Symptomatic Posterior Vitreous Detachment Research Articles

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.

The incidence of retinal breaks in the presenting and fellow eyes in patients with acute symptomatic posterior vitreous detachment and their associated risk factors.

To determine the incidence of retinal breaks in presenting and fellow eyes in patients with acute symptomatic posterior vitreous detachment (PVD) and their associated risk factors. A prospective study of 101 consecutive patients presenting with acute symptomatic PVD. The PVD status and other relevant ophthalmic findings were noted for both presenting and fellow eyes at initial presentation. Patients with PVD in the fellow eye were followed up appropriately whereas those without were invited to return for a further examination 4 years later. Data analysis was performed using general linear model and logistic regression. The mean age was 62 years. Seventy-six eyes had PVD in the presenting eyes, which were more myopic than their fellow eyes. Increased myopia and the presence of vitreous and/or retinal hemorrhage were associated with the presence of retinal tear(s) (P = 0.03 and P < 0.0001, respectively) at presentation. Twenty-three of the presenting eyes and 2 of the fellow eyes had have retinal break(s) at the first clinic visit. Of those, 14 eyes were found not to have a visible Weiss ring. Only 5.9% of the eyes (3 presenting eyes and 3 fellow eyes) developed delayed retinal break(s). Acute symptomatic PVD is a common presentation. It is essential to perform thorough examination to both presenting eye and fellow eye at initial presentation and follow-up appointments to prevent delay of treatment to retinal break(s).

Prophylactic treatment of retinal breaks--a systematic review.

Prophylactic treatment of retinal breaks has been examined in several studies and reviews, but so far, no studies have successfully applied a systematic approach. In the present systematic review, we examined the need of follow-up after posterior vitreous detachment (PVD) - diagnosed by slit-lamp biomicroscopy or Goldmann 3-mirror examination - with regard to retinal breaks as well as the indication of prophylactic treatment in asymptomatic and symptomatic breaks. A total of 2941 publications were identified with PubMed and Medline searches. Two manual search strategies were used for papers in English published before 2012. Four levels of screening identified 13 studies suitable for inclusion in this systematic review. No meta-analysis was conducted as no data suitable for statistical analysis were identified. In total, the initial examination after symptomatic PVD identified 85-95% of subsequent retinal breaks. Additional retinal breaks were only revealed at follow-up in patients where a full retinal examination was compromised at presentation by, for example, vitreous haemorrhage. Asymptomatic and symptomatic retinal breaks progressed to rhegmatogenous retinal detachment (RRD) in 0-13.8% and 35-47% of cases, respectively. The cumulated incidence of RRD despite prophylactic treatment was 2.1-8.8%. The findings in this review suggest that follow-up after symptomatic PVD is only necessary in cases of incomplete retinal examination at presentation. Prophylactic treatment of symptomatic retinal breaks must be considered, whereas no unequivocal conclusion could be reached with regard to prophylactic treatment of asymptomatic retinal breaks.

ORAL ANTICOAGULATION AND THE RISK OF VITREOUS HEMORRHAGE AND RETINAL TEARS IN EYES WITH ACUTE POSTERIOR VITREOUS DETACHMENT

To determine if oral anticoagulation alters the association between vitreous hemorrhage (VH) and retinal tears in eyes with acute, posterior vitreous detachment (PVD). In this retrospective chart review, the complete records of consecutive patients with spontaneous, symptomatic acute PVD from a single referral-based practice were reviewed. The use of oral anticoagulants, the presence of a VH, and the presence of a retinal tear or detachment were recorded. A total of 336 consecutive eligible patients (336 eyes) were included in the final analysis. Vitreous hemorrhage occurred in 118 (35%) eyes; in 43% of patients taking aspirin, clopidogrel, or warfarin versus 31% not taking these medications (P = 0.03). Retinal tears occurred in 46% of patients with VH versus 27% of patients without VH (P = 0.0007). Retinal tears occurred in 39% of patients with VH taking aspirin, clopidogrel, or warfarin compared with 52% of patients not taking these medications. (P = 0.20) A decreased proportion of patients with acute PVD taking one or more of the oral anticoagulant medications studied, regardless of the presence of VH, were diagnosed with a retinal tear (P = 0.0017) or retinal detachment (P = 0.0001). Retinal tears are commonly found (46%) in the eyes of patients who present with symptoms and signs of acute PVD and VH. Patients taking aspirin, clopidogrel, or warfarin who develop an acute PVD are more likely to present with VH. No statistically significant association was demonstrated between the use of oral anticoagulants in patients with acute PVD and VH and the presence of retinal tears or retinal detachment.

