European Journal of Cardiovascular Medicine

The vitreous humor is the gel-like structure of the human eye. It consists of the transparent tissue that makes up the vitreous and accounts for more than 75% of the total volume of the eye. Posterior vitreous detachment (PVD) results from degeneration and collapse of the vitreous, which causes the vitreous to separate from the inner retina. The incidence of this aging process is approximately 24% in people aged 50–59 years and as high as 87% in people aged 80–89 years. Visual disturbances such as stage floaters and/or flashes of light. (1, 2) In addition, a recent study has shown that the incidence of ocular complications in patients with PVD symptoms confirmed by ophthalmoscopy was 14%. OCT) is a widely used, noninvasive technique for delineating retinal vessels and peripapillary retinal nerve fiber layer (RNFL) thickness.

Although aging is often a degenerative process associated with retinal thinning, as confirmed by many studies (3,4) PVD patients with peripheral retinal tears have a higher vitreous response to mechanical injury during posterior vitreous membrane detachment, resulting in more severe lesions that may lead to at least transient peripapillary retinal thickening. >The purpose of this study was to determine whether there is a relationship between optic disc structure and peripapillary RNFL thickness and the incidence of peripheral retinal tears in patients with symptomatic PVD. We hypothesized that patients with peripheral retinal tears may have a greater inflammatory response resulting in a different OCT optic disc compared to patients without retinal tears.

This study was a prospective observational study done in a tertiary medical college in central India from 1^stJan 2023 to September 2023 on 150 patients, 75 patients in 2 groups.

Patients were divided into two groups according to whether peripheral retinal tears were present on fundoscopic examination. 76 patients developed PVD with peripheral retinal tears, while 74 patients developed complete PVD without peripheral retinal tears (control group of this study). Studies on patients with diabetes, optic neuropathy, and malignant peripheral retinal degeneration were excluded. Malignant peripheral retinal degeneration is defined as areas of the peripheral retina with strong adhesion between the vitreous membrane and the retina (e.g., lattice degeneration), because these areas are susceptible to retinal tears during PVD. After mandatory evaluation, patients with peripheral retinal tears were treated with argon laser photocoagulation, while patients in the control group were scheduled for examination after two weeks unless symptoms were newly designed.

Data analysis was performed using MedCalc, version 20.211 (MedCalc Software Ltd, Ostend, Belgium). The Kolmogorov–Smirnov test was applied to test if variables are normally distributed. Continuous variables are expressed as the means ± SD or medians and interquartile range (IQR), and independent-samples t-test or Mann–Whitney U-test were used to evaluate statistical significance. Linear regression was used to test the association between variables. Statistical significance was set at two-sided P < 0.05.

Between Jan 2023 and September 2024, 182 patients consulted the emergency department of the ophthalmological clinic due to PVD-related symptoms. 32 patients were excluded from the study due to insufficient data or poor signal strength on examination scans. Ultimately, we analyzed the data on 150 patients. The baseline demographic and clinical characteristics of the patients are presented in Table 1.

TABLE 1 showing age, gender and ASA grade-wise distribution of patients in 2 groups

The analysis of optic nerve head and peripapillary RNFL thickness in the patients was performed using OCT.

Finally, there was no statistically significant difference between the tear and control groups when comparing rim area, disc area or cup-to-disc ratio parameters.

The distribution of retinal tears per quadrant is presented in Table 2.

Table2: Distribution of patients according to surgical procedure

Figure 1: Compare of axial lengths between groups

OCT Analysis

The analysis of optic nerve head and peripapillary RNFL thickness in the patients was performed using OCT.

When comparing the axial length (mm) between the tear and control groups, a significant difference was observed between the groups (IQR, 23.83 to 24.47 vs 23.27 to 23.98, P = 0.029, Mann–Whitney U-test) (Figure 1).

The linear regression showed that younger patients had a significantly (P < 0.001) longer axial length in comparison with older patients (Figure 2).

Figure 2: Relationship between axial length and age; a linear regression.

Furthermore, when comparing the average RNFL thickness (μm) between the tear and control groups, patients with retinal tears had a significantly greater average RNFL thickness (87.18 [95% confidence interval (CI), 84.47 to 89.9] vs 81.14 [95% CI, 77.81 to 84.46], P = 0.005) (Figure 3).

Figure 3:         Comparison of RNFL thickness between groups.

Average RNFL thickness showed a significant decrease in linear regression analysis (P = 0.029) with increasing age; however, there was no significant difference in decreasing linear regression with age between the tear and control groups (Figure 4).

Figure 4: Relationship between RNFL thickness and age; a linear regression

The size of cup volume (mm3) was significantly different between the two groups (IQR, 0.06 to 0.22 vs 0.04 to 0.1, P = 0.036, Mann–Whitney U-test), as is shown in Figure 5.

Figure 5: Comparison of cup volume between groups.

The current cross-sectional study including 150 patients found that retinal tears after PVD were associated with greater RNFL thickness measured by OCT. Studies have also shown that patients who developed retinal tears after PVD had a larger optic cup volume compared with patients without retinal tears. To our knowledge, this is the first study to evaluate the effects of optic disc structure and peripapillary RNFL thickness on the development of peripheral retinal tears in patients with symptomatic PVD. Tension varies; the tension is greatest around the base of the vitreous body, optic disc, macular area, and large vessels. We also think that this publication may differ depending on the clinical situation affecting optic disc configuration as a risk factor for the development of peripheral retinal tears in PVD. The mean RNFL thickness was significantly increased compared with cleft patients. The changes are due to the separation of the vitreous membrane during PVD and are equivalent to those resulting from surgically induced separation of the epiretinal tissue in the form of the epiretinal membrane or internal limiting membrane (ILM), as seen in many clinical studies. Post-retinal thickness of the epiretinal membrane (ERM)/ILM was observed. We also think that there is a continuation of the vitreous membrane (e.g. peripapillary area) in some places in the retinal periphery and that the same place is the area where the retina spreads, i.e. retinal tears. The rate depends on the use of mechanical and inflammatory processes in the early stages of posterior vitreous detachment. However, electron microscopic examination is required to prove this claim. About. Axial myopia is widely accepted as a significant risk factor for retinal tears and is one of the most important factors in the BRET score. The main difference was that the tear group defined young people.), inferior temporal quadrant (10.5%) and infranasal quadrant (5.3%). Two previous studies have shown that peripheral retinal tears in retinal detachments are similar to isolated tears, most likely occurring in the outer body (55%) and least likely in the infranasal quadrant (6%). (5-10)

Limitation: This study used a randomized design with a sample of 150 patients and does not provide insight into the pathophysiology of the formation of peripheral retinal tears in patients with greater RNFL thickness and greater optic cup volume as measured by OCT and therefore cannot be generalized to the general population, which would be more likely to benefit patients due to potential selection bias. In particular, in the absence of long-term follow-up, it is difficult to monitor changes over time. The wide age range of patients may lead to greater variation in results, and the use of specific measurement tools may affect the reproducibility of results in different settings.

In our study we found In PVD with peripheral retinal tears due to trauma and subsequent inflammation, the mean peripapillary RNFL thickness may be related to greater adhesion of the posterior vitreous membrane to the retina and may also indicate the area of ​​the peripheral retina where the retinal tear occurs. This cross-sectional study suggests that OCT analysis of optic disc structure may be a useful tool in assessing the risk of developing peripheral retinal tears after PVD. However, further investigation of the mechanisms underlying this problem is necessary to improve our understanding and improve clinical outcomes

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