The ability of rapid retinal reattachment to stop or reverse the cellular and molecular events initiated by detachment

PURPOSE: To determine the effects of reattachment on the molecular and cellular events initiated by a retinal detachment lasting 1 hour or 1 day. METHODS: Experimental retinal detachments were created in the right eyes of nine cats. Reattachments were performed 1 hour (n = 3) or 1 day (n = 3) after the detachment, and the animals were killed 3 days after detachment. Three-day detached (n = 3) and normal (n = 3) retinas were used for comparisons. Agarose-embedded sections were double labeled with a panel of antibodies. Some sections were also probed with the TUNEL technique to detect apoptotic cells. Wax-embedded sections were labeled with the MIB-1 antibody to the Ki67 protein to detect proliferating cells. RESULTS: The 1-hour and 1-day detachments followed by reattachment showed a very similar and consistent reduction in photoreceptor deconstruction and the Müller cell gliotic response when compared with 3-day retinal detachments without reattachment. Light microscopy and immunolabeling with opsin antibodies showed a significant reduction in both rod and cone outer segment (OS) degeneration, even though OS length was shorter than normal. The reattachments also showed a reduction in opsin redistribution, retraction of rod terminals, TUNEL-labeled photoreceptors, loss of cytochrome oxidase staining in photoreceptors, neurite outgrowth from second-order neurons, the number of proliferating cells, and the increase in intermediate filaments and loss of soluble proteins from Müller cells. The apparent re-ensheathing of the OS by the apical processes of the retinal pigment epithelium had begun but was not completely normal. CONCLUSIONS: These data indicate that, even though the length of the OS is less than normal, retinal reattachment within 1 day of detachment can either greatly retard or reverse many of the molecular and cellular changes initiated by detachment.     

The ability of hyperoxia to limit the effects of experimental detachment in cone-dominated retina.

PURPOSE: To determine the ability of oxygen supplementation to ameliorate the effects of retinal detachment in a cone-dominated retina. METHODS: Retinal detachments were created in the right eyes of ground squirrels and the animals immediately placed in normoxic (room air) or hyperoxic (70% oxygen) conditions for 3 days. The retinas were sampled from different regions and investigated morphologically or immunocytochemically by light or confocal microscopy. Agarose embedded sections were immunostained with antibody probes to cytochrome oxidase, synaptophysin, medium-to-long wavelength-sensitive (M/L) cone opsin, rod opsin, excitatory amino acid transporter 1 (EAAT1), glutamate synthetase (GS), cellular retinaldehyde-binding protein (CRALBP), and peanut agglutinin (PNA) lectin. Retinal wholemounts were labeled with PNA and antibodies to short (S)-wavelength-sensitive cone opsin and rod opsin. Cell death was examined using a TUNEL assay on agarose sections or using toluidine blue staining on semithin sections. RESULTS: The percentage of dying cells relative to the total nuclei in the photoreceptor layer was significantly reduced, and the total number of nuclei was greater in hyperoxic animals. Triple labeling using TUNEL, anti-M/L cone opsin and anti-rod opsin showed that hyperoxia had a remarkable effect both on the reduction of cone cell death and the maintenance of the overall structure of cone photoreceptors. Analysis of the retinal wholemounts demonstrated the preservation of PNA, S-cone, and rod opsin antibody labeling in the detachments maintained in hyperoxic conditions. Although the disruption of cytochrome oxidase and synaptophysin was seen in normoxic animals, there was minimal disruption in hyperoxic animals. Labeling with anti-EAAT1, anti-GS, and anti-CRALBP was increased in the Müller cells of normoxic animals with detachments, but was decreased in the hyperoxic animals. CONCLUSIONS: Hyperoxia prevents the degeneration of both rods and cones in retinas heavily dominated by cones and mitigates the effect of detachment on Müller cell reactivity. The current results suggest that the rescue of cones is not secondary to that of rods.     

Opsin distribution and protein incorporation in photoreceptors after experimental retinal detachment.

