Accuracy of biomicroscopy, ultrasonography and spectral-domain OCT in detection of complete posterior vitreous detachment

Purpose: To evaluate the accuracy of pre-operative biomicroscopy (BM), ultrasonography (US), and spectral domain optical coherence tomography (SD-OCT) for determining complete posterior vitreous detachment (PVD) confirmed by intraoperative findings of triamcinolone acetonide-assisted pars plana vitrectomy (PPV).

Design: This was a prospective, consecutive, interventional case series.

Methods: The study included all patients admitted for surgical treatment of epiretinal membrane (ERM) and macular hole (MH). Presence of complete PVD was determined one day before PPV using BM, US, and SD-OCT. Preoperative findings were compared to PVD status determined during PPV.

Results: A total of 123 eyes of 123 patients were included in the study. Indications for PPV included ER in 57 (46.34%), full thickness macular hole in 57 (46.34%), and lamelar macular hole in 9 (7.32%) patients. Complete PVD during PPV was observed in 18 (31.58%; 95% CI:18.72–49.91) patients with ERM and 13 (19.7%; 95% CI: 10.49–33.68) patients with MH. Vitreoschisis was present in 30 (24.39%; 95% CI: 15.46–34.82) patients during PPV. The sensitivity of preoperative BM, US, SD-OCT was 48.4% (95% CI: 30.2–66.9), 61.3% (95%CI: 42.2–78.2) and 54.8% (95% CI: 36.0–72.7) respectively. The specificity of preoperative BM, US, SD-OCT was 81.5% (95% CI: 72.1–88.9), 90.2% (95% CI: 82.2–95.4) and 85.9% (95% CI: 77.0–92.3) respectively. With a prevalence of 25.2% of PVD in our sample the positive predictive value of preoperative BM, US, SD-OCT was 46.9% (95% CI: 29.1–65.3), 67.9% (95% CI: 47.6–84.1) and 56.7% (37.4–74.5) respectively.

Conclusion: Preoperative BM, US, and SD-OCT are associated with poor sensitivity and a rather good specificity for detecting complete PVD.  There is relatively a high percentage of patients with vitreoschisis undergoing vitreoretinal surgery, therefore vitreoretinal surgeons should consider routine usage of triamcinolone in all vitreoretinal cases.