Symptomatic posterior vitreous detachment and the incidence of delayed retinal breaks: case series and meta-analysis.

PURPOSE To establish the necessity for an early follow-up examination after an initial funduscopic examination with negative results for patients with acute, symptomatic posterior vitreous detachment (PVD). DESIGN Retrospective case-control study and meta-analysis. METHODS Records were reviewed of patients seeking treatment over a 4.5-year period who were diagnosed with an acute, symptomatic PVD. A MEDLINE search to identify all published observational case studies reporting vitreoretinal pathologic features after acute, symptomatic PVD. RESULTS The incidence of retinal tears in eyes with a symptomatic PVD was 8.2%. The overall rate of retinal break in the meta-analysis portion of the study was 21.7%. In total, 1.8% of patients had retinal tears that were not seen on initial examination. Of the 29 patients with delayed-onset retinal breaks, 24 (82.8%) had at least one of the following: vitreous hemorrhage at initial examination, hemorrhage in the peripheral retina at initial examination, or new symptoms. CONCLUSIONS If the results of an initial examination of a patient with an acute, symptomatic PVD are negative for retinal tears, the necessity of early follow-up may be best determined by the presence of pigmented cells in the vitreous, vitreous hemorrhage, or retinal hemorrhage. Most patients with symptomatic PVD may not need an early follow-up examination.