Dayan M R, Jayamanne D G, Andrews R M, Griffiths P G
Department of Ophthalmology, Newcastle General Hospital, Newcastle upon Tyne, UK.
Eye (Lond). 1996;10 ( Pt 4):456-8. doi: 10.1038/eye.1996.100.
The aim of the study was to determine whether patients presenting with an isolated posterior vitreous detachment require follow-up to identify retinal breaks not apparent at presentation and whether some histories are more predictive of associated serious posterior segment pathology.
The notes of 295 patients presenting to eye casualty with flashes and/or floaters were reviewed.
One hundred and eighty-nine patients (64%) had isolated posterior vitreous detachments, 49 (16.6%) had retinal detachments and 31 (10.5%) had flat retinal tears. Three new breaks (3.3% of all tears found, 1.9% of review appointments) were identified only at follow-up. Although a subjective reduction in vision and a history of less than 6 weeks' duration were strongly predictive of retinal breaks, the large group of patients presenting with floaters alone (124/295, 42%) still harboured a significant proportion (26.7%) of the retinal breaks.
A follow-up visit for patients with an isolated posterior vitreous detachment can be justified to detect the small percentage of asymptomatic retinal breaks. Although a subjective reduction of vision is the symptom most predictive of serious posterior segment pathology, it would be unsafe to identify particular subgroups of patients alone for careful examination.
本研究旨在确定单纯性玻璃体后脱离患者是否需要随访以发现初诊时不明显的视网膜裂孔，以及某些病史是否更能预测相关的严重眼后段病变。
回顾了295例因闪光和/或飞蚊症到眼科急诊就诊患者的病历。
189例（64%）患者为单纯性玻璃体后脱离，49例（16.6%）为视网膜脱离，31例（10.5%）为扁平视网膜裂孔。仅在随访时发现3个新的裂孔（占所有发现裂孔的3.3%，占复诊患者的1.9%）。尽管主观视力下降和病程小于6周强烈提示视网膜裂孔，但仅表现为飞蚊症的大量患者（124/295，42%）中仍有相当比例（26.7%）存在视网膜裂孔。
对单纯性玻璃体后脱离患者进行随访以发现小比例的无症状视网膜裂孔是合理的。尽管主观视力下降是最能预测严重眼后段病变的症状，但仅识别特定亚组患者进行仔细检查是不安全的。
