Vitreoretinal Research Group, John van Geest Centre for Brain Repair, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK.
School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP, UK.
Eye (Lond). 2024 Mar;38(4):786-791. doi: 10.1038/s41433-023-02779-3. Epub 2023 Oct 5.
Retinal tears (RT) from posterior vitreous detachment (PVD) are an important and treatable cause of rhegmatogenous retinal detachment (RRD). Better understanding of the risk of RT from PVD will help plan urgent eye care.
Prospective observational case series over two years. Patients presenting to their optometrist, family doctor or emergency department with flashes and floaters were directed to a research clinic. History and examination, including slit-lamp biomicroscopy (SLB) and indentation indirect ophthalmoscopy (IIO), were performed by a single investigator, with two month follow-up for patients with confirmed PVD. Main outcome measures were incidence of PVD, RT, and RRD.
1010 patients were recruited. 896 (89%) patients had PVD at first assessment, of which 89 (8.8% of total cohort, 9.9% of PVD eyes) had RT and 8 had RRD. 21 (3%) of the remaining PVD patients developed RT in the subsequent two months and a further 9 (11%) patients with RT at initial assessment developed further tears by two months. 7 (0.7%) had asymptomatic RT in the fellow eye. 15% of RT were only visible on IIO and not SLB. Weiss ring was absent in 32% of eyes with RT. Patients with RT or RRD were more likely than 'PVD-only' eyes to have blurred or missing vision (p < 0.001), have higher rate of blue-green cataracts (p < 0.001), and longer axial lengths (p < 0.05).
This large, prospective study demonstrates a 9.9% rate of RT or RRD at the time of PVD, and emphasises the importance of IIO examination.
玻璃体后脱离（PVD）引起的视网膜裂孔是孔源性视网膜脱离（RRD）的一个重要且可治疗的原因。更好地了解 PVD 引起视网膜裂孔的风险有助于计划紧急眼部护理。
为期两年的前瞻性观察性病例系列研究。向验光师、家庭医生或急诊部门出现闪光和漂浮物的患者提供研究诊所。由一名研究人员进行病史和检查，包括裂隙灯生物显微镜（SLB）和压陷间接检眼镜（IIO）检查，对确诊为 PVD 的患者进行两个月的随访。主要结局指标是 PVD、视网膜裂孔和 RRD 的发生率。
共招募了 1010 名患者。896 名（89%）患者在首次评估时患有 PVD，其中 89 名（总队列的 8.8%，PVD 眼的 9.9%）患有视网膜裂孔，8 名患有 RRD。在随后的两个月内，其余 PVD 患者中有 21 名（3%）出现视网膜裂孔，在初次评估时有视网膜裂孔的 9 名（11%）患者在两个月内出现进一步裂孔。7 名（0.7%）患者对侧眼无症状性视网膜裂孔。只有 15%的视网膜裂孔仅在 IIO 上可见，而不在 SLB 上可见。有视网膜裂孔的眼中 Weiss 环缺失的占 32%。有视网膜裂孔或 RRD 的患者比“仅 PVD”眼更有可能出现视力模糊或缺失（p<0.001）、更高的蓝绿色白内障发生率（p<0.001）和更长的眼轴长度（p<0.05）。
这项大型前瞻性研究表明，PVD 时视网膜裂孔或 RRD 的发生率为 9.9%，强调了 IIO 检查的重要性。
