Posterior Vitreous Detachment as Observed by Wide-Angle OCT Imaging

Purpose: Posterior vitreous detachment (PVD) plays an important role in vitreoretinal interface disorders. Historically, observations of PVD using OCT have been limited to the macular region. The purpose of this study is to image the wide-angle vitreoretinal interface after PVD in normal subjects using montaged OCT images. Design: An observational cross-sectional study. Participants: A total of 144 healthy eyes of 98 normal subjects aged 21 to 95 years (51.4 +/- 22.0 [mean +/- standard deviation]). Methods: Montaged images of horizontal and vertical OCT scans through the fovea were obtained in each subject. Main Outcome Measures: Montaged OCT images. Results: By using wide-angle OCT, we imaged the vitreoretinal interface from the macula to the periphery. PVD was classified into 5 stages: stage 0, no PVD (2 eyes, both aged 21 years); stage 1, peripheral PVD limited to paramacular to peripheral zones (88 eyes, mean age 38.9 +/- 16.2 years, mean +/- standard deviation); stage 2, perifoveal PVD extending to the periphery (12 eyes, mean age 67.9 +/- 8.4 years); stage 3, peripapillary PVD with persistent vitreopapillary adhesion alone (7 eyes, mean age 70.9 +/- 11.9 years); stage 4, complete PVD (35 eyes, mean age 75.1 +/- 10.1 years). All stage 1 PVDs (100%) were observed in the paramacular to peripheral region where the vitreous gel adheres directly to the cortical vitreous and retinal surface. After progression to stage 2 PVD, the area of PVD extends posteriorly to the perifovea and anteriorly to the periphery. Vitreoschisis was observed in 41.2% at PVD initiation (stage 1a). Conclusions: Whereas prior work suggests that PVD originates in the perifoveal region and after the sixth decade, our observations demonstrate that (1) PVD first appears even in the third decade of life and gradually appears more extensively throughout life; (2) more than 40% of eyes without fundus diseases at their PVD initiation are associated with vitreoschisis; and (3) PVD is first noted primarily in the paramacular-peripheral region where vitreous gel adheres to the retinal surface and is noted to be more extensive in older ages to ultimately involve the fovea. (C) 2018 by the American Academy of Ophthalmology