Symptomatic Posterior Vitreous Detachment Research Articles

Impaired Visual Function in Posterior Vitreous Detachment Assessed With the Active-Learning Quantitative Contrast Sensitivity Function Test

Introduction: To investigate whether there is visual function impairment in patients with posterior vitreous detachment (PVD) using the active-learning quantitative contrast sensitivity function test. Methods: In this cross-sectional study, contrast sensitivity was measured in eyes with PVD and eyes without PVD using the quantitative contrast sensitivity function algorithm on the Adaptive Sensory Technology platform. Outcomes included the area under the log contrast sensitivity function curve, contrast acuity, and contrast sensitivity thresholds at 1 to 18 cycles per degree (cpd). Snellen visual acuity (VA) was also measured. Mixed-effects multiple linear regression analyses were performed to evaluate the association between the presence of PVD and visual function, controlling for age and lens status. Results: The cohort comprised 232 healthy eyes of 205 participants; of these, 80 eyes of 69 patients had PVD. There was no significant association between VA and PVD presence. However, PVD was significantly associated with decreased contrast sensitivity thresholds at 1.5 cpd (β, −0.058; P = .003) and 3 cpd (β, −0.067; P = .004). Contrast sensitivity thresholds at lower (1 cpd) or higher (6, 12, 18 cpd) spatial frequencies did not significantly correlate with PVD presence. Even in the subgroup of symptomatic PVD eyes, VA was not significantly decreased, while quantitative contrast sensitivity function outcomes showed visual function deficits at low spatial frequencies (1.5 cpd and 3 cpd). Conclusions: Contrast sensitivity measured with the quantitative contrast sensitivity function test showed visual function deficits in eyes with PVD that would have been missed with VA testing alone. Incorporating this test in the retina clinic might offer a more comprehensive functional assessment of eyes with PVD, serving as an adjunct outcome metric in clinical decision-making.

Use of Optical Coherence Tomography in Detecting Retinal Tears in Acute, Symptomatic Posterior Vitreous Detachment.

To evaluate the association of posterior vitreous opacities (PVO) on optical coherence tomography (OCT) with retinal tears identified on exam, in patients with acute, symptomatic posterior vitreous detachment (PVD). Data was retrospectively collected from the medical records of 388 patients with acute, symptomatic PVD between January 1, 2021, and June 30, 2021. Included patients had received a primary diagnosis of PVD and presented with flashes and/or floaters. OCT scans were reviewed by two separate readers for the presence of PVOs. The primary outcome was the presence of retinal tear on fundus photo and on exam. Of 388 patients who presented with acute PVD symptoms, 90 (23.2%) were found to have a retinal tear on dilated fundus exam. Among these patients, 78 (86.7%) were found to have PVOs on OCT. Statistical analysis demonstrated a significant relationship between the presence of PVOs and retinal tear (p < 0.01). The sensitivity and specificity of this finding was 86.7% and 72.5%, respectively. Further analysis included Area Under the Curve (AUC) from Receiver Operating Characteristic (ROC) Curve which was found to be 0.80. The presence of PVOs on OCT is suggestive of a retinal tear in patients with acute, symptomatic PVD.

A Telephone Triage System for Patients Calling with Symptoms of a Posterior Vitreous Detachment

