Posterior Vitreous Detachment: Current Concepts and Management

Alan Ang, FRCO; Arabella V. Poulson, FRCO; David R.J. Snead, FRCP; Martin P. Snead, Md, FRCO

In This Article

Vitreous Hemorrhage

Vitreous hemorrhage has been reported to occur in 6% to 18% of symptomatic PVDs.[24,30,31,32,33] The degree of associated hemorrhage can be variable. Microscopic vitreous hemorrhages are characterized by the presence of red blood cells seen as tiny red dots on slit-lamp biomicroscopy of the anterior vitreous (Figure 5). These dots should not be confused with pigment granules within the anterior vitreous, which tend to be larger in size and less refractile (Figure 6). Greater degrees of hemorrhage result in visible clots of blood within the vitreous or in the pre-retinal space, visible with indirect ophthalmoscopy (macroscopic hemorrhage). Preretinal blood usually collects inferiorly, taking the form of a scimitar-shaped hemorrhage and marking out the limit of the PHM separation from the retina inferiorly.

Red blood cells are seen as tiny red/ brown dots in anterior vitreous.

Pigment granules are larger in size and less refractile than red blood cells.

Although vitreous hemorrhage signifies a likelihood of retinal disruption involving a retinal blood vessel, not all cases are associated with retinal tears. Overall, when PVD is complicated by vitreous hemorrhage, retinal breaks have been reported to occur in 38% to 91% of cases.[24,30,31,32,33] Macroscopic hemorrhages have been found to carry a significantly greater risk of associated retinal tears as compared to microscopic hemorrhages.[34] In such circumstances, the retinal tears are usually large and relatively posterior, as they would have to be associated with a large torn blood vessel. Therefore, one should be suspicious of undetected breaks if only small anterior breaks are found in a patient with macroscopic hemorrhage. A high index of suspicion should also be present for patients with risk factors for retinal tear or detachment (see following section on risk factors).

Retinal hemorrhages, usually in the form of punctate hemorrhages with or without vitreous hemorrhage, have also been described in some cases of PVD and may be related to retinal breaks.[33]