Boston University School of Medicine, Boston, Massachusetts.
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
Ophthalmol Retina. 2023 Apr;7(4):318-324. doi: 10.1016/j.oret.2022.10.012. Epub 2022 Oct 25.
To determine the long-term incidence of and risk factors for delayed retinal tears after acute, symptomatic posterior vitreous detachment (PVD) without concurrent retinal tears.
Retrospective, observational case series.
Patients diagnosed with an acute, symptomatic PVD without concurrent retinal tears at a tertiary eye center between 2013 and 2018.
This is a retrospective, consecutive, and observational case series. Acute and symptomatic PVD was defined as experiencing flashes or floaters for 1 month or less at the time of diagnosis. Patients with a retinal tear or detachment at or before the time of diagnosis were not included. The occurrence and timing of subsequent retinal tears after initial PVD diagnosis were recorded. The age, sex, race, refractive error, lens status, lattice degeneration status, and type of physician (retina specialist vs. nonretina specialist) who saw the patient were also recorded.
Time to the development of a delayed retinal tear.
A total of 389 eyes from 389 patients had acute and symptomatic PVDs without concurrent retinal tears or detachments at diagnosis. Kaplan-Meier analysis showed that 7.39% of eyes developed delayed retinal tears by 6.24 years after initial PVD diagnosis. Of these tears, 50% occurred within 4.63 months of PVD diagnosis, and 63.46% occurred within 1 year of PVD diagnosis. Cox-Mantel log-rank analysis showed that those who were younger (age < 60 years), myopic, or had lattice degeneration were more likely to develop tears. A multivariate Cox proportional-hazards models controlling for other significant risk factors supported lattice degeneration as a likely risk factor for delayed retinal tear.
This study demonstrates that 7.39% of patients with acute, symptomatic PVD without concurrent retinal tears develop delayed retinal tears by 6.24 years after PVD diagnosis, with many developing tears well after a typical 6-week follow-up time for PVD. Lattice degeneration is a significant risk factor for delayed tears. These findings can guide clinicians in establishing optimal follow-up protocols for patients with acute, symptomatic PVD.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
确定无伴发性视网膜裂孔的急性症状性后玻璃体脱离（PVD）后延迟性视网膜裂孔的长期发生率和危险因素。
回顾性、观察性病例系列研究。
在 2013 年至 2018 年期间于一家三级眼科中心诊断为无伴发性视网膜裂孔的急性症状性 PVD 患者。
这是一项回顾性、连续、观察性病例系列研究。急性症状性 PVD 的定义为诊断时出现闪光或漂浮物的时间不超过 1 个月。不包括在诊断时或之前已有视网膜裂孔或脱离的患者。记录初次 PVD 诊断后后续视网膜裂孔的发生和时间。还记录了患者的年龄、性别、种族、屈光不正、晶状体状态、格子样变性状态以及就诊医生（视网膜专家与非视网膜专家）的类型。
发生延迟性视网膜裂孔的时间。
389 例 389 只眼在诊断时均无伴发性视网膜裂孔或脱离，患有急性症状性 PVD。Kaplan-Meier 分析显示，7.39%的眼在初次 PVD 诊断后 6.24 年内发生延迟性视网膜裂孔。其中，50%的裂孔发生在 PVD 诊断后 4.63 个月内，63.46%的裂孔发生在 PVD 诊断后 1 年内。Cox-Mantel 对数秩分析显示，年龄＜60 岁、近视或有格子样变性的患者更容易发生裂孔。多变量 Cox 比例风险模型控制其他显著危险因素后，支持格子样变性为延迟性视网膜裂孔的可能危险因素。
本研究表明，7.39%的无伴发性视网膜裂孔的急性症状性 PVD 患者在 PVD 诊断后 6.24 年内发展为延迟性视网膜裂孔，许多患者在 PVD 典型的 6 周随访时间后发生裂孔。格子样变性是延迟性裂孔的一个显著危险因素。这些发现可以指导临床医生为急性症状性 PVD 患者制定最佳随访方案。
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