The distribution of opsin was examined immunocytochemically after experimental retinal detachment in adult cats. Retinal detachments were produced by injecting fluid between the retinal pigment epithelium and neural retina. One to 60 days later the animals were killed. Tissue areas from detached and attached retinal regions from the eye with the detached retina, as well as normal (control) retinas, were processed for post-embedding light and electron microscopic immunocytochemistry. In normal and attached retinal regions, anti-opsin labeled the outer segments and Golgi apparatus most heavily, although the entire photoreceptor plasma membrane was labeled at a low level. Beginning at 2 days after retinal detachment, immunolabeling increased in the photoreceptor inner segment, cell body and synaptic terminal plasma membranes. This pattern of anti-opsin labeling continued at all intervals up through the 60-day detachment time-point. Injection of radiolabeled amino acid in detachments from 1 to 30 days show that radiolabeled protein is still transported to the truncated outer segments of the photoreceptor cells. In addition, these outer segment disks label with anti-opsin. These data imply that opsin continues to be transported and incorporated into the outer segments of photoreceptors showing severe degeneration as a result of long-term detachment from the RPE.     

Prevention of experimental proliferative vitreoretinopathy with daunomycin and triamcinolone based on the time course of the disease

· Background: Our previous experiments showed a limited effect of treatment with daunomycin when given at the inflammatory phase of the development of proliferative vitreoretinopathy (PVR) induced by macrophages in rabbits. In the present study, we tested the efficacy of daunomycin when given at the proliferative phase and combined with triamcinolone given separately at the inflammatory phase in the same model. · Methods: Four groups of rabbits, 16 animals in each, respectively received 5 μg daunomycin on day 6; 1 mg triamcinolone immediately after macrophage injection; 1 mg triamcinolone immediately and 5 μg daunomycin on day 6 (combined drugs); and 0.1 ml saline (controls). Ophthalmoscopy and ³H-thymidine autoradiography were use to evaluate the effects of drugs on traction retinal detachments and cellular proliferation in the vitreous and on the retina. · Results: Retinal detachment occurred in 33.3%, 16.1%, 8.3% and 83.3% (P<0.01) of the eyes treated with daunomycin, triamcinolone, combined drugs, and the controls, respectively. Autoradiography revealed significantly decreased numbers of labelled nuclei on days 7 and 14 in daunomycin-treated eyes compared with controls. Significantly decreased numbers of inflammatory cells and labelled cells were noted in eyes treated with triamcinolone and combined drugs. · Conclusion: Daunomycin given at the proliferative phase, and combined with triamcinolone given at the inflammatory phase of PVR, can be more effective in preventing PVR development than daunomycin given at the inflammatory phase. Received: 24 July 1998 Revised version received: 15 September 1998 Accepted: 17 September 1998     

Retinal detachment after surgery of the anterior segment using the pars plana approach

Anterior segment surgery via the pars plana was done on 114 eyes with the Kl?ti vitreous stripper between January, 1977 and December 31, 1982. In every case the posterior capsule was removed when present and anterior or total vitrectomy was performed. None of the 114 eyes had a history of retinal detachment prior to nor at the time of anterior segment surgery. There were 37 cases of trauma in this series. Follow-up varied from 1 to 66 months with 58% of cases having a follow-up of greater than one year. There was a 10.50% post-operative retinal detachment rate (12/114 eyes). Seven detachments occurred in the 37 traumatized eyes (19.10%) versus 5 detachments in 77 non-traumatized eyes (6.49%). Of the 12 detachments, 7 presented signs of severe proliferative vitreoretinopathy (PVR) while the remaining 5 detachments appeared to be uncomplicated. No detachment was related to an iatrogenic tear and no case of PVR seemed to be related to the sclerotomy site. Successful reattachment was achieved in 3 out of 4 uncomplicated cases and 3 out of 5 cases with PVR. Vitrectomy and posterior capsulectomy are often mandatory in anterior segment problems: pupillary membranes, secondary cataracts, lens ectopiae and dislocations, vitreous wick and vitreocorneal touch. In our opinion other indications for vitrectomy and posterior capsulectomy are congenital, juvenile and post-uveitis cataracts.(ABSTRACT TRUNCATED AT 250 WORDS)     

Role of the vitreous in idiopathic preretinal macular fibrosis

Of 250 eyes with idiopathic preretinal macular fibrosis, 56 had no posterior vitreous detachment (Group 1), ten had partial posterior vitreous detachments without vitreous traction to the macula (Group 2), 29 had partial posterior vitreous detachments with vitreous traction to the macula (Group 3), and 155 had complete posterior vitreous detachments (Group 4). There were significantly more eyes with visual acuities of 20/60 or worse, cystoid macular changes, or macular fluorescein leakage in Group 3 than in Group 1 or Group 4. Thus, the presence of vitreous traction to the macula was associated with worse anatomic and functional findings.     

