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  • Late Complications in Eyes With Posterior Vitreous Detachment

    By Jean Shaw
    Selected by Andrew P. Schachat, MD
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    Journal Highlights

    Ophthalmology Retina, March 2023

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    Patel et al. set out to examine the incidence of delayed complications of posterior vitreous detachment (PVD) and to identify any patient-specific risk factors. They found that the rate of any complication was 25% and that the rates of isolated vitreous hemorrhage, retinal breaks without detachment, and retinal detachments (RDs) were 13.1%, 16%, and 4.2%, respectively. However, while the majority of complications were noted at presentation, a significant proportion of each type was first noted within the six-month follow-up period.

    For this retrospective observational study, the researchers used the Vestrum Health database to identify eyes with acute PVDs that occurred between 2015 and 2019. All told, 9,635 eyes were included; of these, 3,990 were phakic, 2,225 were pseudophakic, and 1,252 had documented lattice/peripheral retinal degeneration. (Of note, some charts did not list whether an eye was phakic or pseudophakic.) The patients’ mean age was 63 years, and a major­ity (51.4%) were female. Outcomes measured included the rate of compli­cations at initial presentation and at six months as well as the days to presenta­tion with a complication.

    The average time to any complica­tion was 39.4 days. Diagnosis at presen­tation and complications noted during follow-up were as follows:

    • Isolated vitreous hemorrhage. Of 1,261 eyes with an isolated vitre­ous hemorrhage, 652 (51.7%) were diagnosed at presentation. During follow-up, an additional 101 eyes (8%) developed this complication.
    • Retinal breaks without detachment. Of 1,539 eyes that had retinal breaks without detachment, 1,172 (76.2%) were diagnosed at presen­tation. By six months of follow-up, another 295 (19.2%) had developed this complication.
    • RD. Of 403 eyes with an RD, 299 (74.2%) were noted at presentation. During follow-up, another 104 (25.8%) developed an RD.

    With regard to patient-specific risk factors, men were more likely to expe­rience delayed complications than were women (30% vs. 21.7%, respectively; p < .001). The rate of any complication among pseudophakic eyes was 25% and 20.7% in phakic eyes (p < .001). Among eyes with lattice/peripheral retinal degeneration, 44.2% experi­enced complications during follow-up. Similarly, a history of retinal breaks or RDs in the fellow eye was associated with a greater rate of complications (p < .0001 for retinal breaks; p < .02 for RDs) in the eye with a PVD.

    Not all eyes had isolated pathology; for instance, 401 eyes with a vitreous hemorrhage at presentation also had a retinal break without RD at this point, while another 107 had a vitreous hem­orrhage and an RD at presentation.

    Given these findings, the authors recommend follow-up at the four- to six-week mark in all patients, counsel­ing regarding symptoms of progres­sion, and extended follow-up around the three-month mark in male patients and in those eyes found to be at greater risk of delayed complications in this study. 

    The original article can be found here.