Stages Of Posterior Vitreous Detachment Research Articles

Vitreous mobility during the posterior vitreous detachment initiation demonstrated by pseudo-motion optical coherence tomography

PurposeTo document the anatomical changes occurring at the vitreoretinal interface during early posterior vitreous detachment (PVD). MethodsWide-angle and pseudo-motion optical coherence tomography (OCT) were obtained on 27 normal eyes during the early stages of age-related PVD. The wide-angle examination in a static phase consisted of montaged conventional OCT images. GIF-formatted pseudo-animation was generated with OCT images acquired initially in a static eye state, followed by scans immediately after ocular excursions. ResultsInitial stages of PVD included peripheral PVD with (stage 1a) or without (stage 1b) interposed material between the posterior vitreous cortex and the retina, and perifoveal PVD expanding to the periphery (stage 2). All stage 1 PVDs presented anterior to the papillomacular vitreous liquefaction. All eyes demonstrated mobility of the vitreous gel at the anterior face of the vitreous liquefaction; however, the adherent cortical vitreous layer comprising the posterior wall of the lacuna showed no mobility. Mobility of the posterior vitreous cortex was not present in eyes with stage 1a PVD and increased with the progression of the stage of PVD (p = 3.60×10−6). ConclusionDuring nonpathological PVD, macula is protected from tractional insults conveyed by mobile vitreous due to overlying vitreous liquefaction. However, the vitreoretinal interface anterior to the lacunae experiences tractional forces until vitreoretinal separation occurs. These observations reinforce the hypothesis that vitreous liquefaction, vitreous mobility, and vitreoschisis formation contribute to PVD initiation and support that premacular lacunae protect the macula during PVD initiation and early progression.

CLINICALLY RELEVANT POSTERIOR VITREOUS DETACHMENT STAGING USING CIRCUMPAPILLARY AND MACULAR VOLUME OPTICAL COHERENCE TOMOGRAPHY.

This study was designed to investigate retinal nerve fiber layer circumpapillary optical coherence tomography to determine posterior vitreous detachment (PVD) status and to develop a clinically relevant PVD grading scale based on retinal nerve fiber layer circumpapillary optical coherence tomography to determine the incidence of PVD by age and association with vitreomacular traction disorders. Ophthalmic images and medical records of patients with retinal diseases were retrospectively analyzed by three masked graders using retinal nerve fiber layer circumpapillary optical coherence tomography and macular optical coherence tomography. Based on PVD status, eyes were categorized into five newly defined PVD stages. Among 2002 eyes, PVD stages were as follows: A) 25 (1.25%); B) 725 (36.21%); C-) 248 (12.39%); C+) 151 (7.54%); D) 851 (42.51%); X) 2 (0.1%). Posterior vitreous detachment was correlated with advanced age (P < 0.0001). Limited separation or partial separation between lamella within the posterior vitreous cortex (Stage B) was noted early (68% of eyes <18 years). Overall, 34% of eyes >70 years did not exhibit complete PVD. Of 75 eyes with tractional vitreoretinal disorders, 64 (85.3%) were Stage C-/C+, identifying Stage C as the high-risk "complication" stage. Imaging analyses using retinal nerve fiber layer circumpapillary optical coherence tomography and macular optical coherence tomography scans in conjunction allow rapid assessment of the PVD stage. These techniques can assist clinicians and surgeons in counseling patients and planning surgical approaches. Observations confirmed the progression of PVD through predictable stages and the progression of PVD with age.

Bioelectrical impedance analysis in patients with posterior vitreous detachment.

