Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage

Cross-sectional study of 75 consecutive patients presenting with acute symptomatic posterior vitreous detachment（ASPVD） and vitreous hemorrhage was conducted at University Eye Clinic,University Hospital ＂Sveti Duh＂,Zagreb,Croatia.To check ultrasound reliability in detecting retinal tears in patients with ASPVD,transpalpebral ultrasound of the eye and the orbit was performed followed by fundus examination initially and in 6 wk period.In 13（17%） patients membranous lesion with ultrasound characteristics of retinal tear was detected.Ophthalmoscopy confirmed the diagnosis in 8/13 patients.In 62/75 patients neither ultrasound nor clinical examination revealed retinal tear.Sensitivity of ultrasound examination was 100%,specificity 92%,positive predictive value 62% and negative predictive value 100%.Ultrasound proved to be a reliable and accurate method for detection of retinal tears in ASPVD.Given the high sensitivity and negative predictive value,negative result on B-scan ultrasound excludes the probability of the retinal tear with a high degree of certainty.

Assessment of posterior vitreous detachment on enhanced high density line optical coherence tomography

The state of the vitreo-retinal interface affects various retinal diseases, and the presence or absence of a posterior vitreous detachment （PVD） is one of the most important factors. As such, various studies studying PVD in relation to retinal disease have been performed.

Comment on “Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage”

Dear Editor,We were interested to read the paper by Kuzmanovic Elabjer et al.The purpose of the authors was to assess ultrasound reliability in detecting retinal tears in patients with acute symptomatic posterior vitreous detachment （ASPVD）. They performed transpalpebral ultrasound of the eye and the orbit followed by fundus examination initially and in 6wk period.

Spontaneous posterior vitreous detachment:A glance at the current literature

Spontaneous posterior vitreous detachment(PVD)is a common age-related condition in which prevalence tends to increase with age.Acute PVD can cause the onset of symptoms that include visual disturbances,myodesopsia and photopsia.The goal of this short review was to provide a quick glance at the important factors related to PVD based on current literature in this field,which includes incidence,symptoms,diagnosis,risk factors,and education for patients with acute symptoms,and treatments.The take home message is that an ophthalmic examination at the onset of symptoms is of utmost importance,considering that irreversible sight-threatening complications can be prevented if diagnosed and treated promptly.

Missed retinal breaks in rhegmatogenous retinal detachment

AIM： To evaluate the causes and associations of missed retinal breaks（MRBs） and posterior vitreous detachment（PVD） in patients with rhegmatogenous retinal detachment（RRD）.METHODS： Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and191 patients were included for analysis of PVD,depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations.RESULTS： Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs（P =0.033） with the odds of missing a retinal break being1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy（PVR） and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae,pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD.Traumatic RRDs were rarely associated with PVD. CONCLUSION： Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.

Long-term efficacy and safety of YAG laser vitreolysis for vision degrading myodesopsia

AIM:To assess the long-term efficacy and safety of yttrium-aluminum garnet(YAG)laser vitreolysis for vision degrading myodesopsia(VDM)caused by posterior vitreous detachment(PVD).METHODS:This retrospective study reviewed VDM patients of PVD type undergoing YAG laser vitreolysis.The baseline demographic information,the patterns of floaters,the number of floaters,and the subjective improvement of floater sympotoms(ranging from 0 to 100%)from medical records were collected.Significant improvement was defined as a relief of floater symptoms of≥50%at the final visit.The long-term efficacy and safety of YAG laser vitreolysis were analyzed.The risk factors linked to significant improvement of floater symptoms were defined using univariate and multivariate logistic regression analyses.RESULTS:The final analysis included 221 patients with VDM.The mean age of patients was 61.08±7.74y,and the mean length of follow-up was 21.38±5.61mo.Totally 57.01%of patients experienced a significant improvement in their floater symptoms after YAG laser therapy,and none of them developed delayed retinal abnormalities such as retinal tears or detachments.Age(OR=1.049,95%CI=1.007-1.092,P=0.021)was identified as a significant risk factor for significant improvement in VDM.CONCLUSION:YAG laser vitreolysis is an effective and secure treatment for PVD-type VDM,and patients of advanced age are more likely to get favorable outcomes.

Posterior vitreous cortex contributes to macular hole in highly myopic eyes with retinal detachment

Background It was well known that tangential vitreoretinal traction and epiretinal membrane play important roles during the formation of macular hole （MH） associated with retinal detachment （RD） in highly myopic eyes. But it was not clear about the correlations between anteroposterior traction, posterior vitreous cortex （PVC） and MH-RD. The vitreous status in highly myopic eyes were analyzed to explore the effect of PVC in the role of MH-RD formation. Methods Sixteen consecutive highly myopic eyes with RD due to MH were retrospectively analyzed from January 2009 to April 2009. The preoperative examinations for detecting posterior vitreous detachment （PVD） and vitreoretinal traction included B-mode ultrasonography and optical coherence tomography （OCT）. The residual PVC and PVD were confirmed intraoperatively during triamcinolone acetonide （TA） assisted vitrectomy. Results Under ultrasonography, the preoperative PVD patterns were stratified as： complete PVD in three （19%） eyes, partial PVD in eight （50%） eyes, and no PVD in five （31%） eyes. OCT confirmed vitreoretinal traction and no complete PVD in 10 （63%） eyes, including anteroposterior traction in four eyes and tangential traction in six eyes. During TA-assisted vitrectomy, it was confirmed that no complete PVD existed in 16 eyes, including six eyes （38%） finally diagnosed of partial PVD, and five （31%） eyes with vitreoschisis. Anteroposterior vitreoretinal traction around MH is always in conjunction with partial PVD （67%）, and high proportion （80%） of vitreoschisis is associated with tangential vitreoretinal traction. Comparing with the precision of TA staining of PVD diagnosis, the coincidence rate of ultrasonography was 69% （P=0.02）, and that of OCT was 63% （P 〈0.01）. Conclusions The residual PVC due to partial PVD or vitreoschisis may cause the anteroposterior or tangential traction of macular area, which contributes to the formation of MH and subsequent RD in highly myopic eyes. And it is necessary to realize the vitreoretinal relationship and assess the status of PVC synthetically for surgery by combined ultrasonography and OCT preoperatively and TA staining intraoperatively.