Experimental posterior penetrating eye injury in the rabbit. II. Histology of wound, vitreous, and retina.

The histological findings of the wound, the vitreous, and the retina in the rabbit eye with experimental posterior penetrating injury are described. Wound healing had just begun at 3 days after injury and was well established by 9 to 12 days. It involved proliferation of cells from the episclera and from the choroid. The progression to a fibrous ingrowth from the wound occurred only in eyes with blood in the vitreous. The intravitreal fibroblastic proliferation had begen at 6 days after injury and seemed to be derived from the choroid, the nonpigmented ciliary epithelium and, posteriorly, from the optic nervehead. During the development of retinal detachment the configuration of the peripheral and posterior retina, together with the orientation of vitreous strands, suggested the presence of vitreous traction. We postulate that the presence of contractile fibroblasts (myofibroblasts) in the vitreous may provide the mechanism for vitreous traction. The retinal detachments were also characterised by epiretinal and subretinal membranes, but these were not prominent. The end-stage appearance of a soft, shrunken eye with cyclitic membrane formation and retinal detachment resembles the outcome in many human eyes after severe penetrating injuries.     

Experimental vitreous replacement with perfluorotributylamine

Perfluorotributylamine, a liquid fluorochemical used in artificial blood substitution, was evaluated for potential application as a vitreous substitute having heavier density than saline. It was injected into the vitreous of 38 rabbit eyes after mechanical vitrectomy or gas compression of the vitreous with perfluoropropane. The eyes were observed for periods of up to five months. Clinically the liquid occupied the lower vitreous space but gradually dispersed into smaller fluorochemical droplets. In the upper vitreous clusters of cells appeared within three to four weeks which precipitated on the posterior lens surface and in the cortical vitreous. In eyes with experimental retinal detachment perfluorotributylamine had physical properties which provided mechanical retinal tamponade. Its interfacial tension prevented passage through iatrogenic retinal breaks. Histopathologic findings showed irregularly shaped defects in the outer segment disks as early as two days after vitreous replacement. These changes appeared to reverse if perfluorotributylamine was removed after two days. The cellular response in the vitreous consisted primarily of monocyte-derived macrophages capable of ingesting fluorochemical (foam cells).     

后房型人工晶体缝线固定术后视网膜脱离原因分析

目的报告后房型人工晶体缝线固定术后视网膜脱离的临床特征。方法观察后房型人工晶体缝线固定术后视网膜脱离14例14[的患者背景、术中所见及术后观察。结果患者术后视网膜脱离发生在20～204日(平均96.5日),初次手术6[施行了巩膜环扎术,8[玻璃体手术。经玻璃体手术者视网膜全部解剖复位,3[巩膜外手术复位失败,后经玻璃体手术视网膜复位。视网膜脱离发生的原因是睫状沟缝合时医源性裂孔3[,前部玻璃体牵拉性网膜裂孔11[。术后视力提高的5[,不变者6[,3[视力下降。结论后房型人工晶体缝线固定术后前部玻璃体的牵拉是视网膜脱离的主要原因,玻璃体手术是有效的。另外,由于血—[屏障的破坏易发生前部增生性玻璃体病变,早期的玻璃体手术是重要的。     

Plasmin in subretinal fluid

Proteolytic activity was studied in subretinal fluid from 56 eyes with rhegmatogenous retinal detachment without vitreous or subretinal hemorrhage. Active plasmin (1.0-15.2 micrograms/ml) was found in 33 eyes and plasmin-inhibitor complexes in 3 eyes. Plasmin was detected more often in large detachments, but there was no clear correlation with the duration of the detachment or characteristics of the holes in the retina. It seems possible that plasmin in subretinal fluid may enhance release of cells from the pigment epithelium by degrading the extracellular matrix and contribute to the development of proliferative vitreoretinopathy.     

