Abstract
Purpose: :
To describe the natural history of acute, symptomatic Posterior Vitreous Detachment (PVD).
Methods: :
Prospective cohort, time-to-event analysis. Demographic characteristics, ocular axial length, concurrent retinal tears and retinal lesions present in patients with acute symptomatic PVD were noted. Based on dynamic ultrasound evaluation, vitreous status was classified at baseline as complete or incomplete PVD. Patients were followed annually for a period of 4 to 8 years. The probability of experience an adverse outcome and its standard error were estimated using a Kaplan-Meir analysis. The log-rank test was used to determine whether incomplete PVD and initial retinal tears modify the natural history of PVD. A multivariate binary logistic regression model was employed to estimate risk factors for retinal tears along the course of PVD.
Results: :
Two hundred thirty-one patients with acute onset of symptomatic PVD were consecutively enrolled and followed-up in a non-referral hospital.One third of patients showed either retinal tears (10.4%) or incomplete forms of PVD (23.4%) at presentation. After a median and mean follow-up of 5 years, 23 eyes (10% of patients) experienced one or more adverse outcomes in the study eye: there were 11 new retinal tears (4.8%), 3 retinal detachments (1.2%) and/or 15 (6.5%) epimacular membranes. Patients with retinal tears at baseline and patients with incomplete PVD had significantly more delayed retinal tears (25 % and 7.4% respectively) than patients with uncomplicated, complete PVD (0.7%) (p=0.001 and p=0.009 respectively). Though there was a trend for epimacular membranes to occur also more frequently in these patients, this difference was not significant (p=191). Patients with a longer axial length had a higher risk for retinal tears (OR=1.53 [1.13-2.07]).
Conclusions: :
Up to one third of symptomatic, acute PVDs are anomalous PVDs causing either retinal tears or incomplete PVD. Pathologic PVD predisposes patients to late adverse outcomes like delayed retinal tears.
Keywords: vitreous • retinal detachment