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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

• Retinal tear: Laser retinopexy
• Very peripheral retinal tears: consider cryoretinopexy
• Retinal detachment: Surgery

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’s Clinical Ophthalmology: A Systematic Approach; John E Salmon MD; Elsevier; 9th Edition (2019)