What Happens to Untreated Asymptomatic Retinal Breaks, and Are They Affected by Posterior Vitreous Detachment?

Objective: The purpose of the study was to ascertain the natural consequences of asymptomatic retinal breaks and to learn what effects, if any, the occurrence of posterior vitreous detachment (PVD) has on such breaks.

Design: This was a cohort study of consecutive asymptomatic phakic patients, all of whom had asymptomatic retinal breaks, observed without treatment over periods of 1 to 33 years (average, 11 years).

Participants: There were 196 patients with 235 involved eyes.

Intervention: Periodic clinical examinations, including binocular indirect ophthalmoscopy with scleral indentation on all eyes and posterior vitreous examination on 50 eyes, were performed.

Results: In the total study period, one small peripheral retinal detachment developed, without symptoms, from a previous subclinical detachment over a period of 14 years. Nineteen eyes (8%) originally had or developed 22 areas of subclinical detachment, 2 of which were treated because of moderate extension, even though remaining subclinical and without symptoms. Ten eyes encountered acute PVDs, which caused symptomatic retinal tears in three eyes, one of which also had a clinical retinal detachment. Of the 50 asymptomatic eyes examined with Goldmann lens and slit lamp, 12 (24%) were found to have an existing PVD, which had not led to any complication of the previous retinal breaks in any eye.

Conclusions: Asymptomatic retinal breaks discovered in phakic primary eyes do not show any significant tendency toward clinical retinal detachment, with the exception of a few of those cases that progress to subclinical retinal detachment. It is only some of these, comprising 1% to 2% of the total group, that may justify treatment. Posterior vitreous detachment coexists safely with asymptomatic retinal breaks in phakic primary eyes and shows no tendency to provoke complications to pre-existing breaks at the time of its occurrence.