Abstract
Purpose :
Posterior vitreous detachment (PVD) is a separation of the posterior hyaloid from the internal surface of the retina which manifests as symptomatic flashes and floaters. Remaining traction on peripheral retina can form retinal breaks, which can lead to sight-threating retinal detachments. Retinal breaks can be found in up to 25% of symptomatic patients. Shaffer’s sign, or the presence of photoreceptors, or tobacco dust, the presence of pigment in the vitreous, raise the likelihood that a retinal break occurred. Optical coherence tomography (OCT) has been shown to demonstrate posterior vitreous opacities (PVOs) that may correlate with Shaffer’s sign or tobacco dust. This study determined the sensitivity and specificity of PVOs on OCT with retinal breaks in patients presenting with symptoms of flashes or floaters.
Methods :
A retrospective chart review was performed for patients who presented with flashes or floaters and were diagnosed with a posterior vitreous detachment at a single institution by a single provider (The Retina Institute, St Louis, MO). Masked qualitative review of SD-OCT’s was performed by a single reviewer to determine presence of PVOs. An OCT was said to have PVOs if three or more opacities were seen in the vitreous (Figure 1). Sensitivity and specificity of presence of PVOs was correlated with incidence of retinal break.
Results :
In total, 78 patients met criteria to be involved in the study. PVOs were found in 32 patients (41%), and 19 of those patients had a retinal break (59%). In those without PVOs, only 5 (11%) had a break. Sensitivity and specificity of this finding was found to be 76.9% and 75.0% respectively. A total of 17 patients (21%) presented with a vitreous hemorrhage. When eliminating all patients with a vitreous hemorrhage, the sensitivity and specificity of PVOs was found to be 70.0% and 92.6% respectively.
Conclusions :
In patients presenting with symptoms of flashes and floaters, the presence of posterior vitreous opacities on OCT was found to correlate with the presence of a retinal break, especially in the absence of a vitreous hemorrhage. Therefore, an OCT can assist the examiner by providing useful information by raising or decreasing the likelihood a retinal break has occurred with a symptomatic PVD.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.