Subjective Signs of Rhegmatogenous Retinal Detachment Associated With Acute Posterior Vitreous Detachment

Despite recent anatomical successes of surgical treatment for rhegmatogenous retinal detachment (RRD), reattachment fails in 1.1-2.5% of cases [1-3]. In addition, even in cases of reattachment, some patients continue to show poor functional results [1, 2]. Prevention of RRD is therefore undoubtedly desirable. We retrospectively examined subjective signs in patients who underwent surgery for RRD to determine whether they could have received prophylactic laser treatment [4] at an early stage of retinal tear only or minimal retinal detachment. Subjects were 34 consecutive patients (34 eyes; 10 females; mean age ± SD: 58 ± 11 years) who presented with RRD associated with acute posterior vitreous detachment (PVD) on initial visit to Nikko Memorial Hospital. All patients subsequently underwent pars plana vitrectomy between April 2009 and March 2012; 3 were excluded due to complications related to obvious vitreous hemorrhage. Cases with traumatic or atopic RRD were not included. At the initial visit, patients were interviewed about subjective visual symptoms. Informed consent was obtained from all subjects prior to surgery and the study adhered to the tenets of the Declaration of Helsinki. Fourteen patients (41%) visited the hospital because of floaters only or visual field disturbance following floaters; the remainder visited due to visual field disturbance, presumably caused by RRD, with no experience of floaters. Only one patient complained of photopsia with initial floaters. Of those who initially experienced floaters, 2 patients took more than one month from onset to experiencing visual field disturbance (Fig. 1); this late-visit group was significantly younger than the other patients (P = 0.007, Welch’s t test). A significant proportion of patients with acute PVD complain of monocular floaters [5]. In the present study, we therefore considered the onset of floaters to be a potential sign of acute PVD. Patients also showing apparent vitreous hemorrhage on initial visit were excluded from the study because associated floaters may bias the patients’ actions in seeking a consultation. Of the patients without preceding floaters, approximately 60% visited due to visual field disturbance caused by RRD. As a result, it was too late to perform prophylactic laser treatment by the time the subjective symptoms led to consultation. In some of the relatively young patients with preceding floaters, there was quite a long period of time from onset of the initial floater to experiencing visual field disturbance. Since vitreous syneresis has yet to advance in the young generally [6], the tamponade effect of gel-state vitreous or weak vitreous contractions may result in late-onset RRD. Thus, consultation immediately after the onset of floaters might enable prophylactic laser photocoagulation to be performed at an early stage when only retinal tear or minimal retinal detachment has occurred. This suggests the importance of awareness of this state among the relatively young. Several studies suggest that patients with symptomatic PVD do not necessarily need scheduled reexamination if there are no pigmented cells in the vitreous, vitreous hemorrhage, or retinal hemorrhage at initial fundus examination [7-9]. Nevertheless, considering the potential for late-onset retinal breaks or RRD, it may be worth patients younger than 50 to schedule a follow-up examination after initial consultation. The study had certain limitations. This was a single-center

Le vieillissement du vitré

The most important age-related changes in the vitreous are progressive liquefaction and posterior vitreous detachment (PVD). Optical coherence tomography enables better in vivo visualization of the vitreoretinal interface and has improved our understanding of the process of PVD, but knowledge of the biomicroscopic aspects of these vitreous anatomical modifications is required. The most common complications include retinal hemorrhage or vitreous hemorrhage, retinal breaks, and rhegmatogenous retinal detachment. Patients with symptomatic PVD require careful examination.

Prevalence of early and late stages of physiologic PVD in emmetropic elderly population

To investigate the early and late stages of posterior vitreous detachment (PVD) in the foveal area in correlation with age and gender. Three hundred and thirty-five emmetropic eyes of 271 Caucasian patients (216 women/119 men) were examined by optical coherence tomography (OCT) and ultrasound (US). Eyes were classified into groups according to the patients age (up to 69.9; 70-74.9; 75-79.9; over 80 years) and to the clinical findings [Vitreous state: Detached in US; Detached in OCT; Foveal adhesion (FA); Attached vitreous]. The mean age was 76 ± 8 ranging from 44 to 89 years in female and 72 ± 10 ranging from 46 to 87 years in male subjects. The vitreous was attached in 32% of all eyes, 18.5% had FA, 18.5% were detached in OCT and 68% were detached in US. While prevalence of FA decreases with increasing age, OCT-diagnosed detachments did not change significantly with age. Between the ages of 70 and 75, an increase in PVD rates occurred. The prevalence of PVD was similar in both genders. Women were significantly older than men in the late-stage PVD in the eyes. The use of OCT and US enabled us to detect a partial or total PVD in 80% of the eyes. A sudden increase in late-stage PVD between the ages of 70 and 75 was observed, correlating with the reported age prevalence of various macular diseases. In contrast to myopics, both genders of elderly emmetropics have a similar prevalence of PVD.