The purpose of the study is to assess body hydration in patients with posterior vitreous detachment (PVD) by bioelectrical impedance analysis (BIA). PVD, one of the most common eye diseases, is associated in both research and the collective image with reduced daily water intake, but this finding is not supported by strong evidence in the literature. Based on Spectral Domain Optical Coherence Tomography (SD-OCT) evaluation, different PVD stages are identified: absent posterior vitreous detachment, partial posterior vitreous detachment (P-PVD), or complete posterior vitreous detachment (C-PVD). BIA is a simple, non-invasive bedside method used to assess body composition. Patients underwent BIA and completed a floaters symptoms. 30 patients were enrolled and divided into two groups according to the degree of vitreous detachment, in P-PVD (n=12) and C-PVD (n=18). Patients underwent BIA and completed a floaters symptoms questionnaire. BIA measured the Resistance (R), Reactance (Xc), Phase Angle (PhA), Total Body Water (TBW), Extracellular Water (ECW), Fat Mass (FM), Fat-Free Mass (FFM), and Body Cell Mass Index (BCMI). Finally, patients received a test to assess adherence to the Mediterranean diet (Mediterranean Diet Test Score, MDTS) with the addition of daily water intake. Relevant data were obtained from the BIA evaluation: the values of R and Xc were lower in the P-PVD group than C-PVD group (respectively 417.08±58.12 Ω vs. 476.94±51.29 Ω p=0.006 and 41.33±8.23 Ω vs. 50.61±7.98 Ω p=0.004). Instead, patients in the P-PVD group reported higher values of TBW and ECW than C-PVD group (respectively 44.13±7.57 L vs. 37.96±6.27 L p=0.021 and 21.03±4.06 L vs. 17.24±2.63 L p=0.004). In the present study, we reported a significant correlation between vitreous pathology and anthropometric and BIA measurements.

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.

IMAGING THE VITREOUS WITH A NOVEL BOOSTED OPTICAL COHERENCE TOMOGRAPHY TECHNIQUE: Posterior Vitreous Detachment.

To evaluate the anatomic changes in the vitreous associated with evolving posterior vitreous detachment over the macula. A novel scanning method by which four A-scans at each position were averaged before the Fourier transform that boosted the image quality sufficiently such that frame averaging could occur. B-scans and volume rendered images of eyes with evidence of any partial separation of the vitreous in the macular regions were evaluated. There were 43 eyes of 23 subjects with particular attention paid to the findings of seven eyes with various stages of posterior vitreous detachment occurring over the macula. In eyes from young subjects with no vitreous degeneration, the outer vitreous showed a diffuse, poorly defined increase in reflectivity in the region where the vitreous cortex was expected to be. In eyes with vitreous degeneration, there was a hyperreflective zone, called the cortical vitreous condensation, that coursed parallel to the curvature of the retina. The posterior vitreous face elevated from the retina with either a well-defined, smooth outer surface, consistent with the posterior vitreous membrane, or a poorly defined flocculent outer border. The cortical vitreous near the fovea was thin and in eyes in the process of posterior vitreous detachment had visible tears. In more advanced eyes, a circular dehiscence of the cortical vitreous in the central macula occurred with herniation of the vitreous gel through the hole. The methodology produced images of unprecedented clarity that highlighted several newly described details concerning the vitreous changes associated with posterior vitreous detachment over the macula.

POSTERIOR VITREOUS DETACHMENT STATUS AS A PREDICTIVE FACTOR FOR OUTCOMES OF VITRECTOMY FOR DIABETIC VITREOUS HEMORRHAGE.

The purpose of this study was to evaluate the prognostic utility of the degree of vitreous attachment for predicting outcomes of vitrectomy for nonclearing vitreous hemorrhage associated with proliferative diabetic retinopathy. Medical records of patients who underwent primary vitrectomy for dense nonclearing vitreous hemorrhage secondary to proliferative diabetic retinopathy were examined retrospectively. Eyes were divided into four groups based on the intraoperatively assessed stage of posterior vitreous detachment (PVD), ranging from Stage 0/1 (complete or near-complete vitreoretinal adhesion) to Stage 4 (complete PVD). Overall, 136 eyes (117 patients) were included. In comparison with eyes with a partial or complete PVD (Stages 2-4), eyes with no PVD (Stage 0/1) had a higher incidence of postoperative hypotony (8%, P = 0.03) and traction retinal detachment (27%, P = 0.002), an increased rate of repeat vitrectomy (49%, P = 0.04), and poorer best-corrected visual acuity at 6 months and 1 year postoperatively (P = 0.04 and P = 0.01, respectively). Presence of a complete PVD at baseline was independently associated with improved postoperative vision at 6 months (P = 0.04). More extensive vitreoretinal adhesion is associated with higher rates of reoperation and poorer visual outcomes after vitrectomy for dense nonclearing vitreous hemorrhage associated with proliferative diabetic retinopathy. Preoperative determination of PVD status using B-scan ultrasonography may be useful for predicting anatomical and functional outcomes after vitrectomy in these patients.