The purpose of the study was to develop a simple telephone questionnaire, without physical examination input, that predicts which patients calling with symptoms of a posterior vitreous detachment (PVD) have a retinal tear (RT) or rhegmatogenous retinal detachment (RD). Prospective cohort (quality improvement) study. All patients with symptoms consistent with a PVD calling a major academic ophthalmology department over a 4-month period in 2020 and who were seen on follow-up within 1.5 months (211 screened and 193 included). A comprehensive telephone questionnaire assessing for RT/RD risk factors was administered by telephone triage staff to all patients calling with symptoms of flashes, floaters, or curtain/veil in their vision. Multivariable logistic regression was used to determine risk factors most predictive of having an RT/RD during the add-on visit. Risk factor odds ratios were used to develop an RT/RD risk score. Development of a clinical risk score for having an RT/RD at the add-on visit after telephone triage. Approximately 55% of patients were previously established in the retina clinic, 26% were new to the department, 19% were previously established in the comprehensive clinic, and 7% had an RT/RD at the add-on visit. Out of 23 questions and 70 prespecified possible answers from the telephone questionnaire, the final clinical risk score for RT/RDs was derived from 7 questions and 15 possible answers. The simplified questionnaire can be administered quickly by telephone operators without any reference to physical examination or the patient's chart. The receive-operator curve for our final multivariable logistic regression and clinical risk score models have an area under the curve of > 0.90. Using a conservative clinical risk score, approximately 50% of all patients without an RT/RD can be safely seen nonurgently. Progressively higher scores can be used to determine relative urgency of an appointment. To our knowledge, this is the first study to predict risk of an RT/RD in a patient calling with symptoms consistent with a PVD without reference to the patient's physical examination or chart. Our clinical risk scoring system can be used to determine urgency of an add-on appointment and increase the number of low-risk patients with symptomatic PVDs who are scheduled routinely. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Окт диагностика скрытого клапанного разрыва при задней отслойке стекловидного тела

Changes in the posterior vitreous that look like hyperreflective dots are considered as a predictor of peripheral retinal breaks in acute posterior vitreous detachment (PVD), along with Shafer's sign, intraretinal and vitreous hemorrhages. Some of peripheral breaks in acute PVD remain unnoticed at the initial ophthalmoscopic examination due to poor visualization. We report a clinical case of an invisible peripheral retinal flap tear detection with overview wide-field OCT (RTVue XR Avanti, Line mode –12 mm) scanning by «sliding» method in the area of retinal hemorrhage in presence of multiple hyperreflective dots in the vitreous during acute symptomatic PVD. Key words: acute PVD; invisible flap tear; wide-field OCT; retinal hemorrhage; stardust sign; hyperreflective dots.

Incidence and Risk Factors for Delayed Retinal Tears after an Acute, Symptomatic Posterior Vitreous Detachment

To determine the long-term incidence of and risk factors for delayed retinal tears after acute, symptomatic posterior vitreous detachment (PVD) without concurrent retinal tears. Retrospective, observational case series. Patients diagnosed with an acute, symptomatic PVD without concurrent retinal tears at a tertiary eye center between 2013 and2018. This is a retrospective, consecutive, and observational case series. Acute and symptomatic PVD was defined as experiencing flashes or floaters for 1 month or less at the time of diagnosis. Patients with a retinal tear or detachment at or before the time of diagnosis were not included. The occurrence and timing of subsequent retinal tears after initial PVD diagnosis were recorded. The age, sex, race, refractive error, lens status, lattice degeneration status, and type of physician (retina specialist vs. nonretina specialist) who saw the patient were also recorded. Time to the development of a delayed retinal tear. A total of 389 eyes from 389 patients had acute and symptomatic PVDs without concurrent retinal tears or detachments at diagnosis. Kaplan-Meier analysis showed that 7.39% of eyes developed delayed retinal tears by 6.24 years after initial PVD diagnosis. Of these tears, 50% occurred within 4.63 months of PVD diagnosis, and 63.46% occurred within 1 year of PVD diagnosis. Cox-Mantel log-rank analysis showed that those who were younger (age < 60 years), myopic, or had lattice degeneration were more likely to develop tears. A multivariate Cox proportional-hazards models controlling for other significant risk factors supported lattice degeneration as a likely risk factor for delayed retinal tear. This study demonstrates that 7.39% of patients with acute, symptomatic PVD without concurrent retinal tears develop delayed retinal tears by 6.24 years after PVD diagnosis, with many developing tears well after a typical 6-week follow-up time for PVD. Lattice degeneration is a significant risk factor for delayed tears. These findings can guide clinicians in establishing optimal follow-up protocols for patients with acute, symptomatic PVD. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

The effectiveness of laser vitreolysis for vitreous floaters in posterior vitreous detachment.

