Search

Purpose: To evaluate the levels of anxiety and depression in patients with symptomatic vitreous floaters and to determine the possible correlations of psychological implications with the symptoms duration and possible improvement, the degree of posterior vitreous detachment, and the discomfort severity., Methods: Ninety patients complaining for floaters and fifty-seven age- and gender-matched healthy-control subjects were recruited. Every participant underwent a complete ophthalmological examination, including funduscopy and optical coherence tomography scans, while clinical and demographic data were also gathered. The Patient Health Questionnaire-9 (PHQ-9), the Zung Depression Inventory-Self-Rating Depression Scale (Zung SDS), and the Hospital Anxiety and Depression Scale (HADS) were completed by everyone., Results: Between the studied groups, no significant differences were detected regarding the clinical and demographic data (p > 0.05). The patients with floaters had significantly higher scores of PHQ-9, Zung SDS, HADS Anxiety, and HADS Depression (p < 0.001). After adjustment for several confounders, PHQ-9 (p = 0.041), Zung SDS (p = 0.003), and HADS Anxiety (p = 0.036) values remained significantly impaired. Among the patients, PHQ-9 and Zung SDS scores were significantly elevated in the patients with floaters duration less than 4 weeks (p < 0.05). Finally, anxiety and depression were significantly correlated with the symptoms duration and intensity, with the floater-associated discomfort, and with the stage of posterior vitreous detachment., Conclusion: Vitreous floaters have a negative impact on patients' psychological status, by the terms of enhanced depressive and anxiety levels. To the best of our knowledge, our study is the first in the literature to elaborate the aforementioned association, by assessing three different questionnaires simultaneously., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Aim: To evaluate the role of papillary vitreous detachment in the pathogenesis of non-arteritic anterior ischaemic optic neuropathy (NAION) by comparing the features of vitreopapillary interface between NAION patients and normal individuals., Methods: This study included 22 acute NAION patients (25 eyes), 21 non-acute NAION patients (23 eyes) and 23 normal individuals (34 eyes). All study participants underwent swept-source optical coherence tomography to assess the vitreopapillary interface, peripapillary wrinkles and peripapillary superficial vessel protrusion. The statistical correlations between peripapillary superficial vessel protrusion measurements and NAION were analysed. Two NAION patients underwent standard pars plana vitrectomy., Results: Incomplete papillary vitreous detachment was noted in all acute NAION patients. The prevalence of peripapillary wrinkles was 68% (17/25), 30% (7/23) and 0% (0/34), and the prevalence of peripapillary superficial vessel protrusion was 44% (11/25), 91% (21/23) and 0% (0/34) in the acute, non-acute NAION and control groups, respectively. The prevalence of peripapillary superficial vessel protrusion was 88.9% in the eyes without retinal nerve fibre layer thinning. Furthermore, the number of peripapillary superficial vessel protrusions in the superior quadrant was significantly higher than that in the other quadrants in eyes with NAION, consistent with the more damaged visual field defect regions. Peripapillary wrinkles and visual field defects in two patients with NAION were significantly attenuated within 1 week and 1 month after the release of vitreous connections, respectively., Conclusion: Peripapillary wrinkles and superficial vessel protrusion may be signs of papillary vitreous detachment-related traction in NAION. Papillary vitreous detachment may play an important role in NAION pathogenesis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Retinal tears (RT) from posterior vitreous detachment (PVD) are an important and treatable cause of rhegmatogenous retinal detachment (RRD). Better understanding of the risk of RT from PVD will help plan urgent eye care., Methods: Prospective observational case series over two years. Patients presenting to their optometrist, family doctor or emergency department with flashes and floaters were directed to a research clinic. History and examination, including slit-lamp biomicroscopy (SLB) and indentation indirect ophthalmoscopy (IIO), were performed by a single investigator, with two month follow-up for patients with confirmed PVD. Main outcome measures were incidence of PVD, RT, and RRD., Results: 1010 patients were recruited. 896 (89%) patients had PVD at first assessment, of which 89 (8.8% of total cohort, 9.9% of PVD eyes) had RT and 8 had RRD. 21 (3%) of the remaining PVD patients developed RT in the subsequent two months and a further 9 (11%) patients with RT at initial assessment developed further tears by two months. 7 (0.7%) had asymptomatic RT in the fellow eye. 15% of RT were only visible on IIO and not SLB. Weiss ring was absent in 32% of eyes with RT. Patients with RT or RRD were more likely than 'PVD-only' eyes to have blurred or missing vision (p < 0.001), have higher rate of blue-green cataracts (p < 0.001), and longer axial lengths (p < 0.05)., Conclusions and Relevance: This large, prospective study demonstrates a 9.9% rate of RT or RRD at the time of PVD, and emphasises the importance of IIO examination., (© 2023. The Author(s).)

Purpose: Analyze the peripheral vitreoretinal interface with widefield optical coherence tomography., Methods: Retrospective chart analysis and widefield optical coherence tomography in 120 consecutive cases of rhegmatogenous pathology., Results: There were 166 lesions in 120 eyes, including 106 horseshoe tears, 22 operculated holes, 30 nonoperculated holes, six giant tears, and two peripheral lamellar defects followed for 6.1 ± 1.2 months. Posterior vitreous detachment was present in all eyes (101/101, 100%) with tears and operculated holes, but only in 5/19 eyes (26.3%) with nonoperculated holes ( P < 0.001). Axial vitreous traction was evident at the anterior edge of horseshoe tears (106/106, 100%), but not the posterior border (18/106, 17%, P < 0.001). Operculated holes located posterior to the vitreous base were free from vitreous traction, displaying a morphology similar to the macular hole. Nonoperculated holes were farther anterior with signs of tangential traction in 23/30 (76.7%) cases. Peripheral vitreoschisis was more often associated with nonoperculated holes (25/30, 83.3%), than horseshoe tears (17/106, 16%; P < 0.001). Horseshoe tears and nonoperculated holes were more often associated with retinal detachment (58/106 [54.7%] and 15/30 [50%], respectively) than operculated holes (5/22, 22.7%), P = 0.023., Conclusion: Peripheral vitreoretinal interactions are similar to vitreomaculopathies, with axial and vitreoschisis-related tangential traction playing different roles in different rhegmatogenous pathologies. Peripheral optical coherence tomography improves understanding of pathophysiology and risks of retinal detachment.

Purpose: To evaluate prophylactic treatment (PTx) of lattice degeneration (LD) on retinal tear (RT) and rhegmatogenous retinal detachment (RRD) risk in fellow eyes of patients after primary RRD repair in the first eye., Methods: This was a consecutive case series with cohort control involving patients with RRD repair from January 1, 2013, through December 31, 2017. Patients received PTx (PTx cohort) or no PTx (No-PTx cohort) in fellow eye with 5-year follow-up. Primary outcome measure was proportion with new fellow eye RT/RRD. Secondary outcomes included logarithm of minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) and status of myopia, posterior vitreous detachment, and pseudophakia., Results: Four hundred ninety-eight patients were divided into 146 and 352 in PTx and No-PTx cohorts, respectively. PTx cohort developed significantly ( P < 0.05) fewer RT/RRD (17%) than No-PTx cohort (41%). PTx significantly ( P < 0.05) lowered RT/RRD irrespective of posterior vitreous detachment and myopia status. PTx patients undergoing phacoemulsification demonstrated significantly ( P < 0.05) less RT/RRD (22%) than No-PTx cohort (31%). There was no significant ( P = 0.96) final BCVA difference between PTx (median = 0 logMAR) and No-PTx (median = 0 logMAR) cohorts., Conclusion: PTx of asymptomatic fellow eye LD reduced RT/RRD risk.

