Posterior Vitreous Detachment (PVD)

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Definition

  • Detachment of the vitreous body from the membrana limitans interna
  • Patients usually 50-70 years old, earlier with high myopia
  • Retinal tears in about 10-15% of acute symptomatic PVDs, vitreous haemorrhage in about 7.5%.

Symptoms

  • photopsias (flashes), floaters (flies, spiderwebs)
  • Blurred vision/haze, reduced visual acuity (in case of vitreous haemorrhage)

Findings

  • Tobacco dust? (pigmented cells in the anterior vitreous), vitreous haemorrhage?
    • higher risk for retinal tear
  • Fundus examination (with 3-mirror contact glass): Retinal tear or detachment?
  • if complete retinal examination is not possible (vitreous haemorrhage): Ultrasound examination to rule out retinal detachment

Management

Follow up

  • Not evidence-based
  • In case of acute symptoms: Follow up after 7-10 days, 1 month, 3 months
    • further examinations depending on symptoms/findings, generally as long as photopsias are present
  • After laser retinopexy: Follow up after 7-14 days to evaluate if laser treatment is sufficient, consider earlier follow-up if laser treatment was difficult
  • Vitreous haemorrhage (retinal examination not possible): weekly follow ups with ultrasound examination
  • Educate patients about symptoms of retinal detachment (flashes, floaters, curtain-like shadow, reduction in visual acuity)

Sources

  • EyeWiki Posterior Vitreous Detachment
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Kalla Gervasio MD, Travis Peck MD et al; Lippincott Williams&Wilkins; 8th Edition (2021)
  • Kanski‚Äôs Clinical Ophthalmology: A Systematic Approach; John E Salmon MD; Elsevier; 9th Edition (2019)