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Myopia is risk factor for multiple tears during evolution of PVD
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Multiple retinal tears occurring during the evolution of posterior vitreous detachment are more frequently observed in myopic patients, are symptomatic and are correlated with increased rate of retinal detachment, according to a study.
Previous retinal tear or retinal detachment in the fellow eye was also shown to be a predisposing factor.
Retinal tears might occur at different times during the evolution of incomplete posterior vitreous detachment (PVD). In a retrospective series of 176 eyes of 158 patients, the predisposing risk factors for their occurrence were evaluated. Patients were divided into two groups: Group 1 included eyes where retinal tears appeared only at the initial examination, and group 2 included eyes where further retinal tears were observed during the follow up. This second group represented 12.5% of the entire cohort. Reported symptoms were floaters, floaters with flashes, flashes alone and loss of visual acuity.
A clear and significant correlation was found with myopia, which was present in in 86.4% of the patients in group 2. A history of retinal tear or retinal detachment in the fellow eye was found in 31.8% of the patients in this group as compared with 17.2% of the patients in group 1. After initial laser treatment, retinal detachment or vitreous hemorrhage occurred in 36.4% of the patients in this group as compared with 9.7% in group 1.
Retinal tears are commonly occurring within 2 to 6 weeks following the initial symptoms of PVD. In this study, 81.8% of subsequent retinal tears occurred within 4 months following the first diagnosed retinal tear; 90.9% occurred within 1 year and only two cases occurred later.
“PVD needs a close follow-up for at least 4 months after initial symptoms and/or diagnosis, especially in myopic patients and in those with a history of retinal detachment or retinal tear in the fellow eye,” the authors concluded. – by Michela Cimberle
Disclosure: The authors reported no relevant financial disclosures.
Perspective
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Brad Sutton, OD, FAAO
This retrospective review of retinal tears induced by PVD provides a number of very valuable clinical insights. The authors evaluated several eyes that experienced either an initial retinal tear or tears after a PVD, or an initial tear or tears accompanied by a subsequent tear or tears. There were 154 eyes in the former group and 22 eyes in the latter, indicating that 12.5% of eyes with tears developed subsequent tears. It was determined that myopic eyes, defined as having a cycloplegic refraction over -0.50 D and an axial length over 24 mm, had a much greater chance of developing subsequent tears.
In the subsequent tear group, 86.4% of eyes were myopic. This represented a 4.5-fold risk for subsequent retinal tears compared to nonmyopic eyes. It was also more common to develop subsequent tears when there was a history of previous retinal tear or detachment in the fellow eye. When subsequent tears did develop, they did so within 60 days 72.7% of the time and within 120 days 81.8% of the time. Over 90% of the subsequent tears occurred within 1 year.
So, how does this information help guide our clinical management of PVD? When a post-PVD eye presents with a tear, we are clearly not “out of the woods” after the initial management. Treatment of the initial tear or tears does not complete the process. These eyes need to be followed closely for at least 4 months, especially when they are myopic and/or when there is a history of retinal break or tear in the fellow eye.
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