Posterior vitreous detachment often occurs in older patients. The vitreous humor, which is normally in contact with the retina through various parts, shrinks and gradually separates from the posterior vitreous relative to the retina, which is the cause of a posterior vitreous detachment. Especially in the side image, the patient notices flashes of light, dark spots and floaters. Complications may occur in the retina and macula, requiring surgical intervention. The visual outlook is good when posterior vitreous detachment occurs in isolation and variable when other eye-related complications occur.
- Causes of posterior vitreous detachment
- Risk factors
- Symptoms: Seeing spots and floaters in eye
- Diagnosis and examinations
- Treatment via surgery
- Complications: Retinal tear, retinal detachment
- Prognosis is variable
Causes of posterior vitreous detachment
The vitreous humor is a clear substance in the eye with jelly-like consistency that fills the posterior segment of the eye. Vitreous humor consists almost entirely of water. It also contains special substances that give the vitreous its jelly-like consistency (collagen and hyaluronic acid). Normally, the hyaloid, the back surface of the vitreous humor, is in direct contact with the retina at several locations. As we age, the vitreous shrinks, causing the surrounding vitreous to collapse. This releases the hyaloid from its attachment at the back of the eye near the optic nerve. This separation is known as a so-called vitreous detachment.
Risk factors
Patients with nearsightedness (myopia) have a higher chance of developing a posterior vitreous detachment, which then occurs earlier than the natural aging of the eye in older patients.
Symptoms: Seeing spots and floaters in eye
In most patients, the process of separation of vitreous from the retina does not cause noticeable symptoms. Other symptoms include seeing:
- dark spots in peripheral vision (side view)
- floaters (mouches volantes, floaters) (small or sudden increase in new floaters)
- flashes of light (photopsy)
These spots and floaters are moving compactions in the shrinking vitreous or red blood cells. The photopsias can be explained by the detachment of the vitreous from the retina. When symptoms occur, the patient is at higher risk of forming a retinal tear that potentially results in a retinal detachment (medical term: ablatio retinae) that occurs during a vitreous detachment. A retinal tear and subsequent retinal detachment occur rarely, but prompt medical treatment is required as it causes vision loss. In a retinal detachment, the detached vitreous detaches the retina. The patient notices a curtain for part of the visual field that starts from the side . If the macula has also become detached, the patient’s visual acuity decreases.
Diagnosis and examinations
Ophthalmological examination
The only way to diagnose the cause of the eye problem is through a comprehensive eye exam. To do this, the ophthalmologist dilates the patient’s pupils with special eye drops (mydriatics).
Diagnostic research
If the ophthalmologist notices bleeding, he will perform an eye ultrasound. He then gently places a small probe on the patient’s closed eyelid. In case of (suspected) retinal tear or retinal detachment, a visual field examination is also required. This examination gives the ophthalmologist an idea of the extent of the vision loss.
Treatment via surgery
An isolated vitreous detachment requires no treatment. The vitreous body continues to age and shrink, making floaters usually less noticeable. When a retinal tear has occurred, prompt treatment is needed. The ophthalmologist treats the retinal tear using laser therapy or cryopexy (a cold treatment to close the tear). Pneumatic retinopexy or scleral buckling are two surgical techniques that are also possible for retinal detachment. A vitrectomy is also necessary, in which the ophthalmologist removes the vitreous by cutting and aspirating. The ophthalmologist bases the surgical technique used on the number of tears, the visibility of the ocular fundus, the duration of the detachment and the age of the patient.
Complications: Retinal tear, retinal detachment
A retinal tear, retinal detachment and macular detachment are possible complications of a vitreous detachment.
Prognosis is variable
The prospects for surgical intervention for vitreous and retinal detachment are very good in most patients. The visual field recovers in approximately 90% of all operated patients. However, if the macula is also loose, visual acuity often only partially recovers. It is therefore essential to immediately proceed with surgical intervention in the event of retinal detachment with threatened macular detachment in order to preserve the patient’s visual acuity and vision.
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- Nearsightedness (myopia): Blurred vision of objects at a distance
- Aging of the eye: Eye disorders and eye structures
- Floaters: Spotting floaters (mouches volantes, spots).
- Retinal detachment: Detachment of the retina from the eye
- Visual field examination: Examination of visual field loss