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Joshua Uhr, Anthony Obeid, Turner D Wibbelsman, Connie M Wu, Jason Hsu; Incidence and Timing of Delayed Retinal Breaks Following Acute Symptomatic Posterior Vitreous Detachment. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3967.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the incidence of delayed retinal breaks following the onset of acute posterior vitreous detachment (PVD) and the time to development of the break.
Patients with a diagnosis of PVD and history of an extended ophthalmoscopic exam on initial presentation to the Retina Service of Wills Eye Hospital and offices of Mid Atlantic Retina were identified between October 2015 and August 2018 using diagnostic and procedural billing codes. The number of eyes with a history of either laser retinopexy (LR) or cryotherapy for a retinal tear was determined and the duration between the initial visit and the treatment visit was measured.
Of 8,122 patients presenting with PVD, 1,223 patients (15.1%) with retinal breaks were discovered and treated at the initial visit. Of the remaining 6,899 patients who did not have an initial break, 397 patients (5.8%) developed retinal breaks that were treated at a later date, accounting for 24.5% of all patients with retinal breaks. Average (± standard deviation) time from PVD to delayed break was 97.7 (±157.6) days (14 weeks), and median (interquartile range, IQR) time to delayed break was 28 days (IQR, 10-112). Of patients with delayed breaks, 160 (40.3%) were treated more than 6 weeks after initial presentation. In eyes with retinal breaks after six weeks, average time from PVD to retinal break was 220 days (31.4 weeks), median 147 days (21 weeks). An additional five patients were treated with late cryotherapy, three of whom were previously treated for retinal break with LR at the initial visit, and two of whom were previously treated with LR for delayed retinal breaks.
The literature to date has conflicting recommendations regarding follow up for patients presenting with acute PVD without a retinal break. We found clinically significant rates of delayed retinal breaks, underscoring the importance of repeat examination in these patients. Our findings further challenge the assumption that retinal breaks do not develop after six weeks, which is the upper limit of follow-up employed by previous studies on delayed retinal breaks and a common endpoint of follow-up in clinical practice.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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