Objective: To establish if the BElfast Retinal Tear and detachment Score (BERT Score) can be used in triaging patients presenting with vitreous haemorrhage to allow safe differentiation between those with retinal tears and detachments, versus haemorrhagic posterior vitreous detachments., Methods: Retrospective audit of 122 patients presenting to eye casualty with vitreous haemorrhage excluding trauma and vascular causes. Twenty-two patients were excluded from the study as they had no follow-up. The BERT Score was applied to the remaining 100 patients., Results: Vitreous haemorrhages with a BERT score ≥4 points were more likely to have a retinal tear or detachment (P = 0.0056). The sensitivity was 84.6% (confidence interval (CI) 65.0-100.0%), specificity 34.5% (CI 24.5-44.5%), positive predictive value 16.2% (CI 7.4-24.9%) and negative predictive value 94% (CI 85.4-100.0%)., Conclusions: The BERT is a reliable scoring system to risk stratify patients with vitreous haemorrhage. Its high sensitivity and negative predictive value can help clinicians to detect high-risk patients., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Background/purpose: To evaluate the status of the posterior vitreous hyaloid on presenting optical coherence tomography images of the macula and its relationship to clinical characteristics, treatment patterns, and outcomes in eyes with central retinal vein occlusion., Methods: This is a retrospective longitudinal cohort study of consecutive patients with acute, treatment-naive central retinal vein occlusion diagnosed between 2009 and 2021 who had at least 12 months of follow-up. Clinical characteristics, treatment patterns, and outcomes were analyzed between eyes stratified based on the presence or absence of a complete posterior vitreous detachment (PVD) on optical coherence tomography at presentation., Results: Of 102 acute, treatment-naive central retinal vein occlusions identified, 52 (51%) had complete PVD at presentation and 50 (49%) did not. Central subfield thickness was significantly lower in those with complete PVD (12 months: 284.9 ± 122.9 µ m vs. 426.8 ± 286.4 µ m, P < 0.001; last follow-up: 278 ± 127.9 vs. 372.8 ± 191.0 µ m, P = 0.022). One-year intravitreal injection burden was significantly less for those with a complete PVD than those without (5.1 ± 3.6 injections vs. 6.7 ± 3.3 injections, P = 0.013)., Conclusion: Central retinal vein occlusion with complete PVD on presentation had significantly lower central subfield thickness and 1-year injection burden. Assessment of the vitreomacular interface in central retinal vein occlusion may serve as a prognostic imaging biomarker.

Purpose: The purpose of this study was to report the findings of a hyperreflective nodular epiretinal gliosis observed with optical coherence tomography presumed to be due to subclinical hyaloidal traction causing Mϋller cell cone gliosis., Methods: Retrospective, observational case series., Results: Six eyes of six patients (mean age: 57 years, range 35-81 years) presented with a nodular epiretinal gliosis and had an average follow-up interval of 26 months (range 1-82 months). The mean baseline best-corrected visual acuity was 0.25 ± 0.17 (Snellen equivalent 20/38.3 ± 16.9). Fundus photography demonstrated a yellowish lesion overlying the fovea. Optical coherence tomography imaging revealed a hyperreflective preretinal lesion with a mean vertical length of 267 μ m (range 185-497) and a mean greatest linear diameter of 312 µ m (range 124-640). There was no vitreoretinal abnormality including vitreomacular traction or epiretinal membrane noted in any eye, and two of six eyes displayed a definitive posterior vitreous detachment. These nodules may have occurred before and persisted even after a posterior vitreous detachment or may have been acquired after the posterior vitreous detachment. The nodules typically remained stable with minimal change although in one eye, a posterior vitreous detachment occurred 6 months after initial presentation and lifted the gliosis off of the retinal surface where it remained attached to the posterior hyaloid., Conclusion: Foveal nodular epiretinal gliosis may occur due to subclinical hyaloidal traction on the Müller cell cone even without obvious vitreoretinal interface abnormality on optical coherence tomography.

Purpose: To evaluate the prevalence and risk factors for development of paravascular inner retinal defects (PIRDs) using en face optical coherence tomography., Methods: This is a retrospective cross-sectional study. En face and cross-sectional optical coherence tomography images were reviewed (9 × 9 mm or 12 × 12 mm). Paravascular inner retinal defects were classified as either Grade 1 (i.e., paravascular inner retinal cysts) when the lesion was confined within the nerve fiber layer without any communication to the vitreous cavity or Grade 2 (i.e., paravascular lamellar hole) when the defects communicated to the vitreous. Paravascular inner retinal defect grading was correlated with presence of high myopia, stage of posterior vitreous detachment, and presence of epiretinal membrane and retinoschisis., Results: Of 1,074 patients (2,148 eyes), PIRDs were detected in 261 eyes with a prevalence of 261 per 2,148 eyes (12.2%) and 176 per 1,074 patients (16.4%). A total of 116 eyes (44.4%) displayed Grade 2 PIRDs while 145 eyes (55.6%) were Grade 1. In the multivariate logistic regression model, the presence of partial/complete posterior vitreous detachment, retinoschisis, and epiretinal membrane was significantly correlated with PIRDs (OR = 2.78 [1.7-4.4], P < 0.001; OR = 2.93 [1.7-5], P < 0.001; and OR = 25.9 [2.8-242.5], P < 0.001, respectively). The presence of partial/complete posterior vitreous detachment and epiretinal membrane was also significantly associated with Grade 2 PIRDs versus Grade 1 PIRDs ( P = 0.03 and P < 0.001)., Conclusion: Our results indicate that wide-field en face optical coherence tomography facilitates the identification of PIRDs over a large area of retina with a single capture. The presence of PIRDs was significantly associated with posterior vitreous detachment, epiretinal membrane, and retinoschisis, confirming the role of vitreoretinal traction in the pathogenesis of PIRDs.

Aim: The aim of this retrospective review was to analyse the frequency of patients presenting with flashes and/or floaters (F/F) on bright versus dark days to the eye emergency department of a tertiary referral hospital (the Mater Misericordiae University Hospital) over a 3-year period. The diagnostic and clinical outcomes of F/F presentations were also analysed., Methods: This retrospective study assessed eye casualty attendances between January 2018 and December 2020. Solar irradiation (j/cm 2 ) at ground level was retrieved from the records of Met Eireann (Irish National Meteorological Service) via their open access records. A review of electronic patient medical records using the in-house database patient centre was carried out of all patients who attended EED of during the study timeline on the 5 'brightest' and 5 'darkest' days of each year., Results: Seven hundred forty patient presentations were analysed in total. Overall, 16% (n = 119) of all patients that attended EED during the timeframe of the study presented with F/F. One hundred six patients (89%) presented with floaters, 40 patients (34%) presented with flashing lights/photopsia, and 35 patients (29%) presented with both F/F. More patients presented to EED with F/F on bright days when compared with dark days (74 vs 45, p < 0.05). Eighty-nine percent of all patients with F/F presented with monocular floaters. There were more floater presentations during bright when compared with dark days (70 vs 36, p < 0.05). More patients were diagnosed with PVD on bright days when compared with those diagnosed with PVD on dark days (43vs 15, p < 0.05). More RDs were diagnosed on dark days compared with bright days (7 vs 3, p < 0.05)., Conclusion: This study established that F/F presentations were more likely to present during bright days when compared with dark days. The diagnosis of PVD was more common during bright days, and RDs were diagnosed significantly more frequently on dark days. Although incident solar radiation was correlated with greater floaters/PVD presentation, causation is unlikely, and the duration of PVD may have been longer in patients presenting on bright days (i.e. pseudo-sudden symptoms)., (© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Age-related changes in vitreous molecular and anatomic morphology begin early in life and involve two major processes: vitreous liquefaction and weakening of vitreo-retinal adhesion. An imbalance in these two processes results in anomalous posterior vitreous detachment (PVD), which comprises, among other conditions, vitreo-macular adhesion (VMA) and traction (VMT). VMA is more common in patients with neovascular age-related macular degeneration (nAMD) than age-matched control patients, with the site of posterior vitreous adherence to the inner retina correlating with location of neovascular complexes. The pernicious effects of an attached posterior vitreous on age-related macular degeneration (AMD) progression involve mechanical forces, enhanced fluid influx and inflammation in and between the retinal layers, hypoxia leading to an accumulation of vascular endothelial growth factor (VEGF) and other stimulatory cytokines, and probably an infiltration of hyalocytes. It has been shown that vitrectomy not only mitigates progression to end-stage AMD, but existing choroidal neovascularization regresses after surgery. Thus, surgical PVD induction during vitrectomy or by pharmacologic vitreolysis may be considered in non-responders to anti-VEGF treatment with concomitant VMA., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose: To present a case of a myopic macular hole that spontaneously closed twice in the presence of a broadly adherent posterior hyaloid membrane., Methods: Case report., Results: A 49-year-old man with high myopia and pseudophakia had a full-thickness macular hole in the left eye. The hole spontaneously closed in all retinal layers before the elective surgery, but the macular hole recurred one month later. The hole started sealing again spontaneously after one month, leaving a defect in the outer retinal layers. Four months later, the outer layer defect sealed and a lamellar macular hole developed. Throughout the course, the posterior hyaloid membrane remained parallel to the macular surface. The macular morphology and the patient's vision remained stationary at the 2-year follow-up., Conclusion: This case demonstrated that myopic macular holes can form and seal repeatedly with a broadly adherent posterior hyaloid membrane. Although bridging phenomenon was the common sign indicating the initiation of the two hole closures, different patterns of tissue regeneration ensued., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)

