Incomplete posterior vitreous detachment: prevalence and clinical relevance

José Lorenzo Carrero
American Journal of Ophthalmology 2012, 153 (3): 497-503

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

DESIGN: Prospective, observational cohort study.

METHODS: <AbstractText Label="SETTING" NlmCategory="METHODS">Institutional.

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

OBSERVATIONS: 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.

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

RESULTS: 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).

CONCLUSIONS: 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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