To determine the effectiveness of laser vitreolysis in terms of contrast sensitivity function (CSF) and vision-related quality of life (VRQol) for symptomatic floaters due to posterior vitreous detachment (PVD). This is an interventional study that involved 57 eyes of 45 patients with symptomatic floaters for more than 3 months. Patients underwent one to three sessions of vitreolysis via Neodymiun-doped Yttrium Aluminum Garnet (Nd:YAG) laser. We examined the CSF using the computer programs Freiburg Acuity and Contrast Test (FrACT) and VRQoL survey using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) before, and 1 month after, vitreolysis. Twelve patients had both eyes lasered and 33 patients had one eye lasered. The mean CSF improved from 3.20 ± 0.85%W to 2.64 ± 0.63%W 1 month after vitreolysis. Each use of the laser showed a significant mean difference in CSF (%W) as analyzed by paired t-test before and after the first laser (0.29 ± 0.49%W [P ≤ 0.001]); after the first and second laser (0.35 ± 0.53%W [P = 0.01]); and after second and third laser (0.21 ± 0.31%W [P = 0.02]). There was improvement in the median of four subscales in NEI VFQ-25 scores post treatment: general vision (z = -3.30, P = 0.001), near activity (z = 3.396, P = 0.001, distance activity (z = -2.788, P = 0.005), and mental health (z = -2.219, P = 0.026). The mean scores increased to 79.55 ± 9.45 from the baseline 75.06 ± 9.69 (P ≤ 0.001). No adverse events were recorded 1 month after the laser treatments. Vitreolysis by Nd:YAG laser improved the CFS and VRQoL in symptomatic PVD patients.

Association of staffing with Incidence of delayed retinal break or detachment after posterior vitreous detachment in a resident urgent care clinic.

To compare the incidence rate of delayed retinal break or detachment after diagnosis of acute, symptomatic posterior vitreous detachment (PVD) in a resident-run urgent care clinic (UCC) when staffed by a retina attending, non-retina ophthalmology attending, optometrist, or ophthalmologyresident only. Retrospective consecutive case series. Of the 594 patients with acute, symptomatic PVD evaluated in the UCC at Penn State Eye Center between 1/1/2016 and 10/10/2019, 454 were included in the study; 140 were excluded because they were diagnosed with a retinal break or detachment on presentation to the UCC, had media opacity precluding examination, or had no follow-up within one year. Demographics, presenting examination findings, and type of staffing were recorded; subsequent visits up to 1year were analyzed for presence of delayed retinal break or detachment. Among 491 eyes of 454 patients with a mean follow-up of 147days, ten delayed breaks (10/491, 2.0%) and three delayed detachments (3/491, 0.6%) were discovered. Incidence rates of delayed breaks and detachments were 1.8% (5/282) and 0.7% (2/282), respectively, in the retina attending group, 1.0% (1/105) and 1.0% (1/105) in the non-retina ophthalmology attending group, 4.7% (3/64) and 0% (0/64) in the optometrist group, and 2.5% (1/40) and 0% (0/40) in the ophthalmologyresident only group. There was no statistically significant difference in the incidence of delayed break or detachment among the staffing groups (P = 0.7312), but this study was underpowered to detect a statistically significant difference among staffing groups. Patients with a delayed break or detachment were more likely to have lattice degeneration (P = 0.0265) or a history of retinal break in the contralateral eye (P = 0.0014), and most eyes (10 [76.9%]) with a delayed break or detachment were left eyes (P = 0.0466). The overallrate of delayed retinal break or detachment in the current study is similar to previously published rates among retinal physician and retinal fellow examiners. Although no statistically significant difference among staffing groups in the incidence rates of delayed retinal tears or detachments was identified in the study, it is important to note that the optometry and ophthalmologyresident only groups had higher incidence rates of delayed retinal breaks thandid the retina and non-retina ophthalmologyattending groups, and this may be clinically important. Larger cohort studies would be needed in order to have the power to detect statistically significant differences among staffing groups. Varied staffing for acute, symptomatic PVD may assist with resource allocation in similar settings.

