title: Missed retinal breaks in rhegmatogenous retinal detachment.
abstract: OBJECTIVE
  To evaluate the causes and associations of missed retinal breaks (MRBs) and posterior vitreous detachment (PVD) in patients with rhegmatogenous retinal detachment (RRD).
  
  
  METHODS
  Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and 191 patients were included for analysis of PVD, depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations.
  
  
  RESULTS
  Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs (P=0.033) with the odds of missing a retinal break being 1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy (PVR) and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae, pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD. Traumatic RRDs were rarely associated with PVD.
  
  
  CONCLUSIONS
  Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.
authors.affiliation: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi 110029, India.
authors.forename: Brijesh
authors.initials: B
authors.lastname: Takkar
authors.affiliation: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi 110029, India.
authors.forename: Shorya
authors.initials: S
authors.lastname: Azad
authors.affiliation: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi 110029, India.
authors.forename: Adarsh
authors.initials: A
authors.lastname: Shashni
authors.affiliation: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi 110029, India.
authors.forename: Amar
authors.initials: A
authors.lastname: Pujari
authors.affiliation: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi 110029, India.
authors.forename: Indrish
authors.initials: I
authors.lastname: Bhatia
authors.affiliation: Bharti Eye Hospital, New Delhi 110029, India.
authors.forename: Rajvardhan
authors.initials: R
authors.lastname: Azad
keywords: missed retinal breaks; ocular examination; posterior vitreous detachment; retinal detachment; retinal surgery