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Use of OCT in Detecting Retinal Tears in Patients With Acute Symptomatic Posterior Vitreous Detachment
To evaluate the association of posterior vitreous opacities (PVOs) on optical coherence tomography with retinal tears identified on examination in patients with acute, symptomatic posterior vitreous detachment (PVD).
Data were retrospectively collected from the medical records of 388 patients with acute, symptomatic PVD between January 1, 2021, and June 30, 2021. Included patients had received a primary diagnosis of PVD and presented with flashes and/or floaters. Optical coherence tomography scans were reviewed by two separate readers for the presence of PVOs. The primary outcome was the presence of retinal tear on fundus photograph and on examination.
Of 388 patients who presented with acute PVD symptoms, 90 (23.2%) were found to have a retinal tear on dilated fundus examination. Among these patients, 78 (86.7%) were found to have PVOs on optical coherence tomography. Statistical analysis demonstrated a significant relationship between the presence of PVOs and retinal tear ( P < 0.01). The sensitivity and specificity of this finding was 86.7% and 72.5%, respectively. Further analysis included area under the curve from receiver operating characteristic curve which was found to be 0.80.
The presence of PVOs on optical coherence tomography is suggestive of a retinal tear in patients with acute, symptomatic PVD.
Disclosure statements are available on the authors' profiles:
USE OF OPTICAL COHERENCE TOMOGRAPHY IN DETECTING RETINAL TEARS IN ACUTE, SYMPTOMATIC POSTERIOR VITREOUS DETACHMENTRetina (Philadelphia, Pa.) 2023 May 01;43(5)802-807, AV Rao, AR Shah, VT Nguyen, W Pearce, TP Wong, DM Brown, CC Wykoff, SB Patel
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Posterior vitreous detachment (PVD) is a commonly encountered clinical entity that requires prompt evaluation and diagnosis. As the known complications of PVD, such as vitreous hemorrhage (VH) and rhegmatogenous retinal detachment, carry potentially significant visual morbidity, a thorough clinical and diagnostic investigation is warranted. The detection of retinal tears following acute symptomatic PVD may afford the clinician early referral and/or appropriate treatment options, such as prophylactic laser retinopexy. This approach may ultimately spare a patient from undergoing more invasive treatment options for rhegmatogenous retinal detachment, such as vitrectomy with or without scleral buckling.
Rao et al detailed their study utilizing optical coherence tomography (OCT) in the detection of what are described as posterior vitreous opacities (PVOs) on 6 mm2 macular scans. PVOs are fine hyperreflective material posited to be erythrocytes in the setting of vitreous hemorrhage or liberated retinal pigmented epithelial cells. A total of 626 patients were screened, with 388 meeting the inclusion criteria. Patients presented with common symptoms of flashes and floaters, isolated floaters, isolated flashes, or distorted or blurred vision. Of note, symptoms of isolated floaters were found to have the strongest association with findings of a retinal tear on fundoscopy (P ≤ .01). Interestingly, patients presenting with symptoms of both flashes and floaters were not associated with findings of retinal tears (P ≤ .01). Although diagnostic imaging, including OCT, can be useful in a wide range of posterior segment pathologies, such as retinal and optic nerve diseases, physical examination is still extremely valuable. This is supported by a positive Shafer sign predicting retinal tear (P ≤ .02), as well as VH (P < .01) and retinal hemorrhage (P < .01). In this cohort, 23.2% of the patients presented with a retinal tear on fundoscopy, with 86.7% of the patients showing PVOs on macular OCT (P < .01). Additionally, a positive Shafer sign and VH were significantly associated with findings of PVOs on OCT (P < .01). The evaluation of the sensitivity and specificity of diagnostic imaging is imperative in determining the accuracy of any technique. Findings of PVOs on OCT showed 86.7% sensitivity and 72.5% specificity. This study presents compelling evidence that OCT can be quite useful in predicting findings of retinal breaks in patients with acute symptomatic PVDs.
Although the standard of ophthalmic care for the evaluation of retinal pathology includes a physical examination, OCT can certainly augment diagnostic capabilities. This article presents compelling evidence that macular OCT can be implemented in the evaluation of patients with acute symptomatic PVDs. Given the noninvasive, rapid, and technically straightforward nature of image acquisition, OCT offers an invaluable tool that practitioners can utilize for myriad applications.