posterior vitreous detachment - prevalence of and risk factors for retinal tears

Martin Bond-Taylor,1 Gunnar Jakobsson,1,2 Madeleine Zetterberg1,2 1Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, 2Department of Clinical Neuroscience/Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden Purpose: The present study aimed to describe clinical characteristics of patients with posterior vitreous detachment (PVD), to determine the prevalence of retinal tears in PVD patients, and to find predictors for retinal tears in this patient group. Methods: Retrospective analysis of medical records on patients diagnosed with PVD, retinal tears, or vitreous hemorrhage at the Department of Ophthalmology at Sahlgrenska University Hospital, a tertiary eye center. Results: Between February and July 2009, 365 patients consulted the Department of Ophthalmology for PVD-related symptoms. The incidence of retinal tears was 14.5% (n=53) and that of vitreous and/or retinal hemorrhage was 22.7% (n=83). For analysis of possible predictors for complications to PVD, patients diagnosed with retinal tears or vitreous hemorrhage between May and July 2009 were also included in the study, resulting in a total of 426 patients. Predictors of a retinal tear were symptoms of visual impairment (P=0.024), the presence of vitreous or retinal hemorrhage at examination (P<0.001), and a duration of symptoms for <24 hours (P=0.004). Symptoms of flashes did not constitute an extra risk of retinal tears (P=0.135). Subsequent retinal pathology (follow-up time 4.5 years), including vitreous detachment/hemorrhage or retinal tears/detachment, occurred more often in patients presenting with a retinal tear. For patients with a retinal tear, the relative risk of having a retinal detachment in the same eye during the follow-up time was 17.7 when compared to patients without a retinal tear (risk ratio 17.7, 95% confidence interval 2.2–145). Conclusion: Patients seeking care on the first day have a higher risk of retinal tears. Also, symptoms of visual loss or a history of previous PVD-related pathology and vitreous/retinal hemorrhage at examination indicate a substantially higher risk of retinal complications. These findings may lead to better management and order of priority among these patients. Keywords: posterior vitreous detachment, retinal detachment, retinal hemorrhage, retinal tear