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David Rivera, liliana Pérez-Peralta, Aida Jimenez-Corona, Sergio Hernández-Jiménez, Carlos A Aguilar-Salinas, Enrique O Graue; New Proposed Classification For Tomographic Posterior Vitreous Detachment (PVD), And High Prevalence Of Type 3 PVD In Diabetic Macular Edema Among Diabetic Patients.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1205.
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© ARVO (1962-2015); The Authors (2016-present)
<br /> To describe and propose an new classification of posterior vitreous detachment measured by optic coherence tomography, and to describe the correlation between the proposed types of PVD and diabetic macular edema.
A prospective study of 122 eyes of 61 consecutive patients of a diabetes clinic were examined. Patients had the diagnosis of diabetes and OCT was performed with a spectral-domain OCT. The imaging of the macula was assessed by a 300 OCT image crossing the center of the fovea. According the posterior vitreous status 8 types were described. 0 - Attached; 1 - Mild detachment; 2 - Perifoveal detachment with hyaloidal central adhesión in “U” shape; 3 - Perifoveal detachment with hyaloidal central adhesión in “inverted-U” shape; 4 - Perifoveal detachment with central adhesión, asymetric detachment, higher on one side of the fovea, both in “U”shape; 5 - Perifoveal detachment with central adhesión, asymetric detachment, higher on one side of the fovea, one in “U”shape and one in “inverted-U” shape; 6 - Perifoveal detachment with central adhesión, asymetric detachment, higher on one side of the fovea, both in “inverted-U”shape; 7 - Detached; 8 - No classifiable. Macular edema was classified according to the international classification in mild, moderate and sever. Statistical analysis was performed using a Fisher exact test.
Frequencies in the whole population of the different types of PVD are the following: Type 1: 27%, 2: 17%, 3: 11%, 4: 16%, 5:0%, 6:5%, 7: 20%, 8: 2%. Particularly, type 3 PVD was statistically associated with eyes presenting moderate and severe macular edema with an Odds ratio of 4.038 (IC95% 1.34-12.17, P=0.013). Patients with moderate and severe edema had a frequency of 36.8% of type 3 PVD, while patients without edema had a frequency of 13%. Such association was not found with mild and none macular edema.
In this novel classification, patients with moderate/severe macular edema had 4 times more possibilities of having type 3 PVD (Inverted “U” perifoveal) when compared with patients with mild or no edema. Type 3 PVD is statistially associated with moderate and severe stages of diabetic macular edema. This provides another proven factor to the multifactorial pathogenesis of this diabetic macular edema.
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