Posterior Vitreous Detachment (PVD)

Posterior Vitreous Detachment (PVD)
SYMPTOMS Floaters (typically a large floater in the central vision or off to the side), Flashes
SIGNS Vitreous synchysis, Vitreous syneresis, Weiss ring (should be floating near the vicinity of the optic nerve)
WORK-UP Slit lamp examination of the vitreous, Dilated retinal exam, Scleral depression (especially if suspecting a retinal hole, retinal tear, or retinal detachment), OCT of the optic nerve (can help determine if posterior hyaloid face is completely detached), OCT of the macula (can help determine if posterior hyaloid face is completely detached)
FOLLOW-UP Acute PVD: Patient should be seen within 2-4 weeks in order to rule out any retinal holes, retinal tears, or retinal detachments
Chronic/Longstanding PVD: No additional follow-up is needed and patient should be seen back in 1 year
ETIOLOGY Liquefaction within the vitreous and weakening of the vitreoretinal adhesions
DIFFERENTIAL DX Asteroid hyalosis, Vitreous syneresis, Vitritis, Vitreous hemorrhage
NOTES PVDs occur in about 75% of patients over the age of 65
PVDs often occur earlier in patients who are myopic
Incomplete PVDs can be associated with vitreomacular traction and macular holes
PVDs are often associated with epiretinal membranes
A Weiss ring is best seen when doing BIO and looking around the optic nerve as the eye moves
If an intravitreal hemorrhage, preretinal hemorrhage, or vitreous pigment (Shafer’s sign) is noted, a retinal break and/or retinal detachment must be ruled out.
Posterior Vitreous Detachment (PVD): OCT shows complete detachment of the posterior hyaloid face from the macula and optic nerve region