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

• Published in: British journal of ophthalmology Vol. 84; no. 11; pp. 1264 - 1268
• Main Authors: Tanner, Vaughan, Harle, Deacon, Tan, James, Foote, Barney, Williamson, Thomas H, Chignell, Anthony H
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.11.2000; BMJ; BMJ Publishing Group LTD
• Subjects: Acute Disease; Adult; Age; Aged; Aged, 80 and over; Biological and medical sciences; Community; detachment; Female; Humans; Male; Medical sciences; Middle Aged; Ophthalmology; Original articles - Clinical science; Predictive Value of Tests; Prospective Studies; Recruitment; Retina; Retinal Detachment - prevention & control; Retinal Perforations - diagnosis; vitreous; Vitreous body diseases; Vitreous Detachment - complications; Human; Retinopathy; Acute; Break; Vitreous body; Retina; Vitreous body disease; Symptomatology; Eye disease; Posterior; Pigments; Complication; Predictive factor; Unsticking
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.84.11.1264

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.