Diabetic Traction Retinal Detachment: Factors Influencing Final Visual Acuity

A group of eyes with clear media and diabetic traction retinal detachments treated with vitreous surgery were statistically analyzed to identify those parameters that would allow us to improve case selection. The configuration of the retinal detachment proved to be important, with hammock and flat diffuse central detachments having a good prognosis, and highly elevated, atrophic detachments such as table-top and tent-shaped demonstrating a poor prognosis. Eyes with florid diabetic retinopathy did less well than those with more inactive forms of retinopathy. Preretinal membranectomy, although accompanied by an increased rate of iatrogenic retinal tears, has a definite role in the treatment of more complex traction detachments and increases the number of eyes that may benefit from surgery. Eyes with preoperative vision better than 5/200 did significantly better than eyes with poorer preoperative vision.     

Retinal detachment caused by small tears in the equatorial region of the retina

46 Phakic rhegmatogenous retinal detachments due solely to round atrophic holes in the equatorial region were observed in 42 patients. The clinical characteristics and the prognosis of the retinal detachments differ from those of retinal detachments associated with horse-show retinal tears. The 46 phakic retinal detachments due solely to round atrophic holes in the equatorial region account for 5.8% of all rhegmatogenous retinal detachments operated during the same period of time, 81% of the patients were under 40 years of age, 93.5% of the eyes were myopic. The round atrophic holes were located within foci of equatorial lattice degeneration in 97.8% of the eyes. The number of holes per eye varied from 1 to 16 with a mean number of 4.54. The location of the holes showed a significant prevalence for the lower temporal quadrant (83.3% of the eyes) and then the upper temporal quadrant (47.8% of the eyes). The retinal detachments had a slow progression and demarcation lines were present in 56.5% of the eyes. In spite of the long standing duration none of the detachments were associated with clinical evidence of proliferative vitreo retinopathy. Surgical prognosis was excellent. Retinal reattachment was achieved in all cases. Post operative visual acuity of 20/40 or better was achieved in 60% of the eyes. It is assumed that the absence of proliferative vitreo retinopathy in those retinal detachments is related to the absence of significant vitreous degeneration and posterior vitreous detachment.     

B-scan ultrasonography following open globe repair

Purpose

To examine the accuracy and predictive ability of B-scan ultrasonography in the post-repair assessment of an open globe injury.

Methods

In all, 965 open globe injuries treated at the Massachusetts Eye and Ear Infirmary between 1 January 2000 and 1 June 2010 were retrospectively reviewed. A total of 427 ultrasound reports on 210 patients were analyzed. Ultrasound reports were examined for the following characteristics: vitreous hemorrhage, vitreous tag, retinal tear, RD (including subcategories total RD, partial RD, closed funnel RD, open funnel RD, and chronic RD), vitreous traction, vitreous debris, serous choroidal detachment, hemorrhagic choroidal detachment, kissing choroidal detachment, dislocated crystalline lens, dislocated intraocular lens (IOL), disrupted crystalline lens, intraocular foreign body (IOFB), intraocular air, irregular posterior globe contour, disorganized posterior intraocular contents, posterior vitreous detachment, choroidal vs retinal detachment, vitreal membranes, and choroidal thickening. The main outcome measure was visual outcome at final follow-up.

Results

Among 427 B-scan reports, there were a total of 57 retinal detachments, 19 retinal tears, 18 vitreous traction, 59 serous choroidal detachments, 47 hemorrhagic choroidal detachments, and 10 kissing choroidal detachments. Of patients with multiple studies, 26% developed retinal detachments or retinal tears on subsequent scans. Ultrasound had 100% positive predictive value for diagnosing retinal detachment and IOFB. The diagnoses of retinal detachment, disorganized posterior contents, hemorrhagic choroidal detachment, kissing choroidal detachment, and irregular posterior contour were associated with worse visual acuity at final follow-up. Disorganized posterior contents correlated with particularly poor outcomes.

Conclusions

B-scan ultrasonography is a proven, cost-effective imaging modality in the management of an open globe injury. This tool can offer both diagnostic and prognostic information, useful for both surgical planning and further medical management.     

Cataracts, bilateral macular holes, and rhegmatogenous retinal detachment induced by lightning

PURPOSE: To report ocular injuries, including a unilateral rhegmatogenous retinal detachment, induced by lightning. METHOD: Case report. A 30-year-old man was injured by lightning. RESULTS: The patient developed a severe decrease in visual acuity in both eyes, an afferent pupillary defect in his left eye, bilateral cataracts, posterior vitreous detachments, macular holes, and an inferotemporal retinal detachment with an associated flap retinal tear in his left eye. CONCLUSIONS: This is a case of bilateral cataracts, posterior vitreous detachments, macular holes, and a unilateral retinal detachment associated with lightning. We postulate that the heating of the retinal surface, the concussive forces on the eye, and a sudden lateral contraction of the attached vitreous resulted in bilateral posterior vitreous detachments and a unilateral peripheral retinal break.     