Relationship of choroidal thickness and axial length with posterior vitreous detachment in patients with high myopia

Although accumulating evidence suggests a higher prevalence of posterior vitreous detachment (PVD) in highly myopic eyes, the relation between ocular biometric features and PVD stages in such eyes remains unclear. Therefore, we enrolled 170 patients with high myopia (axial length ≥ 26.0 mm) to investigate the status of PVD regarding subfoveal choroidal thickness and axial length. Utilising swept-source optical coherence tomography, we classified the PVD status into five stages. The distribution of PVD grades increased as the choroidal thickness decreased and axial length increased (P < 0.01). On adjusting for age and sex, decreased choroidal thickness and increased axial length were associated with more advanced PVD stages: odds ratios with the highest vs. lowest groups were 0.31 (95% confidence interval [CI] 0.09–1.01; Ptrend = 0.009) for choroidal thickness and 5.16 (95% CI 1.34–19.80; Ptrend = 0.002) for axial length. The inverse association between choroidal thickness and PVD status seemed stronger in women than in men (Pinteraction = 0.05). In conclusion, we firstly observed a significant trend of decreased choroidal thickness, along with increased axial length, with increased grade of PVD, particularly among women with highly myopic eyes, suggesting that advanced morphological myopic changes contribute to PVD in middle-aged adults.

Posterior vitreous detachment after cataract surgery in eyes with high myopia: an optical coherence tomography study.

To compare the progression of posterior vitreous detachment (PVD) after cataract surgery in eyes with high myopia with that in eyes without high myopia. Prospective observational study. Eighty eyes of 80 patients with high myopia and 160 eyes of 160 patients without high myopia scheduled for phacoemulsification were recruited. PVD status was examined using swept-source optical coherence tomography at 2days postoperatively (baseline) and at 3, 6, and 12months postbaseline and classified into 5 stages: 0 (no PVD), 1 (paramacular PVD), 2 (perifoveal PVD), 3 (peripapillary PVD), and 4 (complete PVD). The PVD stage and incidence of progression to complete PVD of the 2 groups were compared. The mean PVD stage did not differ significantly between the groups at baseline or at 3months postbaseline but was significantly more progressed in the high myopia group than in the nonhigh myopia group at 6months and 12months postbaseline (P ≤ 0.0201). The Kaplan-Meier survival rate for complete PVD was significantly lower in the high myopia group (P = 0.0129). After adjusting for age, sex, and baseline PVD stage, the hazard ratio for complete PVD was 1.68-fold higher in the high myopia group than in the nonhigh myopia group (P = 0.0326, 95% CI 1.04-2.70). After cataract surgery, PVD progressed significantly faster in eyes with high myopia than in eyes without high myopia, and the relative risk for complete PVD was 1.68-fold higher in eyes with high myopia, suggesting that highly myopic eyes are at considerably high risk for retinal disease postoperatively.

Inter-Eye Comparison in Highly Myopic Patients with Unilateral Myopic Traction Maculopathy

ABSTRACT Purpose To evaluate the risk factors for myopic traction maculopathy (MTM) through inter-eye comparisons of asymmetric ocular features in patients with unilateral MTM. Materials and Method Highly myopic patients with unilateral MTM were enrolled in the study. The results of comprehensive ophthalmologic examinations, color fundus images, and optical coherence tomography (OCT) were reviewed. MTM and myopic atrophic maculopathy was evaluated according to the ATN classification system. The status of the posterior vitreous detachment (PVD), posterior precortical vitreous pocket, vitreoretinal interface abnormalities, posterior staphyloma height (PSH), and the location of the protrusion of the sclera were assessed through OCT. Results Among the 54 eyes of 27 patients 48.89 ± 12.78 years of age, the affected eyes had worse best-corrected visual acuity, a longer axial length (AXL), greater PSH, and higher rates of posterior staphylomas, vitreovascular traction and epiretinal membranes (ERMs) than the fellow eyes (P < .001; P < .001; P < .001; P = .010; P = .002; P < .001). Thirteen cases present obvious anisometropia with an inter-eye AXL difference of more than 1 mm. In the 14 cases without obvious anisometropia, the eyes with MTM still had longer AXL, greater PSH and a higher ERMs rate than the fellow eyes (P = .039; P = .017; P = .001). Besides, in the 7 cases with an inter-eye AXL difference of less than 1 mm and asymmetrical stages of PVD, 5 cases with greater PVD in the affected eyes. Multiple risk factors coexisted in 96% of cases. Conclusions In patients with unilateral MTM, a longer AXL, greater PSH, posterior staphyloma, vitreovascular traction, and ERMs were the main factors contributing to the occurrence of MTM. The process of PVD might involve in MTM development.

