Time course of development of posterior vitreous detachment in the fellow eye after development in the first eye

Fellow-Eye Retinal Detachment Risk as Stratified by Hyaloid Status on OCT

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.

Vitreous and Vision Degrading Myodesopsia

Macromolecules comprise only 2% of vitreous, yet are responsible for its gel state, transparency, and physiologic function(s) within the eye. Myopia and aging alter collagen and hyaluronan association causing concurrent gel liquefaction and fibrous degeneration. The resulting vitreous opacities and collapse of the vitreous body during posterior vitreous detachment are the most common causes for the visual phenomenon of vitreous floaters. Previously considered innocuous, the vitreous opacities that cause floaters sometimes impact vision by profoundly degrading contrast sensitivity function and impairing quality-of-life. While many people adapt to vitreous floaters, clinically significant cases can be diagnosed with Vision Degrading Myodesopsia based upon echographic assessment of vitreous structure and by measuring contrast sensitivity function. Perhaps due to the ubiquity of floaters, the medical profession has to date largely ignored the plight of those with Vision Degrading Myodesopsia. Improved diagnostics will enable better disease staging and more accurate identification of severe cases that merit therapy. YAG laser treatments may occasionally be slightly effective, but vitrectomy is currently the definitive cure. Future developments will usher in more informative diagnostic approaches as well as safer and more effective therapeutic strategies. Improved laser treatments, new pharmacotherapies, and possibly non-invasive optical corrections are exciting new approaches to pursue. Ultimately, enhanced understanding of the underlying pathogenesis of Vision Degrading Myodesopsia should result in prevention, the ultimate goal of modern Medicine.

Vitreoretinal surgery on the fellow eye: A retrospective analysis of 18 years of surgical data from a tertiary center in England

Purpose:

To determine the long-term incidence of fellow-eye surgical involvement in patients who have undergone first-eye vitreoretinal (VR) surgery for a variety of indications. This was a single-institution retrospective, consecutive series.

Methods:

Eighteen years of electronic surgical data were reviewed at our institution. All patients having surgery for the following indications were included: rhegmatogenous retinal detachment (RRD), macular hole (MH), epiretinal membrane (ERM), proliferative diabetic retinopathy (PDR), vitritis, and dropped nucleus. Primary outcome was the cumulative incidence of fellow-eye surgery at 10 years by Kaplan–Meier analysis.

Results:

Total follow-up was 29,629 patient-years. Cumulative incidence (± standard error) of fellow-eye surgery at 10 years was 7.2% ± 0.6% for RRD, 9.1% ± 1.3% for ERM, 7.5% ± 1.8% for MH, 30.6% ± 1.9% for PDR, 13.7% ± 2.9% for vitritis, and 2.8% ± 1.6% for dropped nuclei. The hazard for second-eye surgery was greatest in the early postoperative period after first-eye surgery for all indications. For RRD, the hazard was 2.7% ± 0.3% at year 1, 1.1% ± 0.2% at year 2, and 0.5% ± 0.2% at year 5. Risk factors for fellow-eye involvement for RRD were younger age (P < 0.001) and male gender (P < 0.01).

Conclusion:

We report the long-term risk of fellow-eye involvement in various VR pathologies, which is important in counseling patients regarding their risks as well as planning service provision.

Flashes and Floaters

Flashes and floaters are common ocular complaints. Flashes refer to aberrations of light that are seen in a patient's field of gaze. The flashes can be of varying sizes, colors, frequency, and durations, depending on the cause. Floaters are another common visual phenomenon caused by particles or debris in the vitreous gel of the eye that cause shadows and thus visual changes, especially against bright backgrounds and in brightly lit environments. Flashes and floaters can occur individually or together. This article discusses common causes of flashes and floaters to help with the triaging and management of these patients.

Incidence of retinal breaks in eyes undergoing 23-gauge or 20-gauge vitrectomy with induction of posterior vitreous detachment

PURPOSE

To compare the incidence rates of retinal breaks in eyes in which posterior vitreous detachment was induced during 23-gauge and 20-gauge vitrectomies to treat macular holes or preretinal membranes.

