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R. Coffee, A.C. Westfall, G. Davis, W. Mieler, E.R. Holz; Case Series and Meta–Analysis of Symptomatic Posterior Vitreous Separation and the Incidence of Delayed Retinal Breaks . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4206.
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To establish the necessity for an early follow–up examination after a negative initial funduscopic exam for patients with acute, symptomatic posterior vitreous detachment
Records were reviewed of patients presenting over a and one half year period who were diagnosed with an acute, symptomatic posterior vitreous detachment (PVD). A MEDLINE search to identify all published observational case studies reporting vitreoretinal pathology following acute, symptomatic PVD.
The incidence of retinal tears in eyes with a symptomatic PVD was 8.2%. The overall retinal break rate in the meta–analysis portion of the study was 21.7%. In total, 1.8% of patients had retinal tears that were not seen on initial examination. Of the 29 patients with delayed onset retinal breaks, 24 (82.8%) had at least one of the following: pigment or hemorrhage in the vitreous at initial examination, new symptoms or aphakia.
If the initial examination of a patient with an acute, symptomatic PVD is negative for retinal tears, the necessity of early follow–up may be best determined on the presence of pigment or hemorrhage in the vitreous and aphakia. Evidence–based medicine does not support the necessity of a routine second exam for the vast majority of patients with symptomatic PVD.
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