Evaluating posterior vitreous detachment by widefield 23-mm swept-source optical coherence tomography imaging in healthy subjects

Posterior vitreous detachment (PVD) is a separation between the posterior vitreous cortex and internal limiting membrane. Although PVD was historically considered an acute event, recent studies using spectral-domain optical coherence tomography (SD-OCT) revealed a gradual progression of PVD in healthy subjects. Although SD-OCT improved PVD studies, the narrow imaging angle and long examination time were problematic to allow wide angle capture. The Xephilio OCT-S1 (Canon), a swept-source OCT (SS-OCT) device, can obtain up to 23-mm of widefield B-scan images in a single acquisition. We used this widefield SS-OCT to quantitatively evaluate the PVD stage in 214 healthy subjects aged 4–89 years and determine whether PVD stages differ between the bilateral eyes of each patient. Age was significantly positively correlated with the overall PVD stage (ρ = 0.7520, P < 0.001). Interestingly, partial PVD occurred in children as young as 5 years, indicating that initial PVD onset may occur much earlier than previously reported. Furthermore, PVD stages of the bilateral eyes were highly consistent in 183 subjects (85.5%). Widefield 23-mm SS-OCT thus revealed that PVD started earlier than anticipated, and age was correlated with the symmetry of PVD stage. Widefield 23-mm SS-OCT may also be clinically useful for the evaluation of diseased eyes.

Progression of posterior vitreous detachment after cataract surgery.

To compare the progression of posterior vitreous detachment (PVD) between eyes that underwent cataract surgery and eyes that did not undergo surgery in non-highly myopic patients. One-hundred twenty-five eyes of 125 patients scheduled for phacoemulsification and 125 eyes of 125 age-matched patients who did not undergo surgery were enrolled. PVD status was evaluated using swept-source optical coherence tomography at 2 days (baseline), and 1, 3, 6, and 12 months postoperatively, and classified into five stages: 0 (no), 1 (paramacular), 2 (perifoveal), 3 (peripapillary), and 4 (complete). The PVD stage and incidence of progression to complete PVD were compared between groups. The mean PVD stage significantly progressed over the 12 months in the surgery group (P = 0.0004), but did not change significantly in the non-surgery group. The PVD stage did not differ significantly between groups at 2 days, or 1, 3, and 6 months postoperatively, but was significantly more progressed in the surgery group than in the non-surgery group at 12 months (P = 0.0390). After adjusting for age, sex, axial length, and baseline PVD stage, the relative risk for progression to complete PVD was 7.1-fold higher in the surgery group than in the non-surgery group (P < 0.0001, 95% confidence interval 2.9-17.3). PVD progressed significantly faster in eyes after cataract surgery compared with eyes that did not undergo surgery, and the relative risk of progression to complete PVD was approximately seven-fold higher within 1 year, indicating that the risk for PVD-related diseases is high after cataract surgery.

PROGRESSION OF PARTIAL POSTERIOR VITREOUS DETACHMENT OVER TIME.