Complications of Acute Posterior Vitreous Detachment

To evaluate the risk factors for retinal tear (RT) or rhegmatogenous retinal detachment (RRD) associated with acute, symptomatic posterior vitreous detachment (PVD) in a large comprehensive eye care setting. Retrospective cohort study. A total of 8305 adult patients in the Kaiser Permanente Northern California Healthcare System (KPNC) during calendar year 2018 who met inclusion criteria. The KPNC electronic medical record was queried to capture acute, symptomatic PVD events. Each chart was reviewed to confirm diagnoses and capture specific data elements from the patient history and ophthalmic examination. Presence of RT or RRD at initial presentation or within 1 year thereafter. Of 8305 patients who presented with acute PVD symptoms, 448 (5.4%) were diagnosed with RT and 335 (4.0%) were diagnosed with RRD. When considering variables available before examination, blurred vision (odds ratio [OR], 2.7; confidence interval [CI], 2.2-3.3), male sex (OR, 2.1; CI, 1.8-2.5), age < 60 years (OR,1.8; CI, 1.5-2.1), prior keratorefractive surgery (OR, 1.6; CI, 1.3-2.0), and prior cataract surgery (OR, 1.4; CI, 1.2-1.8) were associated with higher risk of RT or RRD, whereas symptoms of flashes were mildly protective (OR,0.8; CI, 0.7-0.9). Examination variables associated with a high risk of RT or RRD included vitreous pigment (OR, 57.0; CI, 39.7-81.7), vitreous hemorrhage (OR, 5.9; CI, 4.6-7.5), lattice degeneration (OR, 6.0; CI, 4.7-7.7), and visual acuity worse than 20/40 (OR, 3.0; CI, 2.5-3.7). Late RTs or RRDs occurred in 12.4% of patients who had vitreous hemorrhage, lattice degeneration, or a history of RT or RRD in the fellow eye at initial presentation but only 0.7% of patients without any of these 3 risk factors. Refractive error had an approximately linear relationship with age at presentation of PVD, with myopic patients presenting at a younger age (r= 0.4). This study, based in a comprehensive eye care setting, found the rate of RT and RRD associated with acute PVD to be lower than rates previously reported by retina subspecialty practices. Several patient features strongly predicted the presence of initial and late complications of acute PVD.

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.

OCT Assistance in Identifying Retinal Breaks in Symptomatic Posterior Vitreous Detachments.

Posterior vitreous detachment (PVD) is a separation of the posterior hyaloid from the retina that manifests as photopsias and floaters. Optical coherence tomography (OCT) has demonstrated posterior vitreous opacities (PVOs) that may correlate with Shaffer's sign, which may correlate with retinal breaks. Patients with symptomatic PVDs were retrospectively reviewed at a single institution by a single provider. Masked qualitative review of SD-OCTs by a single reviewer determined presence of PVOs. Among 78 patients, PVOs were found in 32 of the patients (41%), and 19 (59%) had retinal breaks. In those without PVOs, six (13%) had a break. Sensitivity and specificity were 76.0% and 75.5%, respectively. Removing patients with vitreous hemorrhages, sensitivity, and specificity of PVOs was 82.4% and 86.4%, respectively. In symptomatic PVDs, PVOs on OCT correlated with the presence of a retinal break, especially in the absence of a vitreous hemorrhage. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:628-632.].

Posterior vitreous detachment-study of prevalence, symptoms and risk factors for retinal tears

Purpose: To describe clinical characteristics of patients who presented with acute symptomatic posterior vitreous detachment (PVD) and determine the prevalence and predictors of retinal tears and retinal complications.Material and methods: 250 patients who presented in RIO, PGIMS, Rohtak, Haryana with clinical diagnosis of acute symptomatic PVD were examined and followed up over a period of 1 year. Results: A total of 250 patients who presented with acute PVD-related symptoms like floaters, flashes of light or deterioration in vision were enrolled in our study. Incidence of retinal tear was found to be 8% (n=20) and that of vitreous hemorrhage or retinal hemorrhage was 14% (n=35) in our study group over a period of 1 year. Predictors of retinal tears were visual impairment, vitreous hemorrhage and duration of symptoms

Impact of posterior vitreous detachment on contrast sensitivity in patients with multifocal intraocular lens.

