Retinal tears and detachments are among the late complications of acute PVD

Retrospective data from patients enrolled in a large US healthcare system were used to evaluate rates of complicated acute posterior vitreous detachment (PVD).

Study design

Investigators identified 8305 patients diagnosed with acute symptomatic PVD in 2018, and then recorded the occurrence of retinal tears (RT) or rhegmatogenous retinal detachments (RRD) at initial presentation or within 1 year thereafter. Nearly all patients had floaters, and 45% also had flashes; 14% had prior cataract surgery.

Outcomes

A total of 5% of patients were initially diagnosed with RT and 4% were originally diagnosed with an RRD. The presence or absence of vitreous pigment was highly predictive of the presence of complicated PVD (odds ratio (OR) 57.0); other examination and ophthalmoscopic features strongly associated with complicated PVD included the lattice degeneration (OR 6.01), vitreous hemorrhage (OR 5.85), retinal hemorrhage (OR 4.94), or a visual acuity worse than 20/40 (OR 3.00). The most predictive feature for developing a late event was an initial presentation with vitreous hemorrhage, followed by the presence of lattice degeneration or a history of RT or RRD in the fellow eye.

Limitations

The rate of RT and RRD was lower than seen in other studies, which were predominantly from retina practices and not comprehensive medical practices such as the source of data for this study. However, a major limitation was that the method of diagnosis of PVD was not standardized and not all cases had a documented Weiss ring or vitreous floater anterior to the optic nerve. Therefore, it is possible that some of the cases included were not “classic” PVD cases.

Clinical significance

This study highlights the importance of continued follow-up in patients with acute PVD due to the risk of late tears or detachments.