Incomplete Posterior Vitreous Detachment: Prevalence and Clinical Relevance

To investigate the prevalence and clinical relevance of incomplete posterior vitreous detachment (PVD). Prospective, observational cohort study. Institutional. Consecutive patients without previous ocular history who were diagnosed with acute uncomplicated PVD. Baseline kinetic ultrasound evaluation differentiated posterior vitreous separation as complete or incomplete. Prospective follow-up searched for complications related to PVD. Multivariate analysis evaluated associations of baseline demographic and clinical characteristics to incomplete PVD. A Kaplan-Meier analysis evaluated the probability and its standard error of experiencing an adverse outcome. The log-rank test determined whether incomplete PVD modifies the natural history of PVD. Prevalence of incomplete PVD and the estimated incidence of late adverse outcomes such as new retinal tears, epimacular membranes, or both. A total of 54 of 207 patients had incomplete PVD (prevalence, 26.1%). Younger age and lattice degeneration were associated independently with incomplete PVD. After a mean follow-up of 5 years (range, 4 to 8 years), 16 patients (9.7%) experienced some adverse outcome. In 5 patients (2.7%), new retinal tears and 1 retinal detachment developed. In 12 patients (7.6%), epimacular membranes developed. Patients with incomplete PVD at baseline experienced significantly more adverse outcomes than patients with complete PVD (Kaplan-Meier estimated probability and standard error, 19.2% and 0.061 vs 5.4% and 0.02; P = .01, log-rank test). Up to one fourth of symptomatic, acute, and uncomplicated PVDs show incomplete posterior vitreous separation. Delayed complications related to PVD, like retinal tears and epimacular membranes, develop more frequently in patients showing incomplete PVD.

Acute symptomatic posterior vitreous detachment and delayed retinal breaks

Acute symptomatic posterior vitreous detachment and delayed retinal breaks

B-Scan Ultrasonography to Screen for Retinal Tears in Acute Symptomatic Age-Related Posterior Vitreous Detachment

To evaluate the performance characteristics of B-scan ultrasonography (US) as a diagnostic test for the detection of retinal tears in acute symptomatic age-related posterior vitreous detachment (PVD). Evaluation of a diagnostic test through a cross-sectional study with prospective data collection. The study intended to meet the 14 items proposed by the Quality Assessment of Diagnostic Accuracy Studies panel. Two hundred thirty-nine patients with acute-onset age-related PVD were consecutively enrolled in a nonreferral hospital. Comprehensive eye examination including vitreous and retinal biomicroscopy was performed on an emergency basis followed by blind B-scan kinetic US. Sensitivity, specificity and predictive values of the index test (B-scan US) were analyzed and compared with the standard reference (baseline examination). In cases of disagreement between both diagnostic methods, a new gold standard was established based on the findings of subsequent directed indirect ophthalmoscopy based on the echographic findings. Positive and negative likelihood ratios and a likelihood nomogram with pretest and posttest odds of retinal tears were calculated for B-scan US. Index test performance for the detection of retinal tears secondary to age-related PVD. Both diagnostic methods performed comparably. The sensitivity of B-scan US for detection of retinal tears was 96% and that of baseline examination was 89%. Both methods had similar negative predictive values of 99%. B-scan US specificity was 98%. The estimated pretest and posttest probability for a positive B-scan US were 10.8% and 89%, respectively. Proper B-scan kinetic US is a noninvasive and accurate diagnostic method for the detection of retinal tears that can be reliably used in no view or small pupil cases with symptomatic PVD. The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Symptomatic Posterior Vitreous Detachment and the Incidence of Delayed Retinal Breaks: Case Series and Meta-analysis

To establish the necessity for an early follow-up examination after an initial funduscopic examination with negative results for patients with acute, symptomatic posterior vitreous detachment (PVD). Retrospective case-control study and meta-analysis. Records were reviewed of patients seeking treatment over a 4.5-year period who were diagnosed with an acute, symptomatic PVD. A MEDLINE search to identify all published observational case studies reporting vitreoretinal pathologic features after acute, symptomatic PVD. The incidence of retinal tears in eyes with a symptomatic PVD was 8.2%. The overall rate of retinal break in the meta-analysis portion of the study was 21.7%. In total, 1.8% of patients had retinal tears that were not seen on initial examination. Of the 29 patients with delayed-onset retinal breaks, 24 (82.8%) had at least one of the following: vitreous hemorrhage at initial examination, hemorrhage in the peripheral retina at initial examination, or new symptoms. If the results of an initial examination of a patient with an acute, symptomatic PVD are negative for retinal tears, the necessity of early follow-up may be best determined by the presence of pigmented cells in the vitreous, vitreous hemorrhage, or retinal hemorrhage. Most patients with symptomatic PVD may not need an early follow-up examination.

