How to predict a new retinal tear or break?

The study below emphasizes a question you should ask your eyeMD when concerned about retinal detachment risks. Do I have a PVD, Posterior Retinal Detachment. It helps eyeMDs quantify your risk. If you do have a PVD, it means the gelatin inside the eye, the vitreous, has already detached from its attachments to the base of the retina and is little less likely to pull on the retina and cause a tear or break. 
So always ask if you have a PVD or not as it can help you decide if you should be 
 2005 Apr;123(4):479-84.

Symptoms and findings predictive for the development of new retinal breaks.


Vitreoretinal Department, The Rotterdam Eye Hospital, 3011 BH Rotterdam, The Netherlands.



To validate the conclusion of our previous prospective study of 250 patients with isolated posterior vitreous detachment: follow-up visits are only necessary if patients mention symptoms of flashes in combination with multiple floaters or a curtain or cloud at the initial examination, or an increase in number of floaters after the initial examination.


Prospective study of 270 consecutive patients with symptomatic isolated posterior vitreous detachment. All patients completed a questionnaire detailing their symptoms and had a full eye examination at the initial examination and at follow-up visits. Logistic regression with backward elimination was used for statistical analysis. We also performed pooled analysis of our previous and present study data.


New retinal breaks developed in 10 patients (3.7%). Multiple floaters, a curtain or cloud, hemorrhages (retinal or vitreous) at the initial examination, and an increase in the number of floaters after the initial examination were found to be predictive factors for the development of new retinal breaks. These factors were also the only significant predictors after pooled analysis of both studies (520 patients, 23 breaks).


We assume we can formulate a safe policy for scheduling patients with isolated posterior vitreous detachment: only patients with multiple floaters, a curtain or cloud, or hemorrhages (retinal or vitreous) at the initial examination should be scheduled for reexamination. All other patients should return only if the number of floaters increases.
 2012 Mar;153(3):497-503. doi: 10.1016/j.ajo.2011.08.036. Epub 2011 Nov 8.

Incomplete posterior vitreous detachment: prevalence and clinical relevance.


Retina Unit, Department of Ophthalmology, Hospital Povisa, Vigo, Spain.



To investigate the prevalence and clinical relevance of incomplete posterior vitreous detachment (PVD).


Prospective, observational cohort study.





Consecutive patients without previous ocular history who were diagnosed with acute uncomplicated PVD.


Baseline kinetic ultrasound evaluation differentiated posterior vitreous separation as complete or incomplete. Prospective follow-up searched for complications related to PVD. Multivariate analysis evaluated associations of baseline demographic and clinical characteristics to incomplete PVD. A Kaplan-Meier analysis evaluated the probability and its standard error of experiencing an adverse outcome. The log-rank test determined whether incomplete PVD modifies the natural history of PVD.


Prevalence of incomplete PVD and the estimated incidence of late adverse outcomes such as new retinal tears, epimacular membranes, or both.


A total of 54 of 207 patients had incomplete PVD (prevalence, 26.1%). Younger age and lattice degeneration were associated independently with incomplete PVD. After a mean follow-up of 5 years (range, 4 to 8 years), 16 patients (9.7%) experienced some adverse outcome. In 5 patients (2.7%), new retinal tears and 1 retinal detachment developed. In 12 patients (7.6%), epimacular membranes developed. Patients with incomplete PVD at baseline experienced significantly more adverse outcomes than patients with complete PVD (Kaplan-Meier estimated probability and standard error, 19.2% and 0.061 vs 5.4% and 0.02; P = .01, log-rank test).


Up to one fourth of symptomatic, acute, and uncomplicated PVDs show incomplete posterior vitreous separation. Delayed complications related to PVD, like retinal tears and epimacular membranes, develop more frequently in patients showing incomplete PVD.
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