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Jennifer Cattaneo, Valentina Viganò, Luigi Cerri, Simone Donati, Claudio Azzolini; Evolution of vitreoretinal modification after posterior vitreous detachment (PVD) and clinical management. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1105.
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To evaluate the perspective retinal tear risk in patients presenting with acute onset of floaters and/or flashes.
28 patients, 17 females and 11 males, have been recruited. Mean age was 66.7 ± 12.3 years old. Inclusion criteria was recent diagnosis of acute complete or partial PVD with reported flashes and floaters. Exclusion criteria were recent ocular trauma or ocular surgery, retinal laser photocoagulation, severe ocular media opacities, diabetic retinopathy and active inflammatory eye disease. All patients have been investigated about related symptoms and underwent a complete ophthalmic evaluation including visual acuity with refractive error and peripheral retina examination with Goldmann 3-mirror contact lens. Follow up was at 2 weeks, 6 weeks and 3 months. A prompt treatment was expected in presence of tractional retinal tears.
Our patients reported an incidence of retinal tears of 8.6% with a peak at 2 weeks; no more retinal tears were reported on further follow up. All patients reported floaters at baseline and during follow up visits. At baseline, 78,2% of patients reported flashes, 60.8% at 2 weeks, 17.3% at 6 weeks and 8.6% 3 months follow up. 17,3% of patients presented peripheral retinal hemorrhages at baseline which resolved during following clinical visits and no more retinal hemorrhages were reported during follow up. In 4.3% of patients we found mild vitreous hemorrhage at baseline which resolved in the following visits. In 21.7%, we found a peripheral non symptomatic vitreo-retinal traction at baseline, 21.7% at 2 weeks, 13% at 6 weeks,4.3% at 3 months. Weiss ring was clearly appreciable in 13% of patients at the last follow up visit.
Our protocol expected to visit patients 4 times in 3 months. All patients with acute PVD showed floaters that persisted during follow up whereas 78% of patients showed flashes that decreased to 8.6% after 3 months. As the maximum manifestation of retinal tear was at week 2, we conclude that it is important to perform a early clinical evaluation in presence of symptoms in order to refer patients for a possible retinal laser photocoagulation and avoid retinal tear complications. We didn’t find a significative correlation between the entity of refractive error and risk of retinal tears. We underline a significative association between retinal tear and persistence of flashes.
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