by CRVO treated with intravitreal tPA. In 16 of 21 eyes without pretreatment PVD, PVD developed after the treatment. Multiple linear regression analysis was used to evaluate the correlation between logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) changes and several variables. The VA and macular thickness significantly improved after treatment. The pretreatment logMAR VA (R = 0.646; P < 0.0001), PVD development after tPA (R = -0.303; P = 0.025), and age (R = 0.255; P = 0.050) correlated with the logMAR VA at final visit. The greater improvement in logMAR VA was correlated only with PVD development (R = 0.467; P = 0.0041). Macular thickness in the eyes with PVD development was significantly less than without PVD development at the 6-month visit and the end of follow-up. The findings suggest that PVD development after intravitreal tPA may partly contribute to the resolution of macular edema and a better VA outcome.

Time course of posterior vitreous detachment in the second eye

Posterior vitreous detachment is the principal predisposing event for the development of retinal breaks and rhegmatogenous retinal detachments. Patients with unilateral posterior vitreous detachment are potentially at risk of developing the complications associated with posterior vitreous detachment in the fellow eye. Thus, to identify when posterior vitreous detachment develops in the fellow eye after it develops in the first eye is important for managing patients with unilateral posterior vitreous detachment. The main theme in the literature is research regarding the mechanism of the development of posterior vitreous detachment. Various pharmacologic vitreolysis agents can induce posterior vitreous detachment. Changes in the enzymatic activities in the vitreous and vitreoretinal interface tend to promote vitreous separation from the inner retinal surface with aging. Clinical studies have shown a significant increase in the occurrence of posterior vitreous detachment with aging, and the interval between the development of posterior vitreous detachment in the first eye and in the second eye is short. Posterior vitreous detachment is one of the most important age-related changes in human eyes, and age-related changes develop equally in both normal eyes; thus, posterior vitreous detachment may develop in the second eye within a few years of developing in the first eye.