Purpose: To investigate the impact of phacoemulsification on posterior vitreous detachment formation in eyes with vitreomacular traction (VMT) with or without macular holes., Methods: A retrospective search of the medical records was conducted to identify patients with VMT who underwent cataract surgery at Mass Eye and Ear from 2016 to 2021. Patient demographics, ocular comorbidities, and clinical characteristics were extracted from the record, and optical coherence tomography images were assessed to confirm VMT and the presence of a lamellar or full-thickness macular hole (FMTH). Patients who underwent vitrectomy prior to cataract surgery were excluded., Results: A total of 22 patients (15 women [68%]) met inclusion criteria (average age, 71 years). Fifteen eyes had an associated epiretinal membrane (63%), 7 had a lamellar hole (29%), and 8 had an FTMH (33%). Epiretinal membrane was present in 3 of 7 eyes with lamellar holes (43%) and 4 of 8 with a FTMH (50%). No eyes developed a complete posterior vitreous detachment following phacoemulsification. In 2 cases, there was progression of the macular hole stage following phacoemulsification. Ten eyes underwent subsequent pars plana vitrectomy (PPV). There was no statistically significant difference in visual acuity between eyes pre- and post-phacoemulsification; however, there was a statistically significant improvement in visual acuity pre- and post-PPV., Conclusions: Unlike other studies, in this case series of 24 eyes with VMT or VMT with holes, no cases of full posterior vitreous detachment occurred following unremarkable phacoemulsification or YAG capsulotomy., (Copyright ©2023. All rights reserved. Reproduction in whole or in part in any form or medium without expressed written permission of the Digital Journal of Ophthalmology is prohibited.)

Purpose: To evaluate the risk of a rhegmatogenous retinal detachment (RRD) in the fellow eye using posterior hyaloid status as determined by OCT at the time of initial RRD., Design: Retrospective chart review., Participants: Patients with a diagnosis of RRD., Methods: Posterior hyaloid status-presence or absence of a posterior vitreous detachment (PVD)-in both eyes at the time of initial RRD was determined by OCT imaging. Baseline characteristics, including lattice degeneration, refractive error, prior ocular laser procedures, lens status, and family history of RRD, were recorded., Main Outcome Measures: The main outcome measures were the development of fellow-eye RRD and the time to fellow-eye RRD. In addition, OCT imaging was used in those fellow eyes with a visible posterior hyaloid to document whether a PVD developed during follow-up and time to such an event., Results: A total of 1049 patients with an RRD were followed up for an average of 5.7 ± 0.3 years. Overall, 153 patients (14.6%) received a diagnosis of bilateral sequential RRD during this follow-up period. OCT images were available for 582 fellow eyes; PVD was noted in 229 fellow eyes (39.3%), and an attached hyaloid was noted in 353 fellow eyes (60.7%). An RRD occurred in 7 fellow eyes (3.1%) with a PVD at presentation. Within the cohort of fellow eyes with an attached hyaloid, 28 eyes (7.9%) demonstrated an RRD during follow-up; however, when evaluating only those in which a PVD developed during follow-up, 23.7% of such eyes were found to have an RRD as well. At the time of PVD development in the fellow eye, an additional 21 eyes (17.8%) were noted to have a retinal tear that was treated without progression to RRD., Conclusions: OCT imaging of the fellow eye at the time of presentation with an RRD offers a significant amount of information regarding risk stratification for RRD in this eye. Patients noted to have a completely detached posterior hyaloid are at a significantly lower risk of RRD than those with a visible posterior hyaloid, who need to be monitored closely at the time of PVD development., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of the study was to develop a simple telephone questionnaire, without physical examination input, that predicts which patients calling with symptoms of a posterior vitreous detachment (PVD) have a retinal tear (RT) or rhegmatogenous retinal detachment (RD)., Design: Prospective cohort (quality improvement) study., Participants: All patients with symptoms consistent with a PVD calling a major academic ophthalmology department over a 4-month period in 2020 and who were seen on follow-up within 1.5 months (211 screened and 193 included)., Methods: A comprehensive telephone questionnaire assessing for RT/RD risk factors was administered by telephone triage staff to all patients calling with symptoms of flashes, floaters, or curtain/veil in their vision. Multivariable logistic regression was used to determine risk factors most predictive of having an RT/RD during the add-on visit. Risk factor odds ratios were used to develop an RT/RD risk score., Main Outcomes Measures: Development of a clinical risk score for having an RT/RD at the add-on visit after telephone triage., Results: Approximately 55% of patients were previously established in the retina clinic, 26% were new to the department, 19% were previously established in the comprehensive clinic, and 7% had an RT/RD at the add-on visit. Out of 23 questions and 70 prespecified possible answers from the telephone questionnaire, the final clinical risk score for RT/RDs was derived from 7 questions and 15 possible answers. The simplified questionnaire can be administered quickly by telephone operators without any reference to physical examination or the patient's chart. The receive-operator curve for our final multivariable logistic regression and clinical risk score models have an area under the curve of > 0.90. Using a conservative clinical risk score, approximately 50% of all patients without an RT/RD can be safely seen nonurgently. Progressively higher scores can be used to determine relative urgency of an appointment., Conclusions: To our knowledge, this is the first study to predict risk of an RT/RD in a patient calling with symptoms consistent with a PVD without reference to the patient's physical examination or chart. Our clinical risk scoring system can be used to determine urgency of an add-on appointment and increase the number of low-risk patients with symptomatic PVDs who are scheduled routinely., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: This study investigated factors associated with fellow eye horseshoe retinal tear (HST) development in consecutive patients with a presenting eye HST., Materials and Methods: Medical records were reviewed for patients with initial HSTs between 2015 and 2017 and 24 factors were analyzed. Logistic regression was used to assess factors associated with fellow eye HST development., Results: In total, 242 patients with an HST were identified with mean follow-up of 68.3 months. Four associations with fellow eye HST development were identified: (1) presence of fellow eye lattice degeneration, (2) subsequent presenting eye HSTs, (3) fellow eye vitreous hemorrhage at presenting eye HST occurrence, (4) OCT-determined stage 3 fellow eye posterior vitreous detachment at presenting eye HST occurrence., Conclusion: Four clinical findings associated with fellow eye HST development following presenting eye HST were identified. These factors may be important considerations during management patients with HST. [ Ophthalmic Surg Lasers Imaging Retina 2023;54:338-345.] .

Background: Retinopathy of prematurity (ROP) is one of the most frequent causes of severe visual impairment or blindness in childhood and can lead to severe late complications in children even after the initial disease has resolved., Purpose: The present study summarizes possible late effects in childhood after treated and untreated ROP. A special focus is on the development of myopia, retinal detachment, as well as neurological and pulmonary development after anti-vascular endothelial growth factor (VEGF) treatment., Material and Methods: This work is based on a selective literature search on late effects in childhood of treated or untreated ROP., Results: Preterm infants have an increased risk of developing high-grade myopia. Interestingly, several studies indicate that the risk of myopia is reduced following anti-VEGF treatment. With anti-VEGF treatment, however, late recurrences after initial response are possible even after several months, making long-term and frequent follow-up examinations essential. Controversy exists regarding the possible negative effects of anti-VEGF treatment on neurological and pulmonary development. After both treated and untreated ROP, rhegmatogenous, tractional or exudative retinal detachment, vitreous hemorrhage, high myopia and strabismus are possible late complications., Discussion: Children with a history of ROP with or without treatment have an increased risk for late ocular sequelae, such as high myopia, retinal detachment, vitreous hemorrhage and strabismus. A seamless transition from ROP screening to pediatric and ophthalmological follow-up care is therefore essential for timely detection and treatment of possible refractive errors, strabismus, or other amblyogenic changes., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

This study compared the characteristics of posterior vitreous detachment (PVD)-related and glaucomatous optic disc hemorrhage (DH). Fundus photographs of eyes with PVD-related DH (PVD group) and glaucomatous DH (glaucoma group) were reviewed. The shape, type, layer, location (clock-hour sector), and DH/disc area (DH/DA) ratio of DH were investigated. In the PVD group, DH presented as a flame (60.9%), splinter (34.8%), and dot or blot (4.3%) shape. However, most of the glaucomatous DH revealed a splinter shape (92.3%), followed by a flame shape (7.7%, p < 0.001). In the PVD group, the most common type of DH was cup margin type (52.2%), whereas, in the glaucoma group it was disc rim type (53.8%, p = 0.003). Both PVD-related and glaucomatous DH were most commonly observed in the 7 o'clock sector. In the PVD group, DH was also found in the 2 and 5 o'clock sectors (p = 0.010). Mean DH/DA ratio in PVD group (0.15 ± 0.19) was greater than in glaucoma group (0.04 ± 0.04, p < 0.001). PVD-related DH showed a higher frequency of flame shape, cup margin type, nasal location, and greater area compared to the glaucomatous DH., (© 2023. The Author(s).)