To investigate posterior vitreous detachment (PVD) and pars plana vitrectomy (PPV) effects on contrast sensitivity function (CSF) in patients with a multifocal intraocular lens (MfIOL). This single-center prospective case-control study analyzed 27 patients with 43 consecutive eyes. Twenty patients with 36 consecutive eyes received MfIOL implantation with either ZLB00 or ZMB00. CSF was measured as the area under the log contrast sensitivity function (AULCSF) in the presence and absence of PVD (PVD+ group and PVD- group, respectively). Seven eyes associated with a symptomatic PVD and severe visual dissatisfaction after MfIOL implantation underwent PPV (symptomatic PVD+ group). CSF was measured prior to and after PPV. The mean AULCSF was significantly lower in the PVD+ group (1.5 ± 0.1) versus the PVD- group (1.7 ± 0.1, p < 0.0001). Major complaints in the symptomatic PVD+ group included floaters (n = 2) and blurry vision (n = 5). The preoperative AULCSF (1.4 ± 0.1) was significantly lower in the symptomatic PVD+ group versus the PVD- group (p < 0.0001) and PVD+ group (p = 0.02). The preoperative AULCSF in the symptomatic PVD+ group was significantly improved after PPV (1.4 vs. 1.7, respectively, p = 0.002). PVD significantly decreased CSF in patients with MfIOL. Patients with symptomatic PVD exhibited the greatest decrease in CSF, which was significantly improved after PPV. Measurement of CSF and careful assessment of PVD may be useful in determining the appropriateness of surgical intervention for improving visual performance and satisfaction in MfIOL patients with symptomatic PVD.

Ultrasonic examination of the reliability of vitreous hemorrhage after acute symptomatic posterior vitreous detachment of retinal tear

Objective To evaluate the reliability of ultrasonic examination of vitreous hemorrhage after acute symptomatic posterior vitreous detachment of retinal tear. Methods The data of 80 eyes of 80 patients with acute symptomatic posterior vitreous detachment from Jan. 2015 to Dec. 2017 were analyzed retrospectively. Ultrasound examination and indirect ophthalmoscopy were performed on all patients. The results of the indirect ophthalmoscope examination were used as the gold standard to compare the results of the two tests. Results Membrane lesions characterized by retinal tear ultrasound were described in 13 patients (16.25%). Fundus indirect ophthalmoscopy examination confirmed the diagnosis of 8 patients and they recived laser photocoagulation.The local vitreous condensation was detected in other 5 cases.One case received laser photocoagulation due to secondary changes in retinal traction.Sensitivity was 100.00% (95% CI, 60.14%-100.00%), specificity was 93.06% (95% CI, 58.51%-97.82%), positive predictive value was 61.53% (95% CI, 32.82%-85.76%)and negative predictive value was 100.00% (95% CI, 93.09%-100.00%). The positive likelihood ratio was 13.41 (95% CI, 5.82-31.114) and the negative likelihood ratio was 0. Conclusion Ultrasonography has high sensitivity and negative predictive value in the detection of vitreous hemorrhage after acute symptomatic posterior vitreous detachment of the retina, and is used to exclude high reliability of retinal tear. Key words: Ultrasonography; Posterior, detachment, vitreous, symptomatic, acute; Tear, retinal; Hemorrhage, Vitreous

Comment on "Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage".

Comment on "Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage".

