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PURPOSE: This study was performed with the aim of finding a more convenient and less time-consuming method to diagnose retinal breaks in posterior vitreous detachment (PVD) patients. METHODS: A prospective double-blind observational case study was performed with patients who were admitted to the Eye Emergency Department Sahlgrenska University Hospital with PVD symptoms and approved to participate in the study (n = 128). Standard slit lamp examination was compared with images from a Zeiss Clarus 700 ultra-wide-field camera (UWFC). Patients were examined and photographed by an independent operator. Data and image review was performed by three independent reviewers with varying experience. Retinal break detection with the two different methods (detailed eye examination by well-trained ophthalmologist and UWFC evaluations) was analysed statistically. RESULTS: After excluding diagnoses other than PVD as well as unclear images due to cataracts, vitreous bleeding, etc., a total of 103 eyes with PVD were evaluated. A total of 38 ruptures in 25 patients were detected by routine examination and were subjected to laser treatment. UWFC images were reviewed by three ophthalmology consultants and compared with routine examinations. Sensitivity values in detecting retinal ruptures in UWFC images of the three reviewers were 0.89, 0.87 and 0.79, and specificity values were 0.88, 0.86 and 0.93 (kappa values: 0.742, 0.689 and 0.728) respectively. CONCLUSION: Although there have been rapid developments in imaging with UWFC in recent years and it is a very promising method for the future, routine clinical examination is still the only valid method for the detection of retinal tears today.

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PURPOSE: The present study aimed to describe clinical characteristics of patients with posterior vitreous detachment (PVD), to determine the prevalence of retinal tears in PVD patients, and to find predictors for retinal tears in this patient group. METHODS: Retrospective analysis of medical records on patients diagnosed with PVD, retinal tears, or vitreous hemorrhage at the Department of Ophthalmology at Sahlgrenska University Hospital, a tertiary eye center. RESULTS: Between February and July 2009, 365 patients consulted the Department of Ophthalmology for PVD-related symptoms. The incidence of retinal tears was 14.5% (n=53) and that of vitreous and/or retinal hemorrhage was 22.7% (n=83). For analysis of possible predictors for complications to PVD, patients diagnosed with retinal tears or vitreous hemorrhage between May and July 2009 were also included in the study, resulting in a total of 426 patients. Predictors of a retinal tear were symptoms of visual impairment (P=0.024), the presence of vitreous or retinal hemorrhage at examination (P<0.001), and a duration of symptoms for <24 hours (P=0.004). Symptoms of flashes did not constitute an extra risk of retinal tears (P=0.135). Subsequent retinal pathology (follow-up time 4.5 years), including vitreous detachment/hemorrhage or retinal tears/detachment, occurred more often in patients presenting with a retinal tear. For patients with a retinal tear, the relative risk of having a retinal detachment in the same eye during the follow-up time was 17.7 when compared to patients without a retinal tear (risk ratio 17.7, 95% confidence interval 2.2-145). CONCLUSION: Patients seeking care on the first day have a higher risk of retinal tears. Also, symptoms of visual loss or a history of previous PVD-related pathology and vitreous/retinal hemorrhage at examination indicate a substantially higher risk of retinal complications. These findings may lead to better management and order of priority among these patients.