ICO International Clinical Guidelines:
Posterior Vitreous Detachment, Retinal Breaks and Lattice Degeneration (Initial and Follow-up Evaluation)
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(You can also download this Guideline as a PDF file - 138 KB)
On this page:
- Initial exam history
- Initial physical exam
- Ancillary tests
- Care Management
- Surgical and postoperative care if patient receives treatment
- Follow-up history
- Follow-up physical exam
- Patient education
Initial Exam History (Key elements)
- Symptoms of PVD [A:I]
- Family history (e.g., Stickler syndrome) [A:II]
- Prior eye trauma, including surgery [A:II]
- Myopia [A:II]
- History of cataract surgery [A:II]
Initial Physical Exam (Key elements)
- Examination of the vitreous for detachment, pigmented cells, hemorrhage, and condensation [A:III]
- Examination of the peripheral fundus with scleral depression [A:III] The preferred method of evaluating peripheral vitreoretinal pathology is with indirect ophthalmoscopy combined with scleral depression [A:III]
Ancillary Tests
- Perform B-scan ultrasonography if peripheral retina cannot be evaluated. [A:II] If no abnormalities are found, frequent follow-up examinations are recommended. [A:III]
Care Management
Management Options
|
Type of Lesion |
Treatment |
|
Acute symptomatic horseshoe tears |
Treat promptly (A:II) |
|
Acute symptomatic operculated tears |
Treatment may not be necessary (A:III) |
|
Traumatic retinal breaks |
Usually treated (A:III) |
|
Asymptomatic horseshoe tears |
Usually can be followed without treatment (A:III) |
|
Asymptomatic operculated tears |
Treatment is rarely recommended (A:III) |
|
Asymptomatic atrophic round holes |
Treatment is rarely recommended (A:III) |
|
Asymptomatic lattice degeneration without holes |
Not treated unless PVD causes a horseshoe tear (A:III) |
|
Asymptomatic lattice degeneration with holes |
Usually does not require treatment (A:III) |
|
Asymptomatic dialyses |
No consensus on treatment and insufficient evidence to guide management |
|
Fellow eyes atrophic holes, lattice degeneration, or asymptomatic horseshoe tears |
No consensus on treatment and insufficient evidence to guide management |
PVD = Posterior vitreous detachment
Surgical and Postoperative Care if Patient Receives Treatment:
- Inform patient about the relative risks, benefits and alternatives to surgery [A:III]
- Formulate a postoperative care plan and inform patient of these arrangements [A:III]
- Advise patient to contact ophthalmologist promptly if they have a significant change in symptoms such as new floaters or visual field loss [A:II]
Follow-up History
Follow-up Physical Exam
- Visual acuity [A:III]
- Evaluation of the status of the vitreous, with attention to the presence of pigment or syneresis [A:II]
- Examination of the peripheral fundus with scleral depression [A:II]
- B-scan ultrasonography if the media is opaque [A:II]
- Patients who present with vitreous hemorrhage sufficient to obscure retinal details and a negative B-scan should be followed periodically. For eyes in which a retinal tear is suspected, a repeat B-scan should be performed about 4 weeks later [A:III]
Patient Education
- Educate patients at high risk of developing retinal detachment about the symptoms of PVD and retinal detachment and the value of periodic follow-up exams. [A:II]
- Instruct all patients at increased risk of retinal detachment to notify their ophthalmologist promptly if they have a significant increase in floaters, loss of visual field, or decrease in visual acuity. [A:III]
* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2006 (www.aao.org)
(You can also download this Guideline as a PDF file - 138 KB)
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