Purpose: To examine the incidence of complications after posterior vitreous detachment (PVD) through an extended follow-up period and to identify patient-specific factors associated with a greater incidence of complication., Design: Multicenter, retrospective observational study., Participants: Eyes with acute PVDs between 2015 and 2019 were identified through the Vestrum Health database., Methods: Complications (vitreous hemorrhage, retinal break, and retinal detachment) were evaluated after acute PVD at presentation and throughout the 6-month follow-up period., Main Outcome Measures: Rate of complications throughout the 6 month follow-up period after PVD and odds of complications by patient-specific factors., Results: A total of 9635 eyes were included. The rate of any complication was 25.0%, isolated vitreous hemorrhage was 13.1%, retinal breaks without detachment was 16.0%, and retinal detachment was 4.2%. The majority of each complication was noted at presentation; however, 8.0% of isolated vitreous hemorrhages, 19.2% of retinal breaks without detachment, and 25.8% of retinal detachments were first noted within the 6-month follow-up period. Men experienced a significantly higher rate of any complication than women (30.0% versus 21.7%, P < 0.001), as well as retinal breaks and retinal detachments at both presentation and within 6-month follow-up. Patients with pseudophakia experienced significantly higher rates of delayed retinal detachment than phakic eyes (odds ratio, 1.85 [1.13, 3.04], P = 0.01). Among eyes with lattice/peripheral retinal degeneration, 44.2% experienced any complication throughout the clinical course. The presence of a retinal break in the fellow eye and retinal detachment in the fellow eye was associated with a significantly increased rate of any complication at any time point (retinal break: P < 0.0001; retinal detachment: P = 0.02), as well as each individual complication within the 6 month follow-up period. Among eyes with vitreous hemorrhage at presentation, 42.0% had a concurrent or delayed retinal break and 10.5% had concurrent or delayed retinal detachments., Conclusions: A clinically significant proportion of PVD-related complications are detected late, warranting extended follow-up, especially in higher-risk groups such as men, pseudophakic eyes, eyes with lattice/peripheral retinal degeneration, and eyes with a history of retinal breaks or detachment in the fellow eye., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references., (Copyright © 2022. Published by Elsevier Inc.)

Vitreous hemorrhage is associated with a myriad of conditions such as proliferative diabetic retinopathy, proliferative retinopathy following vascular occlusion and vasculitis, trauma, retinal breaks, and posterior vitreous detachment without retinal break. Multiple pathological mechanisms are associated with development of vitreous hemorrhage such as disruption of abnormal vessels, normal vessels, and extension of blood from an adjacent source. The diagnosis of vitreous hemorrhage requires a thorough history taking and clinical examination including investigations such as ultra-sonography, which help decide the appropriate time for intervention. The prognosis of vitreous hemorrhage depends on the underlying cause. Treatment options include observation, laser photo-coagulation, cryotherapy, intravitreal injections of anti-vascular endothelial growth factor, and surgery. Pars plana vitrectomy remains the cornerstone of management. Complications of vitreous hemorrhage include glaucoma (ghost cell glaucoma, hemosiderotic glaucoma), proliferative vitreoretinopathy, and hemosiderosis bulbi.

Purpose: To analyze the typical presentation of acute posterior vitreous detachment (PVD), including demographics and prevalence of various treatable findings in the same and fellow eye., Methods: Retrospective analysis of medical records from 2346 patients with acute PVD. Descriptive statistics were generated on age, sex, contact date, visual acuity, and slit lamp, and fundoscopy findings. Multivariate regressions were used to generate odds ratios with 95% confidence intervals (CI) to quantify associations between variables., Results: A total of 4692 eyes from 2346 patients were analyzed. Most patients were female (60.5%) with an average age of 62.8 years old. Overall, 605 patients (25.8%) had any additional ocular finding on fundus exam, including pigmentation (N = 184, 7.8%), lattice degeneration (N = 158, 6.7%), tear (N = 131, 5.6%), and hole (N = 131, 5.2%). Unilateral retinal detachment was present in 26 patients (1.1%), and these patients demonstrated a similar rate (26.9%) of additional ocular findings compared to the entire sample size. Female sex (OR 1.21, 95% CI 1.03-1.43, p = 0.020) was independently associated with presentation during spring or summer., Conclusion: Acute PVD is associated with a number of risk factors and peripheral lesions. These findings may be useful in treating and predicting the course and development of PVD., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To evaluate the anatomic changes in the vitreous associated with evolving posterior vitreous detachment over the macula., Methods: A novel scanning method by which four A-scans at each position were averaged before the Fourier transform that boosted the image quality sufficiently such that frame averaging could occur. B-scans and volume rendered images of eyes with evidence of any partial separation of the vitreous in the macular regions were evaluated., Results: There were 43 eyes of 23 subjects with particular attention paid to the findings of seven eyes with various stages of posterior vitreous detachment occurring over the macula. In eyes from young subjects with no vitreous degeneration, the outer vitreous showed a diffuse, poorly defined increase in reflectivity in the region where the vitreous cortex was expected to be. In eyes with vitreous degeneration, there was a hyperreflective zone, called the cortical vitreous condensation, that coursed parallel to the curvature of the retina. The posterior vitreous face elevated from the retina with either a well-defined, smooth outer surface, consistent with the posterior vitreous membrane, or a poorly defined flocculent outer border. The cortical vitreous near the fovea was thin and in eyes in the process of posterior vitreous detachment had visible tears. In more advanced eyes, a circular dehiscence of the cortical vitreous in the central macula occurred with herniation of the vitreous gel through the hole., Conclusion: The methodology produced images of unprecedented clarity that highlighted several newly described details concerning the vitreous changes associated with posterior vitreous detachment over the macula.

Purpose: To determine the prevalence of anterior vitreous detachment (AVD) in routine bag-in-the-lens (BIL) cataract cases and possibly to identify risk factors for its presence., Setting: University Hospital of Antwerp, Belgium., Design: Prospective cross-sectional study., Methods: Patients having routine BIL cataract surgery were included. Patients with traumatic cataract, previous intraocular surgeries, YAG laser treatment, intravitreal injection, or medical conditions that might affect normal ophthalmologic anatomy were excluded. Several parameters were collected from the patients' records, and their surgical videos/photographs/optical coherence tomography were evaluated., Results: 99 eyes of 99 patients were included. Detectable AVD was observed in 62 eyes (63%). AVD was not present in 37 eyes (37%). The difference in prevalence of AVD between men and women was not statistically significant ( P = .55, Pearson χ 2 test). The Mann-Whitney U test for axial length was not statistically significant ( P = .38). However, it was statistically significant for age ( P < .005). A logistic regression model to ascertain the effect of age on the likelihood that patients had AVD did reach statistical significance (χ 2 (1) = 8.246, P < .005)., Conclusions: The prevalence of AVD in a routine cataract population was 63%. Age was identified as a risk factor. This study model determined that the odds for AVD increase 5.3% with each year of patient age. These data allowed for better preoperative and postoperative assessment of complications. The BIL, by its mandatory primary posterior continuous curvilinear capsulorhexis, did not increase the risk for postoperative ocular complications in the posterior segment of the eye., (Copyright © 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To evaluate the outcome of pneumatic vitreolysis (PVL) for vitreomacular traction (VMT) with or without full thickness macular hole (MH) < 400 µm., Methods: Forty-seven eyes of 47 patients were included who had undergone PVL for VMT with or without MH. Main outcome measures were release of VMT, MH closure, best-corrected visual acuity (BCVA) and adverse events., Results: Thirty-three patients had isolated VMT and 14 patients VMT with a MH. Four weeks after PVL, the overall VMT release rate was 35/47 (74.5%): 25/37 (67.6%) in phakic and 10/10 (100%) in pseudophakic eyes (p = 0.03). Four of 14 MH (28.6%) were closed. Twenty-two of 47 (46.8%) eyes required a subsequent PPV: 12/33 (36.4%) in the VMT only group and 10/14 (71.4%) in the VMT with MH group. Mean BCVA improved from 0.48 (± 0.24) to 0.34 (± 0.23) logMAR at 6 months in patients with VMT alone (p < 0.001), and from 0.57 (± 0.27) to 0.41 (± 0.28) logMAR in patients with VMT and MH (p = 0.008). Adverse events included new formation of a large MH in 4/33 (12.1%) eyes, failure of MH closure in 10/14 (71.4%) eyes, progression of mean minimum linear diameter (MLD) MH size from baseline 139 (± 67) to 396 (± 130) µm (p < 0.001) and development of a retinal detachment in 4/47 (8.5%) eyes., Conclusion: While PVL leads to a high VMT release rate particularly in pseudophakic eyes, it is associated with a relatively high incidence of MH formation, MH size progression and retinal detachment., (© 2022. The Author(s).)

