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Original Investigation | Clinical Sciences

Evolution of Vitreomacular Detachment in Healthy Subjects

Hirotaka Itakura, MD1; Shoji Kishi, MD1
[+] Author Affiliations
1Department of Ophthalmology, Gunma University, School of Medicine, Maebashi, Japan
JAMA Ophthalmol. 2013;131(10):1348-1352. doi:10.1001/jamaophthalmol.2013.4578.
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Importance  Development of posterior vitreous detachment (PVD) plays an important role in vitreomacular diseases. Spectral-domain optical coherence tomography (SD-OCT) with noise reduction can visualize a posterior precortical vitreous pocket (PPVP) and classify PVD stages according to the state of the posterior wall of the PPVP.

Objective  To describe the role of the PPVP in early-stage PVDs in healthy individuals.

Design, Setting, and Participants  We performed biomicroscopy and SD-OCT in the right eyes of 368 healthy volunteers (188 males and 180 females; mean [SD] age, 57.1 [19.4] years; range, 12-89 years).

Results  The condition of the posterior wall of the PPVP was classified into stages according to the biomicroscopic findings and SD-OCT images: stage 0, no PVD with PPVP (134 eyes; mean [SD] subject age, 38.7 [16.5] years; range, 12-76 years); stage 1, paramacular PVD with PPVP (47 eyes; mean age, 55.2 [10.3] years; range, 36-77 years); stage 2, perifoveal PVD with PPVP (27 eyes; mean age, 62.0 [8.7] years; range, 46-81 years); stage 3, vitreofoveal separation with persistent attachment to the optic disc (19 eyes; mean age, 65.8 [6.2] years; range, 55-80 years; stage 3a, vitreofoveal separation with an intact posterior wall of the PPVP in 12 eyes; stage 3b, vitreofoveal separation with a defect in the posterior wall of the PPVP in 7 eyes; and stage 4, complete PVD (141 eyes; mean age, 73.2 [8.3] years; range, 48-89 years).

Main Outcomes and Measures  Ages in each PVD stage.

Conclusions and Relevance  The posterior wall of the PPVP initially detaches at the paramacular area and extends to the perifoveal area, which results in a perifoveal PVD. A vitreofoveal detachment may develop with or without a defect in the PPVP. When the vitreous detaches from the optic disc, a complete PVD develops. An anatomical feature of the PPVP may play a role in the development of a perifoveal PVD.

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Figure 1.
Stages of Posterior Vitreous Detachment (PVD) Development

A, Stage 0, no PVD. B, Stage 1, paramacular PVD. C, Stage 2, perifoveal PVD. D, Stage 3a, vitreofoveal separation with persistent attachment to the optic disc and intact posterior precortical vitreous pocket (PPVP). E, Stage 3b, vitreofoveal separation with disrupted posterior wall of the PPVP. F, Stage 4, complete PVD. P indicates PPVP; C, Cloquet canal; S, superior; T, temporal; I, inferior; N, nasal; thin arrows, anterior border of PPVP; thick arrows, posterior wall of PPVP; and 1, single scan.

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Figure 2.
Percentage of Subjects With Each Stage of Posterior Vitreous Detachment (PVD) by Decade of Life

Percentages for each stage of PVD are displayed by age group; see Table 1 for details.

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Tables

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