Fibrovascular proliferation and retinal detachment after intravitreal injection of activated macrophages in the rabbit eye

Injection of activated macrophages into the posterior vitreous of the rabbit induced vigorous fibrovascular proliferation over the optic disk and medullary rays, as demonstrated by 3H-thymidine autoradiography. One week after injection, endothelial cells and pericytes of the capillaries near the inner surface of the optic disk and rays were labeled; fibroblast-like cells, which were also labeled, migrated and formed vitreous strands. By the second week after injection, the fibrovascular tissue proliferated most actively, and traction medullary ray detachment and peripapillary retinal fold formation were observed. The cellular proliferation was accompanied by inflammatory cell infiltration. Glial cells within the optic disk, as well as retinal pigment epithelial cells beneath the detached retina, were labeled by 3H-thymidine. These results demonstrate that the fibrovascular proliferation originates from the vessel complex of the optic disk and medullary rays in this experimental model of retinal detachment.     

Incidence of retinal detachment and visual outcome in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage

PURPOSE: To determine visual outcomes and the incidence of retinal detachment in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage. DESIGN: Retrospective consecutive noncomparative interventional case series. PARTICIPANTS: Thirty-six eyes (15 right eyes and 21 left eyes) of 34 patients (18 female and 16 male) ranging in age from 42 to 94 years. Mean follow-up was 14 months. METHODS: A comparison of the best-corrected initial visual acuities versus final visual acuities after spontaneous resolution of vitreous hemorrhage or surgical intervention. The number of eyes that were found to have retinal tears or that had a rhegmatogenous retinal detachment develop was documented. Logarithm of the minimum angle of resolution-converted visual acuities was used for comparison. Categorical data were analyzed by Fisher's exact test, and population means were compared by Student's t test. MAIN OUTCOME MEASURES: Final mean visual acuities, number of eyes with at least one retinal tear, location of retinal tears, number of eyes that had retinal detachment develop, and the number of eyes repaired with scleral buckling surgery and/or pars plana vitrectomy. RESULTS: Twenty-four of 36 eyes (67%) were found to have at least one retinal break (range, 0-4 breaks), with 88% of breaks located in the superior retina. Eleven eyes (31%) had more than one retinal break. Fourteen of 36 eyes (39%) had a rhegmatogenous retinal detachment develop that was repaired with pars plana vitrectomy and scleral buckling. An additional 14 eyes (39%) underwent vitrectomy for nonclearing vitreous hemorrhage. The incidence of retinal detachment in eyes with a history of retinal detachment in the contralateral eye was 75% (P = 0.04). Seven of 14 eyes (50%) with retinal detachment had coexisting proliferative vitreoretinopathy. Most retinal breaks and detachments occurred in emmetropic or myopic eyes. For all 36 eyes the mean preoperative visual acuity was 20/1233, and the mean final visual acuity was 20/62 (P < 0.0001). Eyes that had a macula-off retinal detachment develop had worse final visual outcomes (20/264; P = 0.01), as did eyes that had proliferative vitreoretinopathy develop (20/129; P = 0.04). CONCLUSIONS: Acute, spontaneous, nontraumatic posterior vitreous separation with dense fundus-obscuring vitreous hemorrhage is associated with a high incidence of retinal tears and detachment. Close follow-up with clinical examination and ultrasonography is necessary, because many of these eyes may eventually require surgical intervention. Aggressive management with early vitrectomy should be considered when there is a history of retinal detachment in the contralateral eye.     