We investigated interindividual differences in the rate of change of posterior vitreous detachment (PVD) stage and vitreomacular adhesion area (VMAA). Crosssectional studies demonstrated increasing PVD stage and decreasing VMAA with age, but population-level means may mask interindividual variation in the rate of change. We retrospectively evaluated PVD stage and VMAA in asymptomatic eyes of subjects who underwent repeated optical coherence tomography screening for high-risk medication use or isolated retinal disease in the fellow eye. A Turnbull estimator modeled changes in the PVD stage, and linear mixed models evaluated VMAA change. We evaluated 101 eyes of 101 subjects. Seventy-six eyes remained in the same stage. Twenty-three eyes progressed to a higher stage. Modeling of longitudinal data predicts that at age 30, time to convert to Stage 4 is 26 years; at age 40, it is 16 years; at age 50, it is 9 years; and at age 60, it is 8 years. In 37 eyes with Stage 1 partial PVD, VMAA decreased at a similar rate. The average population level decline in VMAA was 0.13 mm2/year. Individuals vary in age at which they progress to complete PVD. In early partial PVD, VMAA decreases at a similar rate across individuals.

Acute symptomatic vitreous floaters assessed with ultra-wide field scanning laser ophthalmoscopy and spectral domain optical coherence tomography

To describe the eyes with vitreous floaters and to analyze the development of acute symptomatic posterior vitreous detachment (PVD). A retrospective review of medical records was performed on patients with the vitreous floater developed for the first time of their life. Peripapillary vitreous opacity (pVO) was searched in Ultra-wide field (UWF) scanning laser ophthalmoscopy and PVD stage was assessed through spectral-domain optical coherence tomography (SD-OCT). 196 patients (55 males and 141 females), who were 58.4 (± 9.1) years old, visited a retinal clinic 9.4 (± 9.1) days after they experienced vitreous floaters. In 196 eyes, pVO was noticed in 122 eyes (62.2%) at UWF. In 106 eyes where SD-OCT data were available, PVD was noticed in 100 eyes (94.3%). Symptomatic eyes showed more advanced stage of PVD (p < 0.001) than symptom free eyes. Eyes with floaters were more myopic (− 0.7 ± 2.2D vs − 0.5 ± 1.9D, p = 0.02), and had lower intraocular pressure (IOP) (14.7 ± 3.2 mmHg vs 15.2 ± 3.0 mmHg, p = 0.02) than the other symptom free eyes. In patients with first floater symptoms, PVD was in progress in most of the eyes not only the symptomatic eyes but also on the contralateral symptom free eyes. Eyes with vitreous floaters were more myopic and had lower IOP than the opposite symptom free eyes.

Continued smoking and posterior vitreous adhesion in the elderly evaluated on swept-source optical coherence tomography

In this cross-sectional study including 1150 eyes of 681 volunteers ≧ 65 years old without retinal pathology, factors affecting the progression of posterior vitreous detachment (PVD) were investigated.PVD stages were diagnosed based on swept-source optical coherence tomography (SS-OCT). Linear mixed effect model was used to determine whether age, gender, diabetes mellitus (DM), hypertension (HT), dyslipidemia (DL), and smoking status were associated with various stages of PVD. As a result, the multivariable analysis disclosed that the associations between older age and higher PVD stages (estimate [95% CI], 0.031 [0.020 to 0.042]; P < 0.0001), and current smokers and lower PVD stages (estimate [95% CI], − 0.24 [− 0.43 to − 0.056]; P = 0.011) were statistically significant. In contrast, female gender was not an independent factor affecting PVD stages in the elderly. Our analysis indicated that higher PVD stages observed in female eyes may be due to confounding effect, in which current smokers were predominantly males (i.e., 12.6% among males vs. 3.9% among females, P < 0.0001). In conclusion, our findings suggest that continuous smoking is associated with an adherent vitreoretinal interface in the elderly.

Posterior vitreous detachment and macular microvasculature in the elderly.

