Posterior Vitreous Detachment
It is a separation of the posterior vitreous cortex from the neurosensory retina - the vitreous collapses anteriorly towards the vitreous base.
Initially there is liquefaction and syneresis → rupture in the posterior hyaloid → liquified vitreous flows out → separates the posterior hyaloid from the retina
Begins as a partial PVD at the perifoveal region → progresses to optic disc and formation of Weiss ring
Vitreous traction at firm sites of adhesion → retinal tear → retinal detachment
Risk factors: increasing age, myopes, inflammation, following cataract surgery, trauma
Symptoms: Floaters & Photopsias
Weiss Ring: Vitreous opacity or floater located near the optic disc
Echography may be useful in detecting retinal tears with flap or retinal detachment, especially if haemorrhage or other opacification of media limits visualization
Treatment:
Observation with strict retinal detachment precautions and follow up exam to rule out retinal breaks.
Vitrectomy can be considered for non-clearing vitreous hemorrhage, or vision threatening pathology
After the diagnosis of an acute PVD, a follow up dilated fundus examination should be performed approximately 1 month afterwards. It is possible for a new retinal tear or retinal detachment to occur during this dynamic period.
Strict recommendation of urgent follow-up is given to the patient for onset of recurrent photopsias with an increase in floaters.
If a partial PVD is present that is causing vision threatening vitreomacular traction syndrome, pars plana vitrectomy with membrane peeling may be indicated.
Image from Rajan Eye Care Hospital
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