METHODS

We retrospectively reviewed 122 eyes of 115 patients with a macular hole or preretinal membrane who underwent induction of posterior vitreous detachment during 23-gauge vitrectomy (23-gauge group) and 61 eyes of 58 consecutive patients with the disorders who underwent induction of posterior vitreous detachment during 20-gauge vitrectomy performed by 1 surgeon.

RESULTS

No difference was found in the incidence rates of intraoperative retinal breaks between the 23-gauge (16% [20/122]) and 20-gauge (16% [10/61]) groups. A postoperative rhegmatogenous retinal detachment developed in 2 (2%) eyes in the 23-gauge group, whereas no eyes in the 20-gauge group had postoperative retinal breaks or rhegmatogenous retinal detachment. The incidence rates of retinal breaks in eyes with a macular hole and preretinal membrane did not differ significantly.

CONCLUSION

Posterior vitreous detachment induced during vitrectomy frequently results in intraoperative retinal breaks, the incidence of which may be independent of the gauge of the vitreous instruments. Surgeons should be alert to the development of retinal breaks.

The vitreomacular interface in retinal vein occlusion

PURPOSE

To evaluate the posterior vitreous adhesion status in patients with a history of central or branch retinal vein occlusion and to compare the results with the natural time-course of posterior vitreous detachment in healthy age-related controls.

METHODS

A retrospective chart review in terms of the posterior vitreous adhesion status was performed in 132 patients (133 eyes) with a history of a central (CRVO) or branch (BRVO) retinal vein occlusion. All patients underwent vitrectomy. Based on the operation reports, the vitreous adhesion status was classified as attached, partially detached or completely detached. The results were compared to the natural time-course of posterior vitreous detachment development in healthy age-related controls.

RESULTS

Eighty-one eyes met the inclusion and exclusion criteria. Fifty-two eyes (64%) had a history of CRVO and 29 eyes (36%) a history of BRVO, respectively. In the CRVO group, the posterior vitreous was attached in 47 eyes (90%) and completely detached in five eyes (10%). In the BRVO group, the posterior vitreous was attached in 27 eyes (93%), partially detached in 1 eye (3%) and completely detached in another eye (3%). A subdivision into age classes and a comparison with healthy age-related controls [data by Weber-Krause & Eckardt (1997) Ophthalmologe, 94, 619-623] showed in patients between 65 and 69 years of age an attached posterior vitreous cortex in 72% in healthy eyes, in 100% in CRVO (p = 0.109) and in 89% in BRVO (p = 0.440), in patients between 70 and 79 years of age an attached posterior vitreous cortex in 56% in healthy eyes, in 86% in CRVO (p = 0.010) and in 100% in BRVO (p = 0.038) and in patients between 80 and 89 years of age an attached posterior vitreous cortex in 43% in healthy eyes, in 100% in CRVO (p = 0.191) and in 67% in BRVO (p = 0.582) (Fisher's exact t-test).

CONCLUSION

In patients with a history of CRVO or BRVO, the posterior vitreous cortex stays attached more frequently in all age groups in comparison with the healthy age-related controls.

Time course of posterior vitreous detachment in the second eye

PURPOSE OF REVIEW

Posterior vitreous detachment is the principal predisposing event for the development of retinal breaks and rhegmatogenous retinal detachments. Patients with unilateral posterior vitreous detachment are potentially at risk of developing the complications associated with posterior vitreous detachment in the fellow eye. Thus, to identify when posterior vitreous detachment develops in the fellow eye after it develops in the first eye is important for managing patients with unilateral posterior vitreous detachment.

RECENT FINDINGS

The main theme in the literature is research regarding the mechanism of the development of posterior vitreous detachment. Various pharmacologic vitreolysis agents can induce posterior vitreous detachment. Changes in the enzymatic activities in the vitreous and vitreoretinal interface tend to promote vitreous separation from the inner retinal surface with aging. Clinical studies have shown a significant increase in the occurrence of posterior vitreous detachment with aging, and the interval between the development of posterior vitreous detachment in the first eye and in the second eye is short.

SUMMARY

Posterior vitreous detachment is one of the most important age-related changes in human eyes, and age-related changes develop equally in both normal eyes; thus, posterior vitreous detachment may develop in the second eye within a few years of developing in the first eye.