7 Posterior Vitreous Detachment

Posterior vitreous detachment (PVD) is the dehiscence of the posterior vitreous cortex from the retina, usually in patients aged 50 and over, as a result of the weakening of the vitreoretinal adhesion in conjunction with vitreous liquefaction (synchysis senilis). PVD typically begins in the perifoveal macula and extends slowly over months or years until complete vitreous separation occurs. PVD manifestations are usually benign, but in some cases vitreous liquefaction occurs without concurrent weakening of vitreoretinal adherence, which may induce numerous pathologic events at the vitreoretinal interface. The most known PVD complications usually occur in the retinal periphery, following the complete PVD, such as retinal tear and rhegmatogenous retinal detachment. Visual symptoms related to PVD include floaters and photopsias, which tend to improve over time. The conventional method for diagnosing PVD is slit-lamp biomicroscopy or indirect ophthalmoscopy by the presence of Weiss ring attached to the posterior hyaloid membrane. Ultrasonography and optical coherence tomography may also have value. No active treatment is usually needed; however, in cases of PVD complications, laser or pars plana vitrectomy surgery may be required.