Results of vitrectomy for proliferative diabetic retinopathy

The authors treated 1007 eyes with vitrectomy for complications of proliferative diabetic retinopathy. Indications for surgery were: vitreous hemorrhage, 353 eyes (35%); traction retinal detachment, 360 eyes (36%); combined traction-rhegmatogenous retinal detachment, 172 eyes (17%); and other progressive fibrovascular proliferation 122 eyes (12%). During the study period, the frequency of vitreous hemorrhage as an indication for surgery decreased from 42 to 25%, and other progressive fibrovascular proliferation increased from 5 to 22%. The frequency of traction and traction/rhegmatogenous retinal detachments did not change. The results of surgery varied according to the indication. Seventy-nine percent of eyes with vitreous hemorrhage obtained final vision of 5/200 or better. Similar results were obtained in 64% of eyes with traction detachment, 56% of eyes with rhegmatogenous detachment, and 81% of eyes with progressive fibrovascular proliferation. The percentage of eyes achieving final vision of 20/100 or better are as follows: vitreous hemorrhage, 48%; traction detachment, 27%; rhegmatogenous detachment, 24%; and progressive fibrovascular proliferation, 46%. The success rate improved in each anatomic category during the last 3 years of the study.     

继发于圆形视网膜裂孔的视网膜脱离临床分析

目的探讨继发于圆形视网膜裂孔的视网膜脱离临床特点、手术方式及治疗效果。方法对67例(73只眼)继发于圆形视网膜裂孔的视网膜脱离患者临床资料进行回顾性分析,分析患者年龄、性别、屈光状态、术前视力、视网膜裂孔数量分布、视网膜脱离范围、玻璃体后脱离以及手术方式、手术效果、术后视力。结果患者平均年龄30.12岁,以女性(64.17%)和近视(87.37%)为主,46只眼(63.01%)不伴有玻璃体后脱离。对侧眼视网膜变性和圆形裂孔31只眼(42.46%)。71只眼行巩膜扣带术。2只眼行玻璃体切割术。手术复位71只眼(97.26%)。结论继发于圆形视网膜裂孔的视网膜脱离多发于女性患者尤其是女性近视患者,病情进展缓慢,多不伴有玻璃体后脱离,由于双眼同时发病概率较高,必须常规进行对侧眼检查。巩膜扣带术是治疗该类病变的有效方法。     

Involution of retinopathy of prematurity after laser treatment: factors associated with development of retinal detachment

PURPOSE: To identify specific features during the process of involution of retinopathy of prematurity after treatment at threshold that are associated with development of a retinal detachment. DESIGN: Retrospective case series. METHODS: The evolution of retinal detachments over time was analyzed retrospectively in 262 treated eyes of 138 infants. Specific features hypothesized to be associated with development of a retinal detachment were analyzed, including vitreous organization defined as clinically important, active stage 3 disease and active plus disease more than 21 days after treatment, and vitreous hemorrhage defined as clinically important. RESULTS: A retinal detachment developed in 36 (13.7%) of 262 eyes. Vitreous organization meeting our clinically important definition was associated with a 31-fold (confidence interval [CI] 5.37-183.63; P < .0001) and 13-fold (CI 2.97-58.59; P < .0001) increase in the odds for retinal detachment for right and left eyes, respectively. Vitreous hemorrhage defined as clinically important was associated with a 38-fold (CI 2.69-551.19; P = .007) and 15-fold (CI 1.65-144.12; P = .02) increase in the odds for retinal detachment for right and left eyes, respectively. The timing of retinal detachment relative to vitreous hemorrhage was not determined. Prolonged activity of Stage 3 disease or plus disease more than 21 days after treatment was not associated with development of a retinal detachment. CONCLUSIONS: Clinically important vitreous organization and vitreous hemorrhage were predictive for development of a retinal detachment. Evaluation of preemptive reintervention strategies for eyes at highest risk for developing a retinal detachment may be reasonable.     

Complications of acute symptomatic posterior vitreous detachment

During a ten-year period, 172 eyes of 155 patients developed acute symptomatic posterior vitreous detachments. The study included only patients examined within three months of the onset of symptoms. The patients ranged in age from 22 to 82 years, with an average age of 60 years. Of the 172 eyes, 118 (69%) developed no retinal or vitreous complications. Retinal tears occurred in 14 eyes (8%) and vitreous or retinal hemorrhages occurred in 36 eyes (21%). Seventeen patients (11%) who had acute symptomatic posterior vitreous detachment in one eye later developed acute symptomatic posterior vitreous detachment in the fellow eye. The second posterior vitreous detachment developed within two years of the first one in 15 eyes (88%). In 13 patients (76%), the second eye responded in the same manner to the posterior vitreous detachment as had the first, that is, ten pairs of eyes had no further complications, two pairs had retinal or vitreous hemorrhages, and one pair had retinal breaks.