Purpose: The purpose of this study was to evaluate the prognostic utility of the degree of vitreous attachment for predicting outcomes of vitrectomy for nonclearing vitreous hemorrhage associated with proliferative diabetic retinopathy., Methods: Medical records of patients who underwent primary vitrectomy for dense nonclearing vitreous hemorrhage secondary to proliferative diabetic retinopathy were examined retrospectively. Eyes were divided into four groups based on the intraoperatively assessed stage of posterior vitreous detachment (PVD), ranging from Stage 0/1 (complete or near-complete vitreoretinal adhesion) to Stage 4 (complete PVD)., Results: Overall, 136 eyes (117 patients) were included. In comparison with eyes with a partial or complete PVD (Stages 2-4), eyes with no PVD (Stage 0/1) had a higher incidence of postoperative hypotony (8%, P = 0.03) and traction retinal detachment (27%, P = 0.002), an increased rate of repeat vitrectomy (49%, P = 0.04), and poorer best-corrected visual acuity at 6 months and 1 year postoperatively (P = 0.04 and P = 0.01, respectively). Presence of a complete PVD at baseline was independently associated with improved postoperative vision at 6 months (P = 0.04)., Conclusion: More extensive vitreoretinal adhesion is associated with higher rates of reoperation and poorer visual outcomes after vitrectomy for dense nonclearing vitreous hemorrhage associated with proliferative diabetic retinopathy. Preoperative determination of PVD status using B-scan ultrasonography may be useful for predicting anatomical and functional outcomes after vitrectomy in these patients.

Purpose: The purpose of this study was to investigate the clinical characteristics of paravascular abnormalities (PVAs) and retinoschisis, and their associations with choroidal thickness (ChT) in young highly myopic (HM) adults., Methods: A total number of 645 eyes were included. Paravascular microfolds (PMs), paravascular cystoid spaces (PCs), paravascular lamellar holes (PLHs), and retinoschisis were detected using swept-source optical coherence tomography. Their associations with macular ChT and risk factors were analyzed., Results: PMs, PCs, and PLHs were detected in 203 (31.5%), 141 (21.9%), and 30 (4.7%) eyes, respectively. Retinoschisis was found in 50 (7.8%) eyes, 43 (86.0%) of which were located around the retinal vessels surrounding the optic disc. A decreasing trend of macular ChT (P < 0.001) was observed in the eyes with PMs only, with both PCs and PMs, and with PLHs, PCs, and PMs. After adjustments for age, sex, and axial length (AL), the presence of PCs, PLHs, or retinoschisis around the optic disc was negatively associated with macular ChT (all P < 0.05). Eyes with longer AL, incomplete posterior vitreous detachment (PVD), and myopic atrophic maculopathy (MAM) were more likely to have PCs (all P < 0.01) and retinoschisis around the optic disc (all P < 0.05)., Conclusions: PVAs were observed in approximately one third of the young HM adults in this study. The presence of PCs, PLHs, or retinoschisis around the optic disc was associated with thinner macular ChT. Eyes with longer AL, incomplete PVD, and MAM may be at risk of developing PVAs and retinoschisis around the optic disc., Translational Relevance: PCs, PLHs, and retinoschisis around the optic disc could serve as early indicators for myopia progression.

Purpose: To evaluate the risk factors for myopic traction maculopathy (MTM) through inter-eye comparisons of asymmetric ocular features in patients with unilateral MTM., Materials and Method: Highly myopic patients with unilateral MTM were enrolled in the study. The results of comprehensive ophthalmologic examinations, color fundus images, and optical coherence tomography (OCT) were reviewed. MTM and myopic atrophic maculopathy was evaluated according to the ATN classification system. The status of the posterior vitreous detachment (PVD), posterior precortical vitreous pocket, vitreoretinal interface abnormalities, posterior staphyloma height (PSH), and the location of the protrusion of the sclera were assessed through OCT., Results: Among the 54 eyes of 27 patients 48.89 ± 12.78 years of age, the affected eyes had worse best-corrected visual acuity, a longer axial length (AXL), greater PSH, and higher rates of posterior staphylomas, vitreovascular traction and epiretinal membranes (ERMs) than the fellow eyes ( P < .001; P < .001; P < .001; P = .010; P = .002; P < .001). Thirteen cases present obvious anisometropia with an inter-eye AXL difference of more than 1 mm. In the 14 cases without obvious anisometropia, the eyes with MTM still had longer AXL, greater PSH and a higher ERMs rate than the fellow eyes ( P = .039; P = .017; P = .001). Besides, in the 7 cases with an inter-eye AXL difference of less than 1 mm and asymmetrical stages of PVD, 5 cases with greater PVD in the affected eyes. Multiple risk factors coexisted in 96% of cases., Conclusions: In patients with unilateral MTM, a longer AXL, greater PSH, posterior staphyloma, vitreovascular traction, and ERMs were the main factors contributing to the occurrence of MTM. The process of PVD might involve in MTM development.