Acute posterior vitreous detachment: the predictive value of vitreous pigment and symptomatology

Aim—To establish whether the presence of a retinal break can be predicted either by the presence of a positive Shafer’s sign (pigment granules in the anterior vitreous) or symptomatology in patients presenting with an acute posterior vitreous detachment (PVD). Methods—200 eyes of 200 phakic patients with a symptomatic PVD of less than 1 month’s duration underwent documentation of symptomatology and examination of the anterior vitreous for the presence of pigment granules. Indentation ophthalmoscopy was then carried out by an experienced vitreoretinal surgeon with no knowledge of the symptomatology or anterior vitreous gel examination findings. A second prospective group of 115 consecutive patients were assessed in a similar manner before primary rhegmatogenous retinal detachment repair. Results—In 200 eyes presenting with an acute PVD, 25 were found to have an associated retinal break, 23 of which were also Shafer positive. In 115 eyes presenting for retinal detachment repair, 111 had an associated PVD and were found to be Shafer positive. Symptomatology was not predictive of an associated retinal break in the PVD group or in those presenting with a retinal detachment. Conclusion—The increased use of Shafer’s sign is recommended as a valuable aid in determining which patients require urgent referral for an expert retinal examination. It is not possible to predict those patients with a retinal break secondary to PVD on the basis of symptomatology alone. (Br J Ophthalmol 2000;84:1264‐1268)

Acute posterior vitreous detachment: the predictive value of vitreous pigment and symptomatology

AIMTo establish whether the presence of a retinal break can be predicted either by the presence of a positive Shafer's sign (pigment granules in the anterior vitreous) or symptomatology in...

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

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

Prevalence of retinal tears in an optometric population

The prevalence of fresh retinal tears and acute symptomatic posterior vitreous detachment (PVD) was determined for a metropolitan optometric population by retrospectively examining the records of 2...

Optic disc haemorrhages in posterior vitreous detachment

Posterior vitreous detachment (PVD) is a common clinical entity but is not often associated with a significant ocular disorder. Optic disc haemorrhages are rarely associated with a PVD and are more commonly associated with other local or systemic disease. The symptoms of a PVD, combined with a careful examination of the vitreoretinal interface allows a confident diagnosis of secondary disc haemorrhage to be made. Two cases of acute symptomatic PVD complicated by disc haemorrhage are presented.

Complications of Acute Symptomatic Posterior Vitreous Detachment

During a ten-year period, 172 eyes of 155 patients developed acute symptomatic posterior vitreous detachments. The study included only patients examined within three months of the onset of symptoms. The patients ranged in age from 22 to 82 years, with an average age of 60 years. Of the 172 eyes, 118 (69%) developed no retinal or vitreous complications. Retinal tears occurred in 14 eyes (8%) and vitreous or retinal hemorrhages occurred in 36 eyes (21%). Seventeen patients (11%) who had acute symptomatic posterior vitreous detachment in one eye later developed acute symptomatic posterior vitreous detachment in the fellow eye. The second posterior vitreous detachment developed within two years of the first one in 15 eyes (88%). In 13 patients (76%), the second eye responded in the same manner to the posterior vitreous detachment as had the first, that is, ten pairs of eyes had no further complications, two pairs had retinal or vitreous hemorrhages, and one pair had retinal breaks.

Outflow changes in normal eyes after closed-angle glaucoma.

Twenty-four patients with spontaneous acute closed-angle glaucoma in one eye were selected for study. All 24 eyes had a peripheral iridectomy, were normotensive, and had no gonioscopically visible peripheral anterior synechiae. Of the 24 contralateral eyes 14 gave a positive response to provocative tests and had peripheral iridectomy. The remaining 10 eyes did not give positive responses to the tests and were on no treatment. The 24 pairs of eyes were provoked with pilocarpine and phenylephrine. Tonography was performed at the start of the test, 1 1/2 hours later, and at its termination. At the start of the test the 24 eyes that had had spontaneous closed-angle glaucoma showed a higher pressure and lower outflow facility than the 24 contralateral eyes. This difference disappeared as the test progressed. It is concluded that apparently normal eyes--after an acute attack--do none the less show a significant degree of damage to the outflow system. Ten pairs of eyes from 10 normal persons were provoked in a similar fashion and at no point did a significant difference appear between right and left eyes.