Evaluation of a posterior vitreous detachment: a comparison of biomicroscopy, B‐scan ultrasonography and optical coherence tomography to surgical findings with chromodissection

Abstract

ABSTRACT.Purpose: To find the most reliable and efficient noninvasive technique to clinically detect a posterior vitreous detachment. Methods: In a prospective study of 30 eyes in 30 patients with macular pucker or macular hole formation, the posterior vitreous cortex was examined 1 day prior to a scheduled vitrectomy. Three independent investigators classified the posterior vitreous cortex of each eye as 'attached' or 'detached' via slit-lamp biomicroscopy (BM), 10-MHz B-scan ultrasonography (I 3 Innovative Imaging Inc.), and optical coherence tomography [OCT III Stratus Ò (Carl Zeiss Meditec Inc.) and RTVue-100 OCT (Optovue Corp.)]. These preoperative findings were then compared during a triamcinolone acetonide-assisted vitrectomy 1 day later. Results: Triamcinolone acetonide-assisted vitrectomy showed in 60% a posterior vitreous detachment and in 40% an attached posterior vitreous cortex. Preoperatively conducted B-scan ultrasonography and BM revealed the highest, correct evaluation of the posterior vitreous status. The prediction of the OCT was confirmed intraoperatively in 12.5%. In all other cases, the evaluation by OCT was not possible or was inadequate. Conclusion: The prognostic most reliable but investigator-dependent methods to clinically detect whether the posterior vitreous cortex is detached are B-scan ultrasonography and BM. The objective technique of the high-resolution, twodimensional time-domain OCT allows only in a few cases a clear differentiation of preretinal structures.

Prevalence and risk factors of posterior vitreous detachment in a Chinese adult population: the Handan eye study

“…PVD was defined as separation of the posterior vitreous cortex from the retinal surface with a peripapillary ring and/or an optically empty subhyaloid space [18,19]. The dynamic vitreous examination was used to decrease the rate of misdiagnosis of PVD [18,20,21].…”

The Vitreous, the Retinal Interface in Ocular Health and Disease

“…The greater the difference in density between two media, the more prominent the echo [109]. Contact B scan is superior to biomicroscopy and OCT even in the absence of media opacity [110]. It is the technique of choice in cases with vitreous hemorrhage [111].…”

Spectral Domain Optical Coherence Tomography in the Diagnosis and Management of Vitreoretinal Interface Pathologies

“…Subsequently, ultrasonography was used as the main imaging modality for documentation of PVD [2]. Despite its relatively gross resolution (1 mm) it is nonetheless a reliable tool to determine the presence of a PVD [10]. It is indeed advantageous in eyes with media opacities such as corneal opacities, dense cataracts, vitreous hemorrhage, or vitreous inflammation.…”