Purpose: To compare the incidence rate of delayed retinal break or detachment after diagnosis of acute, symptomatic posterior vitreous detachment (PVD) in a resident-run urgent care clinic (UCC) when staffed by a retina attending, non-retina ophthalmology attending, optometrist, or ophthalmology resident only., Methods: Retrospective consecutive case series. Of the 594 patients with acute, symptomatic PVD evaluated in the UCC at Penn State Eye Center between 1/1/2016 and 10/10/2019, 454 were included in the study; 140 were excluded because they were diagnosed with a retinal break or detachment on presentation to the UCC, had media opacity precluding examination, or had no follow-up within one year. Demographics, presenting examination findings, and type of staffing were recorded; subsequent visits up to 1 year were analyzed for presence of delayed retinal break or detachment., Results: Among 491 eyes of 454 patients with a mean follow-up of 147 days, ten delayed breaks (10/491, 2.0%) and three delayed detachments (3/491, 0.6%) were discovered. Incidence rates of delayed breaks and detachments were 1.8% (5/282) and 0.7% (2/282), respectively, in the retina attending group, 1.0% (1/105) and 1.0% (1/105) in the non-retina ophthalmology attending group, 4.7% (3/64) and 0% (0/64) in the optometrist group, and 2.5% (1/40) and 0% (0/40) in the ophthalmology resident only group. There was no statistically significant difference in the incidence of delayed break or detachment among the staffing groups (P = 0.7312), but this study was underpowered to detect a statistically significant difference among staffing groups. Patients with a delayed break or detachment were more likely to have lattice degeneration (P = 0.0265) or a history of retinal break in the contralateral eye (P = 0.0014), and most eyes (10 [76.9%]) with a delayed break or detachment were left eyes (P = 0.0466)., Conclusions: The overall rate of delayed retinal break or detachment in the current study is similar to previously published rates among retinal physician and retinal fellow examiners. Although no statistically significant difference among staffing groups in the incidence rates of delayed retinal tears or detachments was identified in the study, it is important to note that the optometry and ophthalmology resident only groups had higher incidence rates of delayed retinal breaks than did the retina and non-retina ophthalmology attending groups, and this may be clinically important. Larger cohort studies would be needed in order to have the power to detect statistically significant differences among staffing groups. Varied staffing for acute, symptomatic PVD may assist with resource allocation in similar settings., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: To evaluate vitreoretinal interface abnormalities in patients with pseudoexfoliation (PEX) syndrome., Methods: This case-control study was performed in 136 patients diagnosed with unilateral PEX (PEX group) and 139 age- and sex-matched healthy volunteers (Control group). Both the affected and contralateral eyes were evaluated in the PEX group and the right eye was evaluated in the Control group. Vitreoretinal interface abnormalities and posterior vitreous detachment (PVD) were evaluated on optical coherence tomography (OCT) examination., Results: The incidences of incomplete and complete PVD were significantly higher in the affected than contralateral eye in the PEX group and in the right eye in the Control group (P = 0.009, P = 0.012 and P = 0.004, P = 0.017, respectively). The rates of 'no PVD' were significantly higher in the contralateral eye in the PEX group and the Control group compared to the affected eye in the PEX group (P = 0.003 and P = 0.001, respectively). The odds ratio for incomplete PVD was 3.1 in PEX eyes compared to the contralateral eye in the PEX group and 3.9 compared to the Control group. The rate of epiretinal membranes (ERMs) in the affected eye was significantly different from the contralateral eye in the PEX and Control groups (P < 0.001 and P < 0.001, respectively). The odds ratio for ERM in PEX eyes was 3.51 compared to the contralateral eye in the PEX group and 4.23 compared to the Control group. In the presence of incomplete PVD, the odds ratio for ERM development was 3.81 in PEX eyes., Conclusions: We detected high rates of ERMs and incomplete PVD in patients with PEX. It is important to evaluate and follow up PEX cases in terms of vitreoretinal interface abnormalities., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To evaluate the risk factors for retinal tear (RT) or rhegmatogenous retinal detachment (RRD) associated with acute, symptomatic posterior vitreous detachment (PVD) in a large comprehensive eye care setting., Design: Retrospective cohort study., Participants: A total of 8305 adult patients in the Kaiser Permanente Northern California Healthcare System (KPNC) during calendar year 2018 who met inclusion criteria., Methods: The KPNC electronic medical record was queried to capture acute, symptomatic PVD events. Each chart was reviewed to confirm diagnoses and capture specific data elements from the patient history and ophthalmic examination., Main Outcome Measures: Presence of RT or RRD at initial presentation or within 1 year thereafter., Results: Of 8305 patients who presented with acute PVD symptoms, 448 (5.4%) were diagnosed with RT and 335 (4.0%) were diagnosed with RRD. When considering variables available before examination, blurred vision (odds ratio [OR], 2.7; confidence interval [CI], 2.2-3.3), male sex (OR, 2.1; CI, 1.8-2.5), age < 60 years (OR, 1.8; CI, 1.5-2.1), prior keratorefractive surgery (OR, 1.6; CI, 1.3-2.0), and prior cataract surgery (OR, 1.4; CI, 1.2-1.8) were associated with higher risk of RT or RRD, whereas symptoms of flashes were mildly protective (OR, 0.8; CI, 0.7-0.9). Examination variables associated with a high risk of RT or RRD included vitreous pigment (OR, 57.0; CI, 39.7-81.7), vitreous hemorrhage (OR, 5.9; CI, 4.6-7.5), lattice degeneration (OR, 6.0; CI, 4.7-7.7), and visual acuity worse than 20/40 (OR, 3.0; CI, 2.5-3.7). Late RTs or RRDs occurred in 12.4% of patients who had vitreous hemorrhage, lattice degeneration, or a history of RT or RRD in the fellow eye at initial presentation but only 0.7% of patients without any of these 3 risk factors. Refractive error had an approximately linear relationship with age at presentation of PVD, with myopic patients presenting at a younger age (r = 0.4)., Conclusions: This study, based in a comprehensive eye care setting, found the rate of RT and RRD associated with acute PVD to be lower than rates previously reported by retina subspecialty practices. Several patient features strongly predicted the presence of initial and late complications of acute PVD., (Copyright © 2021 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine whether the RETeval electroretinography (ERG) system can be used to evaluate eyes with dense vitreous hemorrhage (VH)., Methods: This retrospective case series study included 69 eyes of 69 patients with acute dense VH. Flicker ERGs were recorded by the RETeval system, an ERG device with adhesive skin electrodes. We evaluated the flicker ERG amplitudes in eyes with VH and the ratio of the VH eye amplitudes compared with the fellow eye amplitudes for each VH cause., Results: In patients with rhegmatogenous retinal detachment, the amplitude ratios were extremely low (0.08 ± 0.03). To detect rhegmatogenous retinal detachment, the area under the receiver operating characteristic curve was 0.977 (95% confidence interval, 0.943-1.000) (best rhegmatogenous retinal detachment cutoff value, 0.14; sensitivity, 100.0%; and specificity, 95.4%). The flicker ERG amplitude was not significantly correlated with the initial visual acuity (ρ = -0.189, P = 0.120) but was positively correlated with the postoperative visual acuity in eyes with VH (ρ = -0.328, P = 0.006)., Conclusion: The RETeval ERG system was found to be a useful diagnostic option in situations where dense VH precluded fundus examination or posterior vitreous detachment was indistinguishable from rhegmatogenous retinal detachment.

Introduction: The aim of this study was to determine symptom-level risk factors for retinal tear/retinal detachment (RT/RD) in our patients presenting with symptoms of posterior vitreous detachment (PVD)., Methods: We conducted a prospective cohort study of patients presenting to outpatient ophthalmology clinics at a single academic institution with complaint(s) of flashes, floaters, and/or subjective field loss (SFL). Patients received a standardized questionnaire regarding past ocular history and symptom characteristics including number, duration, and timing of flashes and floaters, prior to dilated ocular examination. Final diagnosis was categorized as RT/RD, PVD, ocular migraine, vitreous syneresis, or "other." Simple and multivariate logistic regressions were used to identify symptoms predictive of various pathologies., Results: We recruited 237 patients (age 20-93 years) from March 2018 to March 2019. The most common diagnosis was PVD (141, 59.5%), followed by vitreous syneresis (38, 16.0%) and RT/RD (34, 14.3%). Of those with RT/RD, 16 (47.1%) had retinal tear and 15 (44.1%) had RD. Significant differences in demographic and examination-based factors were observed between these groups. Symptom-based predictive factors for RT/RD were the presence of subjective visual reduction (SVR; OR 2.77, p = 0.03) or SFL (OR 2.47, p = 0.04), and the absence of either floaters (OR 4.26, p = 0.04) or flashes (OR 2.95, p = 0.009). The number, duration, and timing of flashes and floaters did not predict the presence of RT/RD in our cohort. Within the RT/RD group, patients with RT were more likely to report floaters (100% vs. 66.7%, p = 0.018) and less likely to report SFL (0% vs. 86.7%, p < 0.001) compared to those with RD., Conclusion: While well-known demographic and exam-based risk factors for RT/RD exist in patients with PVD symptoms, the relative importance of symptom characteristics is less clear. We found that the presence of SVR and SFL, as well as the absence of either flashes or floaters, predicts RT/RD in patients with PVD symptoms. However, the number, duration, and timing of flashes and floaters may be less relevant in the triage of these patients., (© 2022 S. Karger AG, Basel.)

The primary objective was to create and establish a new formula that predicts the individual probability of macular hole closure for eyes with full thickness macular holes (FTMH) accompanied by vitreomacular traction (VMT) which received enzymatic vitreolysis using intravitreally administered ocriplasmin. The secondary objective was to evaluate the forecast reliability of a previously published formula for VMT resolution in VMT-only eyes (Odds IVO-Success  = e Intercept  × OR years  × OR ln(µm) ; Probability IVO-Success  = Odds IVO-Success /(Odds IVO-Success  + 1)) on VMT resolution using the current dataset of eyes with FTMH accompanied by VMT. Retrospective analysis of the OASIS, ORBIT, and INJECT-studies. Patients with FTMH and VMT with complete information (n = 213) were included. The effect of gender, age, FTMH diameter, lens status and the presence of epiretinal membranes (ERM) on FTMH closure was assessed using separate univariate logistic regression analyses. With regard to VMT release separate univariate regression analyses were carried out and results were compared with formerly published data of VMT resolution in eyes with VMT only. Overall, 126 eyes (63%) experienced VMT resolution within 28 days. Younger age (p < 0.0001) and VMT diameter (p = 0.041) had a significant impact on VMT release. Overall, 81 eyes (38%) treated with ocriplasmin showed FTMH closure within 28 days. Univariate analysis of the different predictors analyzed revealed that FTMH diameter < 250 µm had a significant impact on treatment success (p = 0.0495). It was not possible to calculate and establish a new multivariate formula that can predict the individual FTMH closure probability for eyes with FTMHs and VMT. However, the results of VMT release prediction in eyes with FTMHs accompanied by VMT matched the prediction of VMT release in eyes with VMT only when using the previously published formula. All in all, predictors for calculating the individual probability of VMT resolution on the one hand and FTMH closure on the other hand are different suggesting diverse pathophysiological mechanisms., (© 2021. The Author(s).)

