Predicting retinal tears in posterior vitreous detachment

Objective: The purpose of this study is to determine whether patients with acute posterior vitreous detachment (PVD) who develop delayed retinal tears within the first 6 weeks after initial presentation have predictive characteristics. Design: Prospective cohort study. Participants: All patients presenting to the Hotel Dieu Hospital Emergency Eye Clinic between September 2008 and July 2009 diagnosed with acute PVD were offered enrollment. Methods: At the initial visit, patients were given the previously validated Queen's University Posterior Vitreous Detachment Patient Diary to record their daily symptoms for 6 weeks. Two or 6 weeks later, patients were reexamined in detail, and their diaries were collected and analyzed. Exact logistic regression was used to establish characteristics predictive of delayed retinal tears. Results: In our study population of 99 patients, 2 developed delayed retinal tears. One had retinal hemorrhages and the other had a cloud-like floater at initial presentation. Vitreal or retinal hemorrhage, large number of floaters at initial presentation, and high floater frequency at initial presentation indicated a high risk of delayed retinal tear formation, yielding a median unbiased estimated odds ratio of 36.18 with p value 0.009. No other presenting risk factors or symptomatology followed daily over the first 6 weeks after acute PVD were predictive of delayed retinal tear formation. Conclusions: PVD patients with retinal or vitreal hemorrhage, a significant number of floaters or a cloud like appearance to the floaters, or high floater frequency are at higher risk of developing delayed retinal tears.