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PVD patients seeking care on first day of symptoms have higher rate of retinal tears
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Patients with posterior vitreous detachment who seek care on the first day of their symptoms have a statistically significant higher risk for retinal tears.
Researchers retrospectively analyzed medical records of 365 patients with posterior vitreous detachment (PVD) symptoms at the Department of Ophthalmology at Sahlgrenska University Hospital, Sweden. Patients with retinal tears or vitreous hemorrhage were also included to analyze possible predictors for PVD complications, resulting in 426 patients in the study.
In patients with symptoms of PVD, 14.5% had retinal tears and 22.7% had vitreous and/or retinal hemorrhages. When PVD patients with retinal tears were compared with those without retinal tears, age, symptomatology and laterality did not have a significant impact regarding floaters and flashers.
Symptoms of visual impairment (P = .024), the presence of vitreous or retinal hemorrhage at examination (P < .001) and duration of symptoms for less than 24 hours (P = .004) were significant predictors of retinal tears.
“Special regard and prompt attention to patients who present with visual impairment and seek care within 24 hours of symptom onset should be given, whereas patients with only floaters and long duration of symptoms may be regarded as low-risk patients of retinal tears,” the researchers wrote. – by Robert Linnehan
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Veeral Sheth, MD
The authors conclude in their analysis that patients presenting with posterior vitreous detachment acutely have a higher risk for retinal tear. In addition, symptoms such as subjective visual loss or clinical findings such as vitreous hemorrhage portend higher risk for retinal complications.
These findings along with previous study results help us fine-tune triage algorithms and how we counsel our patients and staff. When patients sought care with a symptom duration of less than 24 hours, they had a significantly higher risk (P = .004) of having a retinal tear. Over the course of 4.5 years of follow-up the authors found that patients who presented with retinal tear and were treated with barricade laser still progressed to retinal detachment 5.8% of the time. We can use statistics like this to set expectations for our patients as well as to help our staff understand why timely evaluation of these patients is critical.
With retrospective analyses we should always acknowledge hindsight biases and some of the limitations associated with these type of reviews. This study used diagnosis codes to define disease. Future prospective studies, especially in today’s setting of improved diagnostic imaging modalities to confirm vitreoretinal interface changes, may be warranted.
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