Purpose: To compare posterior vitreous detachment (PVD) identification rate between clinical examination versus spectral domain optical coherence tomography in patients with retinal detachment (RD)., Methods: Data from the Primary Retinal Detachment Outcomes Study were used for this retrospective cross-sectional study of 506 patients. Spectral domain optical coherence tomography scans were reviewed to detect the separation of the posterior hyaloid face from the retina and the optic nerve on all 31 raster cuts of a 30 × 30 scan. Statistical analysis was performed to compare spectral domain optical coherence tomography-identified PVD with PVD identified on slit-lamp biomicroscopy., Results: There was a significant difference in the rate of PVD identification by clinical examination versus spectral domain optical coherence tomography in patients with RD. Clinical examination identified 51.58% of patients with PVD, whereas spectral domain optical coherence tomography identified 78.42% of patients with PVD. In patients with macula-on RD, 61.68% were found to have PVD on clinical examination versus 83.90% by imaging. Spectral domain optical coherence tomography identified larger number of PVD in patients with macula-off RD compared with clinical examination, 46.28% versus 75.43%, respectively. There was low agreement between the two methods (kappa score = 0.137). There was a significant difference in surgical procedure type chosen in those with versus without PVD., Conclusion: Knowledge about the posterior hyaloid anatomy is important before undergoing RD repair. Spectral domain optical coherence tomography can better identify PVD than clinical examination in patients with RD.

Acute onset of floaters is most likely caused by a posterior vitreous detachment (PVD). A PVD can lead to a retinal tear and subsequently to a retinal detachment with permanent vision loss if left untreated. A patient who presents to a primary care physician with acute onset of floaters, in the absence flashes or visual field loss, is often referred to an ophthalmologist without urgency. In the current Dutch general practitioners standard, acute onset or increase of floaters, without flashes or visual loss, is not included as a reason for urgent referral to an ophthalmologist. Patients who present with acute onset of floaters without flashes have a 14-23% risk of having a retinal tear. Risk factors for developing a retinal tear are high myopia, trauma, cataract surgery, or a retinal tear or retinal detachment in the past medical or family history. Patients with acute onset of floaters should be triaged for urgent ophthalmologic assessment.

The purpose of this study was to determine the relationship between a posterior vitreous detachment (PVD) and retinoschisis (RS) in 73 highly myopic (HM) young patients age 16.4 ± 6.9 years and 24 non-HM children age 8.4 ± 1.5 years. The presence of the paravascular retinal abnormalities was determined in the images obtained by a ultra-widefield OCT (UWF OCT) instrument with an image field of 23 × 20 mm. The results showed that a partial PVD was detected in 15 (21%) of the HM patients, and the number increased significantly with increasing age (P = 0.02). PVDs of any type were not found in the non-HM eyes. The number of microvascular folds also increased with age in the HM patients (P = 0.03). Medium-reflective columnar tissues were present between the detached vitreous and inner retinal surface in 4 (5%) eyes of the HM patients. Myopic RS was found in 3 (4%) HM patients in the paravascular area but not in the macular area. These results suggest that early partial PVD may play a role in pathological and proliferative vitreous changes of HM eyes. An intense vitreoretinal traction with bridging tissues may cause the various paravascular retinal abnormalities. In HM eyes, paravascular RS is already present at an early age which may progress to macular RS with aging., (© 2021. The Author(s).)

Competing Interests: Competing interests: None declared.

Background and Objective: Posterior vitreous detachment (PVD) is a separation of the posterior hyaloid from the retina that manifests as photopsias and floaters. Optical coherence tomography (OCT) has demonstrated posterior vitreous opacities (PVOs) that may correlate with Shaffer's sign, which may correlate with retinal breaks., Patients and Methods: Patients with symptomatic PVDs were retrospectively reviewed at a single institution by a single provider. Masked qualitative review of SD-OCTs by a single reviewer determined presence of PVOs., Results: Among 78 patients, PVOs were found in 32 of the patients (41%), and 19 (59%) had retinal breaks. In those without PVOs, six (13%) had a break. Sensitivity and specificity were 76.0% and 75.5%, respectively. Removing patients with vitreous hemorrhages, sensitivity, and specificity of PVOs was 82.4% and 86.4%, respectively., Conclusion: In symptomatic PVDs, PVOs on OCT correlated with the presence of a retinal break, especially in the absence of a vitreous hemorrhage. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:628-632.]., (Copyright 2020, SLACK Incorporated.)

Purpose: To report the causes, clinical features and surgical outcomes of retinal detachment (RD) in young adults., Methods: Retrospective study of 111 eyes of 99 patients aged between 18 and 40 years, who underwent primary RD surgery between January 2011 and January 2019. All patients underwent either scleral buckling or pars plana vitrectomy. We analyzed the demographic data, characteristics of the RD, primary and final anatomic success rate and best-corrected visual acuity (BCVA) at the conclusion of follow-up., Results: The mean age of the patients was 30.3±6.5 years. RD was more frequent in males, with a gender ratio of 1.8. The breaks were atrophic round holes or retinal dialysis in 49 (44.2%) cases and were associated with posterior vitreous detachment in 62 (55.8%) cases. The main etiologies were high myopia (45.0%) and trauma (9.0%). Retinal reattachment was achieved in 74 (66.5%) eyes overall with a single procedure and in 108 (97.2%) eyes with two or more procedures. The primary success rates were 69.6% (46/66 eyes) with scleral buckling and 62.2% (28/45 eyes) with vitrectomy. High myopia was a risk factor for surgical failure (P<0.01). The mean BCVA improved from 0.71±0.64 logMAR to 0.41±0.35 logMAR (P<0.01) CONCLUSION: RD in young adults differs from that in older adults in clinical features and etiology. The main causes are trauma and high myopia. The anatomic outcomes appear less favorable, with a primary reattachment rate of 66.5%. However, the functional prognosis remains satisfactory with an improvement of 3 lines of visual acuity., (Copyright © 2020. Published by Elsevier Masson SAS.)

Purpose: To determine the incidence and timing of delayed retinal breaks and retinal detachments (RDs) after acute posterior vitreous detachment (PVD) and associated risk factors., Design: Retrospective case-control study., Participants: Acute PVD eyes treated between October 2015 and August 2018 at a single academic retina practice., Methods: Eyes with a PVD diagnosis and history of extended ophthalmoscopic examination on presentation were identified using diagnostic billing codes. The number of eyes with a history of laser retinopexy, cryotherapy for retinal tear, or RD repair was determined using procedural billing codes, and the duration between initial and treatment visits was measured. Records of eyes with a delayed retinal break or RD and of a reference group comprising the first 100 presenting eyes with no initial or delayed retinal break or RD were reviewed to determine and compare the presence of select risk factors on initial examination., Main Outcome Measures: Development of a delayed retinal break or RD., Results: Of 7999 eyes with acute PVD, 1280 (16.0%) showed a retinal break and 499 (6.2%) showed an RD on presentation. Delayed retinal breaks and RDs were found in 209 (2.6%) and 80 (1.0%) eyes, respectively. Of delayed breaks, 116 (55.5%) were found in 6 weeks or less and 93 (44.5%) were found more than 6 weeks after presentation. Of delayed RDs, 26 (32.5%) were found in 6 weeks or less and 54 (67.5%) were found more than 6 weeks after presentation. Compared with the reference group, vitreous hemorrhage (hazard ratio, 2.53 [P < 0.001] and 2.80 [P = 0.001]) and male gender (hazard ratio, 1.36 [P = 0.03] and 1.87 [P = 0.02]) were risk factors for delayed retinal breaks and RDs, respectively. Pseudophakia (hazard ratio, 2.10; P = 0.004) was also a risk factor for delayed RD; older age (odds ratio, 0.96; P = 0.01) was slightly protective. Vitreous hemorrhage was a risk factor for earlier retinal breaks (≤6 weeks vs. >6 weeks; odds ratio, 3.58; P < 0.001)., Conclusions: Clinically significant rates of newly detected retinal breaks and RDs may occur after acute PVD, suggesting that repeat examination may be prudent in these patients., (Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Competing Interests: None

Purpose: To confirm the presence of incomplete vitreolenticular adhesion via microscope-integrated intraoperative optical coherence tomography (iOCT) during cataract surgery and via diagnostic spectral-domain OCT (SD-OCT) postoperatively., Setting: S. Fyodorov Eye Microsurgery Complex State Institution, Moscow, Russia., Design: Prospective noninterventional single-center study., Methods: Clinical characteristics and surgical videos of 27 patients (28 eyes) who had cataract surgery were documented. Real-time iOCT integrated into the surgical microscope was directed to view the retrolenticular anatomy at the end of the surgery. Postoperatively, SD-OCT was also performed., Results: This study comprised 28 eyes of 27 patients. Berger space was identified in 21 cases (75%) intraoperatively via iOCT and in 23 cases (82%) postoperatively via stationary OCT. Depth dimensions varied from 33.5 ± 87.0 μm to 383.1 ± 226.3 μm. Hyperreflective dots and particles of different shapes and sizes were documented within Berger space in 16 cases (57%) intraoperatively and in 9 cases (32%) postoperatively. Capsular rupture occurred in 1 case due to excessive posterior capsular movement anteriorly. The posterior capsular rupture was converted into a posterior capsulorhexis, leaving the anterior hyaloid membrane intact., Conclusions: iOCT confirmed the penetration of crystalline lens microfragments, cellular material, or medical suspension (triamcinolone) into the space between the posterior lens capsule and the anterior hyaloid membrane. This occurs due to discontinuity of both lenticular zonules and Wieger ligament attachment. A Wieger ligament rupture can also allow excessive Berger space hydration during phacoemulsification leading to anterior displacement of the posterior lens capsule increasing the risk of instrument touch and posterior capsule rupture.