PurposeTo investigate the association between different stages of posterior vitreous detachment (PVD) and macular microvasculature in the elderly.MethodsSwept-source optical coherence tomography (OCT), OCT angiography, and color fundus images of 490 eyes without retinal pathologies of 322 participants aged ≥65 years were evaluated. PVD was classified using enhanced vitreous visualization mode as no apparent PVD (stage 0/1), vitreous adhesions at the fovea and optic disc (stage 2), adhesion at the optic disc (stage 3), or complete PVD (stage 4). Microvascular parameters, including foveal avascular zone (FAZ) and vessel density (VD), were analyzed for their associations with complete PVD. Additionally, the association between PVD and central retinal thickness (CRT) was also addressed.ResultsOverall, 80, 31, 31, and 349 eyes were categorized into stages 0/1, 2, 3, and 4, respectively. Using multivariate mixed-effects model, the mean superficial FAZ area was smaller in stage 4 compared with stages 0–3 (0.29 vs. 0.32 mm2; P = 0.014), and the mean superficial VD was lower in stage 4 compared with stages 0–3 (34.96% vs. 35.24%; P = 0.0089). However, PVD was not significantly associated with deep macular microvascular parameters or CRT.ConclusionsComplete PVD was associated with smaller FAZ area and lower VD in superficial macular microvasculature, while it was not associated with central retinal thickness.

Posterior vitreous detachment in patients with diabetes mellitus.

To compare the progression of posterior vitreous detachment (PVD) during aging among eyes of diabetics with diabetic retinopathy (DR), eyes of diabetics without DR, and eyes of nondiabetics. Prospective cross-sectional study. One-hundred thirty-three diabetic eyes with DR (DR group), 254 diabetic eyes without DR (non-DR group), and 577 nondiabetic eyes (nondiabetic group) were divided into four age categories: 1) 40-49 years, 2) 50-59 years, 3) 60-69 years, and 4) 70-79 years. The PVD state was examined using swept source-optical coherence tomography and classified into five stages: 0 (non PVD), 1 (paramacular PVD), 2 (perifoveal PVD), 3 (vitreofoveal separation), and 4 (complete PVD). The PVD stage significantly progressed in the DR, non-DR, and nondiabetic groups (p <0.0001). At 40-49 and 50-59 years, the PVD stage did not differ significantly among the three groups. At 60-69 and 70-79 years, the PVD stage was significantly less progressed in the DR than the non-DR and nondiabetic groups (p ≤0.0027), and did not differ significantly between the non-DR and nondiabetic groups. At 70-79 years, complete PVD was detected in 40.6% of eyes in the DR group, 69.6% in the non-DR group, and 73.5% of eyes in the nondiabetic group. PVD progresses later in diabetic eyes with DR than in diabetic eyes without DR and nondiabetics eyes at 60 and 70 years of age, suggesting a stronger vitreomacular adhesion in diabetics with DR.

Sex-Related Differences in the Progression of Posterior Vitreous Detachment with Age

To compare the difference in the progression of posterior vitreous detachment (PVD) between men and women in relation to age. Observational cross-sectional study. One hundred eyes of 100 male patients and 100 eyes of 100 female patients in 4 age groups: 40 to 49 years of age, 50 to 59 years of age, 60 to 69 years of age, and 70 years of age or older. Using swept-source (SS) OCT, PVD was classified into 5 stages: 0, no PVD; 1, paramacular PVD; 2, perifoveal PVD; 3, vitreofoveal separation; and 4, complete PVD. The PVD stage distribution was compared between men and women in the 4 age groups and among the age groups. Stage of PVD determined using SS OCT. In both male and female eyes, the stage of PVD progressed significantly in association with the age group (P < 0.0001). The distribution of the PVD stage did not differ significantly between men and women in the 40- to 49- and the 50- to 59-year age groups. The distribution of the PVD stage was significantly more progressed in women than in men, however, in those 60 to 69 years of age and those 70 years of age and older (P ≤ 0.0292). At 40 to 49 years of age, no PVD (stage 0) and paramacular PVD (stage 1) were detected in 92 (92.0%) female eyes and 93 (93.0%) male eyes. At 70 years of age or older, vitreofoveal separation (stage 3) and complete PVD (stage 4) were detected in 93 (93.0%) female eyes and 78 (78.0%) male eyes. Posterior vitreous detachment significantly progresses with age in both genders, specifically between 40 years of age and 70 years of age or older. Posterior vitreous detachment progression occurs significantly faster in female eyes than in male eyes at 60 years of age or older, suggesting that the macular pathologic features associated with PVD occur at a younger age in women.

Prevalence of posterior vitreous detachment in glaucoma patients and controls.

