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Mercy Kibe, ALAN LETSON; Acute Posterior Vitreous Detachment – Evaluating modalities of detection and associated clinical findings. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3741.
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Indirect ophthalmoscopy with scleral depression remains an integral part of clinical evaluation for patients presenting with acute onset of flashes and floaters, the symptoms of a posterior vitreous detachment (PVD). However, this exam can be uncomfortable for patients and can be a difficult exam for some practitioners to perform.We performed a retrospective chart review to evaluate the efficacy of modalities, including scleral depression, dilated retinal exam with indirect biomicroscopy, 3-mirror contact lens, slit lamp bio-microscopy of the retina, ultrasound, and retinal imaging in detecting retinal tears and retinal pathology in patients presenting with symptoms of an acute PVD at initial and follow-up examinations.
We performed a retrospective chart review of 71 patients who were diagnosed with an acute PVD, retinal tear, or a retinal detachment over the study period. We recorded demographic information, ocular history, presenting symptoms, duration of symptoms, anterior and posterior segment exams, examination techniques, and findings at follow-up exams.
All patients (n=71) underwent dilated fundus exam (DFE). Of those who underwent DFE, 10% (n=7) underwent scleral depression. Other exam techniques included OCT (n=4, 6%), fundus photography (n= 2, 3%), and a combination of OCT and photography (n=2, 3%). 3-mirror contact lens and ultrasound were not recorded as exam techniques.Of the retinal pathology detected, 11 out of 71 patients (15%) were found to have a retinal tear, 8 out of 71 patients(11%) were found to have a retinal hole, and 6 of 71 patients (8.5%) were found to have retinal detachment on exam. For the detected retinal tears and retinal detachments, scleral depression was not recorded as part of the exam. However, of the patients found to have a retinal hole, one patient had a scleral depressed exam documented. Further, for patients with follow-up visits, scleral depression was recorded for 5 patients (7.5%), however, no retinal pathology was noted on exam.
This study suggests that even in absence of documented scleral depressed exam, peripheral retinal pathology is still detected on dilated fundus exam. However, this is a small study, and in future we hope to further explore how other methods of evaluation compare to scleral depression in the detection of retinal tears in patients presenting with symptoms of an acute PVD.
This is a 2020 ARVO Annual Meeting abstract.
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