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Ian Kirchner, David Ellenberg, Philip Henry Scharper; THE INCIDENCE OF PREVIOUS POSTERIOR VITREOUS DETACHEMENT IN PATIENTS UNDERGOING PARS PLANA VITRECTOMY FOR RESOLUTION OF SYMPTOMATIC VITREOUS FLOATERS. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1231.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate if the presence or absence of a posterior vitreous detachment (PVD) is significant with regards to the symptoms of vitreous floaters and patients decision to undergo pars plana vitrectomy (PPV) for removal of vitreous floaters.
A retrospective review of all patients who underwent PPV from 2013 through October 2014 was initially performed. All patients with current or history of retina or vitreous pathology including vitreous hemorrhage, macular hole, history of uveitis, history of retinal detachment, previous retina surgery or other concurrent retinal pathology were excluded from the study. All patients undergoing PPV strictly for symptomatic floaters were included. Standard 23G PPV (Constellation, Alcon, TX) was performed on all patients. The posterior hyaloid was visualized intraoperativly with intravitreal triamcinolone. All operative reports were reviewed to evaluate whether there was a previous PVD preoperatively or if the PVD was created surgically.
157 eyes of 140 patients were initially identified. 18 eyes were excluded for vitreous hemorrhage, 18 eyes for to previous retina surgery, 7 eyes for previous uveitis, 5 eyes for macular hole, 38 eyes for retained lens material or a dislocated IOL, 5 eyes for endophthalmitis, 1 eye for asteroid hyalosis, and 1 eye for hemorrhagic choroidal detachment. 64 eyes met the inclusion criteria and underwent PPV strictly for resolution of symptomatic floaters. An additional 6 eyes were then excluded because there was not mention of the presence or absence of a PVD in the operative report. 27/58 eyes (47%) already had a PVD prior to surgery confirmed intraoperatively with triamcinolone. 31/58 eyes (53%) did not have a previous PVD and a surgical PVD was created.
While it is often thought that a PVD is responsible for symptomatic vitreous floaters, our study shows that the presence of a PVD is not necessarily related to the severity of symptoms or patients’ decision to undergo surgical removal of floaters. In our study, more than half of the patients who choose to undergo PPV for symptomatic floaters did not have PVD pre-operatively. It is likely that location of the vitreous opacities and density of the vitreous syneresis has a greater significance than the presence or absence of a PVD.
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