Symptoms predictive for the later development of retinal breaks

Objective: To identify symptoms in patients with isolated posterior vitreou s detachment predictive for the later development of retinal breaks. Methods: Two hundred eighty consecutive patients seen with symptoms of post erior vitreous detachment were prospectively asked to complete a questionna ire detailing their symptoms. At the time of presentation and follow-up, al l patients had a full ophthalmologic examination including slitlamp biomicr oscopy with Goldmann 3-mirror contact lens after maximal pupil dilatation. Two hundred fifty patients with an isolated posterior vitreous detachment w ere included and reexamined 6 weeks after the onset of symptoms. If small r etinal or vitreous hemorrhages were detected, patients were reexamined afte r 2 weeks. Results: In 13 patients (5.2%) a retinal break was detected at reexaminatio n. Logistic regression analysis with backward elimination revealed that sym ptoms of flashes in combination with clouds or multiple (> 10) small dots a t the time of the initial examination or an increase of floaters after the initial examination were statistically significantly (P < .001) related to the development of new breaks. These symptoms had a predictive value for th e presence or absence of a new retinal break of 75.0% and 99.6%, respective ly. Conclusions: Specific symptoms can identify patients at risk for the develo pment of new retinal breaks after an initial examination in which no abnorm alities were found and may obviate the need for follow-up appointments of p atients not at risk.