Delayed Retinal Tears May Occur Long After Acute Vitreous Detachment

The widely accepted 6-week follow-up visit after an acute, symptomatic posterior vitreous detachment (PVD) may wind up catching less than half of eventual delayed retinal tears, according to a 6-year study published in Ophthalmology Retina. The study is the longest investigation into the topic that includes variables of race and ethnicity among other factors.

Investigators examined medical records of 389 patients (mean age 64.58±9.36 years) at Boston Medical Center with acute, symptomatic PVD diagnosed using fundoscopy between January 1, 2013 and December 31, 2018. One eye of bilateral cases was randomly selected, and individuals presenting with simultaneous retinal tear or prior retinal break were excluded. The researchers defined symptoms as floaters, flashes, or vision loss in the month before acute PVD, and delayed retinal tear as onset at least 1 day after acute detachment. 

Twenty eyes of 20 patients experienced delayed retinal tears; a rate of 7.39% in 6.24 years, with a range of 5 days to 2.99 years. Of these, 9 eyes (45%) developed this complication in the first 6 weeks after PVD, but 55% of tears happened after that initial period. In 4.63 months, 50% of retinal tears occurred, and 63.46% by 1 year. None developed rhegmatogenous retinal detachment (RRD) needing surgery.

Bivariate analysis revealed 3 risk factors: lattice degeneration (HR, 6.48; 95% CI, 2.65-15.88), myopia (HR, 3.25; 95% CI, 1.06-9.95), and age younger than 60 years (HR, 2.55; 95% CI, 1.04-6.25). There were no significant differences by phakic status, sex, or type of physician who diagnosed PVD or tear. Also, no individual of Asian descent had a delayed tear. Excluding this demographic subcategory, race was not a large factor (P =.82).

In the multivariate model, only lattice degeneration (HR, 4.91; 95% CI, 1.66-14.53) was a significant risk factor (P =.004).

“Most patients (75%) in our study did not experience additional symptoms before the discovery of their delayed retinal tears, so follow-up evaluation after acute PVDs should not rely solely on the presence of these symptoms,” according to the investigators. They also advise treating retinal tears early to prevent RRD, and counseling those with acute PVD — even without peripheral pathology — that delayed tears and RRD are possible.

Most previous research examining symptomatic PVDs involve 4- to 6-week studies, showing a rate of 1.5% to 3.4% for delayed tears. A number of analyses longer than 6 weeks found similar delayed retinal tear rate to the existing literature, but did not exceed 1 year or were designed without a specific final follow-up time.

Only 1 pseudophakic eye exhibited a delayed retinal tear; thus sample size may have been limited. Also, causes of delayed tear were not described; such as persistent vitreoretinal traction, or a missed retinal tear, and institutional policy did not require notation of scleral depression during funduscopic examination. Due to exclusion of prior or presenting retinal tear with PVD, there was no data on correlations with fellow eyes. Strengths include the long follow-up period, and a gender- and racially-diverse population.