7.1 Features
Posterior vitreous detachment (PVD) is the separation between the posterior vitreous cortex and the internal limiting membrane of the retina. Usually it occurs after the fifth decade of life, with a prevalence of 53% after 50 years with increasing occurrence with age. PVD is part of natural aging and represents the result of two progressive vitreous alterations: the weakening of the vitreoretinal adhesion and vitreous liquefaction (synchysis senilis). PVD typically begins in the perifoveal macula as a shallow separation from the perifoveal retina and slowly extends until vitreous separation from the optic disc margin is complete (▶ Fig. 7.1). In the absence of PVD-related complications, the early stages of PVD are asymptomatic. However, if vitreous liquefaction occurs before adequate weakening of the vitreoretinal adhesion, the traction forces may lead to several pathologic events at the vitreoretinal interface. These complications may occur throughout the retinal surface, including in the retinal periphery (e.g., retinal tears and vitreous hemorrhage retinal detachment; ▶ Fig. 7.2a) and also in the posterior pole (e.g., epiretinal membrane, macular hole, and vitreomacular traction; ▶ Fig. 7.3).
Fig. 7.1 Optical coherence tomography images of posterior vitreous detachment (PVD) stages. (a) Early-stage PVD with shallow vitreous separation from the perifoveal retina. (b) Perifoveal PVD with vitreofoveal adhesion. (c) PVD progression through the fovea. (d) Complete PVD.
Fig. 7.2 Fundus photograph of a complete posterior vitreous detachment (PVD). (a) Fundus photograph showing peripheral retinal tear associated with rhegmatogenous retinal detachment (arrow), 2 weeks after PVD symptoms. (b) Zoom demonstrating Weiss ring (arrow).
Fig. 7.3 Optical coherence tomography scan of symptomatic patient (visual acuity 20/40), presenting vitreofoveal traction syndrome; note vitreofoveal adhesion with anterior traction of the macula causing foveal thickening.
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