This 73YO female presented with several days of new floaters in her left eye. Vision was 20/15 bilaterally. Optos color RGB imaging shows extremely prominent mobile string-like posterior hyaloid condensations floating over the disc and macula. There were no retinal breaks or detachment.
Learning Points:
The clinical diagnosis for a complete posterior vitreous detachment (PVD) remains challenging and can be established with biomicroscopy when a Weiss ring, representing avulsed peripapillary glial tissue, is visualized. OCT can be helpful in supplementing the clinical exam (Wagley et al, Retina 2021;41:2296-2300).
An acute PVD is the moment of truth for when a retinal break or detachment develops. The historical risk of a break is 10-15%, although a large retrospective study from Kaiser Permanente found this risk to be significantly lower at 5% for a retinal break and 4% for retinal detachment (Ophthalmology 2022;129:67-72). The presence of vitreous pigment or blood and lattice, and a history of a retinal break or detachment in the fellow eye, increases this risk.
