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Symptoms and findings predictive for the development of new retinal breaks.

by van Overdam KA, Bettink-Remeijer MW, Klaver CC, Mulder PG, Moll AC, van Meurs JC

Article Abstract:

OBJECTIVE: To validate the conclusion of our previous prospective study of 250 patients with isolated posterior vitreous detachment: follow-up visits are only necessary if patients mention symptoms of flashes in combination with multiple floaters or a curtain or cloud at the initial examination, or an increase in number of floaters after the initial examination. METHODS: Prospective study of 270 consecutive patients with symptomatic isolated posterior vitreous detachment. All patients completed a questionnaire detailing their symptoms and had a full eye examination at the initial examination and at follow-up visits. Logistic regression with backward elimination was used for statistical analysis. We also performed pooled analysis of our previous and present study data. RESULTS: New retinal breaks developed in 10 patients (3.7%). Multiple floaters, a curtain or cloud, hemorrhages (retinal or vitreous) at the initial examination, and an increase in the number of floaters after the initial examination were found to be predictive factors for the development of new retinal breaks. These factors were also the only significant predictors after pooled analysis of both studies (520 patients, 23 breaks). CONCLUSIONS: We assume we can formulate a safe policy for scheduling patients with isolated posterior vitreous detachment: only patients with multiple floaters, a curtain or cloud, or hemorrhages (retinal or vitreous) at the initial examination should be scheduled for reexamination. All other patients should return only if the number of floaters increases.

follow up for PVD's

By: Anonymous - Tue 11/08/2005 PM
A prospective study of patients with new onset floaters were examined without indirect ophthalmoscopy nor scleral depression at 2 and 6 weeks after initial complaint, and then only 10 out of the 270 patients with new pvd's were found to have retinal breaks. They have a great algorithm using the presence of vit heme, subjective loss of vision, and more floaters at follow up to determine which patients are at higher risk of developing a retinal break. There needs to be a follow up study using scleral depression with indirect ophthalmoscopy, and perhaps a longer follow up period than just 6 weeks to detect retinal breaks in these patients.
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