Incidence of Acute Symptomatic Posterior Vitreous Detachment, its Complications and Impact on Emergency Eye Care Set Up

Purpose. To determines the incidence of complications of acute symptomatic posterior vitreous detachment (PVD) and its impact on ophthalmic emergency setup. Design. A retrospective study of 172 patients presented in one years’ time, with acute symptomatic posterior vitreous detachment. Methods. A retrospective record of 172 patients (n=172) was reviewed who were seen in one years’ time period at local hospital’s eye departments as emergency referrals. Referrals were made by primary care physicians and optometrists. Only patients with acute symptomatic PVD were taken into account. Their symptomatology, visual acuity, fundus examination findings, follow up appointments and outcomes were checked. Results. Mean age at presentation was 62.76 years. Acute Symptomatic Posterior vitreous detachment was detected without complications in 126 (73.25%). Retinal breaks were found on initial presentation in 33 patients (19.18%). Out of these, 18 had rhegmatogenous retinal detachment on initial presentation (10.46%), while one patient who also had vitreous haemorrhage developed it later. PVD was seen with vitreous haemorrhage in 4 patients (2.32%). Seven patients presented with PVD and associated retinal haemorrhages (4.06%). Demographically 96 patients were females (55.81%) as compared to 76 males (44.186%). The highest incidence was between 51 to 75 years of age (84.29%). Posterior vitreous detachments accounted for 7.50% of total eye emergencies in one year. Conclusions. Patients with flashes and floaters should be seen urgently. Priority should be given to patients with cells in vitreous (shafer’s sign) as well as retinal or vitreous haemorrhages. These patients should be seen by experienced ophthalmologist to rule out any break with 360 degree indirect ophthalmoscopic examinations. Junior doctors should have extensive training with indirect ophthalmoscopy with scleral indentation and should not miss shafer’s sign in all patients with acute symptomatic PVD.

Ultra-wide Field Fundus Photography Using Eye Steering Technique in Patients with Symptomatic Posterior Vitreous Detachment

Ultra-wide Field Fundus Photography Using Eye Steering Technique in Patients with Symptomatic Posterior Vitreous Detachment

Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage.

Cross-sectional study of 75 consecutive patients presenting with acute symptomatic posterior vitreous detachment (ASPVD) and vitreous hemorrhage was conducted at University Eye Clinic, University Hospital "Sveti Duh", Zagreb, Croatia. To check ultrasound reliability in detecting retinal tears in patients with ASPVD, transpalpebral ultrasound of the eye and the orbit was performed followed by fundus examination initially and in 6wk period. In 13 (17%) patients membranous lesion with ultrasound characteristics of retinal tear was detected. Ophthalmoscopy confirmed the diagnosis in 8/13 patients. In 62/75 patients neither ultrasound nor clinical examination revealed retinal tear. Sensitivity of ultrasound examination was 100%, specificity 92%, positive predictive value 62% and negative predictive value 100%. Ultrasound proved to be a reliable and accurate method for detection of retinal tears in ASPVD. Given the high sensitivity and negative predictive value, negative result on B-scan ultrasound excludes the probability of the retinal tear with a high degree of certainty.

Myopia as a risk factor for subsequent retinal tears in the course of a symptomatic posterior vitreous detachment

BackgroundRetinal tears complicating the course of a posterior vitreous detachment (PVD) may be unique or multiple, and when multiple they may occur simultaneously or subsequently at different moments in the evolution of a PVD. The purpose of our study was to analyze the prevalence of subsequent retinal tears (SRT) in patients with a PVD, and to identify possible risk factors for SRT.MethodsOne hundred and seventy six eyes in 165 consecutive patients that presented one or more retinal tears in the evolution of a symptomatic PVD, with a minimum follow-up of 12 months, were retrospectively evaluated. The primary outcome measure was to characterize the clinical features associated with SRT formation against those eyes with non-subsequent retinal tear (NSRT-retinal tear/s diagnosed at initial examination) formation. For that purpose, this cohort of patients was divided into two different groups: group 1 included eyes presenting one or multiple retinal tears only at initial examination (NSRT), and group 2 eyes that progressed to a further retinal tear/s (SRT) during follow-up.ResultsGroup 1 comprised 154 eyes from 145 patients, 48.7% males and 51.3% females with a mean age of 56.9 ± 14.0 years (range = 15-89); 17.2% of patients had a previous retinal tear or retinal detachment in the fellow eye; mean number of retinal tears per eye 1.42 ± 0.8 (range = 1-5); 20.8% presented bilateral retinal tears; 59.1% were myopic eyes (p < 0.05). Group 2 comprised 22 eyes from 20 patients; mean age was 53.3 ± 13.6 years (range = 30-69); 63.6% were male (p = 0.13), and 7 patients (31.8%) had a history of SRT or retinal detachment in the fellow eye (p = 0.13). The mean number of retinal tears per eye was 1.36 ± 0.5 (range = 1-2); bilateral retinal tears were noted in 18.2% of eyes; 86.4% were myopic eyes (p = 0.01); 81.8% occurred within a 120 days-period following diagnosis of the first retinal tear.ConclusionsMultiple retinal tears may be diagnosed in the evolution of a PVD. SRT are most frequently observed in myopic patients, and are usually symptomatic. Follow-up must extend for at least 4 months after the initial symptoms.