Purpose: To compare outcomes in dense vitreous hemorrhage versus mild vitreous hemorrhage due to nontraumatic posterior vitreous detachment., Methods: We compared 315 eyes, divided into 2 patient groups, one with dense and the other with mild vitreous hemorrhage. The main outcome measures were final mean best-corrected visual acuity, number of retinal tears, number of retinal detachments, and the number of pars plana vitrectomy and/or scleral buckle surgeries., Results: In 33.4% of the patients, posterior vitreous detachment without complications was found. Retinal breaks after posterior vitreous detachment were found in 59% of the eyes. Rhegmatogenous retinal detachment was principally treated with pars plana vitrectomy and scleral buckle. In nonvisible fundus hemorrhage group, 44.4% of the patients underwent vitrectomy. In visible fundus hemorrhage group, 9.52% of the patients underwent pars plana vitrectomy. The mean final visual acuity was 20/25, without significant difference between groups (P = 0.064)., Conclusion: Acute, spontaneous, nontraumatic posterior vitreous separation with vitreous hemorrhage is associated with a high incidence of retinal complications. Close follow-up is necessary. We did not find significant differences in final visual acuity neither between the two groups nor among the treatments.

Purpose: To describe the occurrence of epiretinal membrane (ERM) in eyes with vitreomacular traction and to correlate the presence of ERM with retinal structural alterations detected using spectral domain optical coherence tomography., Methods: In this retrospective observational cross-sectional study, we collected data from 502 eyes (307 patients) with diagnosis of vitreomacular traction. The presence of ERM and retinal lesions (cystoid cavities, neuroepithelial detachment, external limiting membrane, and ellipsoid zone discontinuity) was determined by standardized grading of macular spectral domain optical coherence tomography scans., Results: The occurrence of ERM in eyes with vitreomacular traction was 37.5%. The mean ± SD central foveal thickness was 411 ± 60 µm in eyes with ERM and 380 ± 148 µm in eyes without ERM (P < 0.05). The occurrence of cystoid cavities (38.3% vs. 23.2%, P < 0.05), neuroepithelial detachment (24.5% vs. 9.9%, P < 0.0001), external limiting membrane discontinuity (16.5% vs. 5.1%, P < 0.0001), and ellipsoid zone discontinuity (13.3% vs. 6.7%, P < 0.05) was higher in eyes with ERM. The mean ± SD best-corrected visual acuity was 0.45 ± 0.16 logarithm of the minimum angle of resolution (Snellen equivalent of approximately 20/50) in eyes with ERM and 0.37 ± 0.09 in eyes without ERM (Snellen equivalent of approximately 20/40, P < 0.0001). Symptoms of metamorphopsia were present in 55 of 188 eyes with ERM (29.3%) and 40 of 314 eyes without ERM (12.7%, P < 0.0001)., Conclusion: This study reported the occurrence of ERM in eyes with vitreomacular traction and demonstrated that ERM is significantly associated with an increased occurrence of other structural changes of the neuroretina and a negative effect on quantity and quality of vision.

Flashes and floaters are the hallmark symptoms of a posterior vitreous detachment (PVD) which itself is related to an increased risk of the development of retinal tears, retinal detachment and vitreous haemorrhage. The aim of this study is to assess the associations between different symptoms related to PVD and the risk of developing retinal tears. A systematic review of articles written in English, using MEDLINE, Embase (via Embase.com) and the Cochrane Controlled Trials Register (1996-2017) was conducted. Search terms included five elements: PVD, retinal tears, retinal detachment, floaters and flashes. Independent extraction of articles was conducted by two authors using predefined data fields, including study quality indicators. Thirteen studies fulfilled the selection criteria. Analysis of pooled data revealed that presence of isolated flashes was associated with the development of retinal tears in 5.3% of symptomatic eyes [mean 2.9 eyes; 95% CI (2.1, 5.7)].Conversely, floaters alone had a stronger association with retinal tears (16.5% of eyes), as compared to flashes. The association to retinal tears was even greater for those patients reporting both flashes and floaters [mean 17.8 eyes (20.0%); 95% CI (17.4, 18.1)]. Retinal and/or vitreous haemorrhage was also associated with the presence and later development of retinal tears [mean 12.5 eyes (30.0%); 95% CI (11.7, 13.9)]. Patients with more than 10 floaters or a cloud in their vision had a high risk of developing retinal tears (OR19.8, p-value 0.032). In the setting of a PVD, the onset of flashes and floaters, and the presence of retinal and/or vitreous haemorrhage are risk factors for the development of retinal tears. The association is greater when both symptoms are present, and even greater when the patient reports more than 10 floaters, a curtain or a cloud and/or there is a positive finding of a vitreous or retinal haemorrhage. This study supports the necessity of an immediate examination of patients presenting with symptoms related to a PVD, and a follow-up examination might be prudent in a subgroup of these patients., (© 2019 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Objectives: To report the prevalence and severity of metamorphopsia, estimate its impact on vision-related quality of life (VRQoL) and evaluate predictors of VRQoL in patients with vitreomacular traction (VMT)., Patients and Methods: A prospective, cross-sectional multi-centre study in the United Kingdom of 185 patients with VMT, with or without a full thickness macular hole (FTMH). Self-reported metamorphopsia was determined using the metamorphopsia questionnaire. VRQoL was assessed using the Visual Function Questionnaire (VFQ-25). Physicians recorded clinical and ocular characteristics in both eyes including a physician assessment of metamorphopsia. ANOVA and predicted least-squares means were used to estimate the impact of metamorphopsia on VRQoL. Predictors of VRQoL were assessed using ordinary-least-squares regression adjusting for clinically important variables., Results: The prevalence of self-reported metamorphopsia was 69.7% (95% CI 62.6-76.3%) and was higher in eyes with a concomitant FTMH vs. without FTMH (85.4% vs. 64.2%). Physician assessment of metamorphopsia was 53.0% (95% CI: 45.5-60.3%). Comparing eyes with metamorphopsia vs. without metamorphopsia, the VFQ-25 composite score was lower (82.3 vs. 91.4), and mean VA (LogMAR) was worse (0.44 vs. 0.33). The largest difference in VFQ-25 scores was observed for near activities (metamorphopsia: 75.3, No metamorphopsia: 90.2). The adjusted model showed that metamorphopsia severity and age were significantly associated with lower VFQ-25 scores., Conclusion: Metamorphopsia was highly prevalent in patients with VMT and associated with significantly lower VRQoL. Physician assessment of symptoms underestimated the self-reported presence of metamorphopsia. Metamorphopsia severity acts as a predictor of impaired VRQoL, over and above decrements due to reduced vision.

Purpose: To evaluate the effects of ocriplasmin and symptomatic vitreomacular adhesion resolution on visual fixation and macular sensitivity using microperimetry., Methods: MP-1 parameters were analyzed from 3 OASIS sites after the use of standardized instruments and testing procedures over 24 months., Results: A total of 27 patients (19 ocriplasmin, 8 sham) were evaluated. Mean distance of the preferred fixation locus to the anatomical center was farther in the sham group at baseline and farther in the sham versus ocriplasmin group throughout the study. Retinal sensitivity values were consistently higher in the ocriplasmin versus sham group after Month 3. Fewer patients in the ocriplasmin group had predominantly eccentric fixation at study end compared with the sham group, which also had an increased number of patients with unstable fixation. Patients with vitreomacular adhesion resolution had lower bivariate contour area, fewer relative scotomas, and higher retinal sensitivity parameters at baseline than those with unresolved vitreomacular adhesion., Conclusion: Substudy results suggest that fixation and sensitivity parameters tended to be better in the ocriplasmin group than in the sham group over time. The substudy identified parameters that were distinct between patients with and without vitreomacular adhesion resolution, suggesting that microperimetry warrants further study as a relevant biomarker for visual function.