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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Richardson
P S
PS
Birmingham and Midland Eye Centre, City Hospital, UK. p.richardson@sheffield.ac.uk
Benson
M T
MT
Kirkby
G R
GR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D011379:Prognosis; D011446:Prospective Studies; D012167:Retinal Perforations / Q000175:diagnosis / Q000209:etiology*; D020255:Vitreous Detachment / Q000150:complications*; D014823:Vitreous Hemorrhage / Q000150:complications