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

• Published in: American journal of ophthalmology Vol. 144; no. 3; pp. 409 - 413.e1
• Main Authors: Coffee, Robert E, Westfall, Andrew C, Davis, Garvin H, Mieler, William F, Holz, Eric R
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2007; Elsevier; Elsevier Limited
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Case-Control Studies; Confidence intervals; Female; Follow-Up Studies; Hemorrhage; Humans; Incidence; Male; Medical sciences; Meta-analysis; Middle Aged; Miscellaneous; Myopia; Ophthalmology; Retina; Retinal Perforations - epidemiology; Retinal Perforations - etiology; Retrospective Studies; Risk Factors; Studies; Surgery; Vitreous Body - pathology; Vitreous Detachment - complications; Vitreous Detachment - diagnosis; Posterior; Break; Vitreous body; Retina; Ophthalmology; Retinal; Delay; Incidence; Metaanalysis
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2007.05.002

Purpose 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). Design Retrospective case-control study and meta-analysis. Methods 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. Results 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. Conclusions 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.