To evaluate the impact of oxidative stress - present in glaucoma - on the vitreous. We therefore compare the presence of early and late stages of posterior vitreous detachment (PVD) between patients with glaucoma and controls. The vitreous state was evaluated by the combination of optical coherence tomography and ultrasound. The main outcome was the vitreous state classified into 'no PVD', 'initial PVD' and 'advanced PVD'. We evaluated the vitreous state in 48 patients with glaucoma (age: mean 66.5±11.9years; visual field deviation: mean 10.4±6.8dB) and compared the results with 101 previously investigated controls (age: mean 73.6±9.3years). After one-to-one matching on age and sex, ordinal logistic regression revealed that patients with glaucoma were significantly more likely to exhibit advanced PVD stages compared to non-glaucoma patients (OR 2.60, 95% confidence interval: 1.06-6.36, p=0.037). Our results suggest that the presence or absence of PVD might be a valuable hint for diagnosing glaucoma - however, further research is needed to determine whether PVD can be used to supplement current glaucoma screening guidelines.

Advances of optical coherence tomography in myopia and pathologic myopia.

The natural course of high-axial myopia is variable and the development of pathologic myopia is not fully understood. Advancements in optical coherence tomography (OCT) technology have revealed peculiar intraocular structures in highly myopic eyes and unprecedented pathologies that cause visual impairment. New OCT findings include posterior precortical vitreous pocket and precursor stages of posterior vitreous detachment; peripapillary intrachoroidal cavitation; morphological patterns of scleral inner curvature and dome-shaped macula. Swept source OCT is capable of imaging deeper layers in the posterior pole for investigation of optic nerve pits, stretched and thinned lamina cribrosa, elongated dural attachment at posterior scleral canal, and enlargement of retrobulbar subarachnoid spaces. This has therefore enabled further evaluation of various visual field defects in high myopia and the pathogenesis of glaucomatous optic neuropathy. OCT has many potential clinical uses in managing visual impairing conditions in pathologic myopia. Understanding how retinal nerve fibers are redistributed in axial elongation will allow the development of auto-segmentation software for diagnosis and monitoring progression of glaucoma. OCT is indispensable in the diagnosis of various conditions associated with myopic traction maculopathy and monitoring of post-surgical outcomes. In addition, OCT is commonly used in the multimodal imaging assessment of myopic choroidal neovascularization. Biometry and topography of the retinal layers and choroid will soon be validated for the classification of myopic maculopathy for utilization in epidemiological studies as well as clinical trials.

VITREOMACULAR INTERFACE AND OUTER FOVEAL MICROSTRUCTURE IN FELLOW EYES OF PATIENTS WITH UNILATERAL MACULAR HOLES

To investigate the relationship between the vitreomacular interface and the integrity of the photoreceptor microstructures in the normal fellow eyes of patients with unilateral macular holes. Retrospective observational case series. Fifty-five normal fellow eyes of 55 patients with unilateral macular holes were enrolled in the study. All patients underwent complete ophthalmologic examination including best-corrected visual acuity, slit-lamp biomicroscopy, fundus photography, and spectral domain optical coherence tomography at initial and follow-up visits. The features of the vitreomacular interface were graded based on spectral domain optical coherence tomography findings. At the initial visit, 28 of 55 eyes (51%) had vitreomacular attachments with or without perifoveal posterior vitreous detachment. On their initial visit, a triangular elevation of the cone outer segment tips line was identified in 11 of 18 eyes (61%) with perifoveal posterior vitreous detachment across all quadrants with persistent attachment to the fovea. Conversely, none of the remaining 37 eyes with the other stages of posterior vitreous detachment showed any abnormalities. Over a mean follow-up period of 18 months (range, 12-24 months), the elevation of the cone outer segment tips line resolved after spontaneous vitreomacular separation without macular holes in 3 eyes, remained unchanged in 6 eyes, and showed progression to a full-thickness macular hole in 2 eyes. These findings suggest that an elevation of the cone outer segment tips line in the normal fellow eyes of patients with macular holes is caused by the focal traction of the vitreous at the foveal center. This is considered to be an important primary change observed in the macular tissue in full-thickness macular hole formation.