Vitreous Hyper-Reflective Dots in Optical Coherence Tomography and Retinal Tear in Patients with Acute Posterior Vitreous Detachment

ABSTRACTPurpose: To report the presence of hyper-reflective dots in the vitreous cavity using spectral-domain optical coherence tomography (SD-OCT) in patients with acute symptomatic posterior vitreous detachment (PVD) and investigate their association with the presence of retinal tear.Methods: The medical records of 77 patients with acute symptomatic PVD, who were examined between March 2013 and February 2015, were reviewed. The severity of vitreous hyper-reflective dots (VHDs) was graded using SD-OCT images, and the presence of retinal tear was assessed.Results: Forty-one (53.2%) eyes had mild VHDs, 13 (16.9%) eyes had moderate VHDs, and 14 (18.2%) eyes had severe VHDs. Retinal tear was found in 21 (27.3%) eyes. The presence of severe VHDs was associated with an increased likelihood of retinal tear (positive likelihood ratio, 9.78; 95% confidence interval, 3.02–31.63). In 14 (66.7%) eyes with retinal tear, the mean number of VHDs significantly decreased from 23.2 ± 20.27 to 2.3 ± 2.66 at a mean follow-up interval of 2.8 ± 1.48 weeks (P = 0.002).Conclusions: The presence of severe VHDs is suggestive of retinal tear in patients with acute symptomatic PVD. However, this SD-OCT finding should be limited to the acute phase of PVD.

Small-Gauge Pars Plana Vitrectomy for the Management of Symptomatic Posterior Vitreous Detachment after Phacoemulsification and Multifocal Intraocular Lens Implantation: A Pilot Study from the Pan-American Collaborative Retina Study Group.

Purpose. To determine the efficacy of 23-gauge pars plana vitrectomy (PPV) for symptomatic posterior vitreous detachment (PVD) on visual acuity (VA) and quality after multifocal intraocular lenses (IOLs). Methods. In this prospective case series, patients who developed symptomatic PVD and were not satisfied with visual quality due to floaters and halos after multifocal IOL implantation underwent PPV. Examinations included LogMAR uncorrected visual acuity (UCVA), intraocular pressure, biomicroscopy, and indirect ophthalmoscopy at baseline and 1, 7, 30, and 180 days postoperatively. Ultrasonography and aberrometry were performed. The Visual Functioning Questionnaire 25 (VFQ-25) was administered preoperatively and at 30 days postoperatively. Both the postoperative UCVA and questionnaire results were compared to preoperative findings using the Wilcoxon test. Results. Sixteen eyes of 8 patients were included. VA significantly improved from 0.17 to 0.09 postoperatively (P = 0.017). All patients reported improvement of halos, glare, and floaters. VFQ-25 scores significantly improved in general vision (P = 0.023), near activities (P = 0.043), distance activities (P = 0.041), mental health (P = 0.011), role difficulties (P = 0.042), and driving (P = 0.016). Conclusion. PPV may increase UCVA and quality of vision in patients with bilateral multifocal IOLs and symptomatic PVD. Larger studies are advised.