Posterior Vitreous Detachment in Normal Healthy Subjects Younger Than Age Twenty

Abstract

Purpose: To describe the initiation of posterior vitreous detachment (PVD) in the eyes of normal individuals, under 20 years of age, using wide-angle optical coherence tomography (OCT).

Methods: This is an observational cross-sectional study. Montaged images of horizontal and vertical OCT scans were obtained in 63 healthy eyes of 35 consecutive subjects ranging in age from 4 to 17 years.

Results: Forty-five eyes (71.4%) had obvious PVD, defined as a contiguous line of posterior cortical vitreous separated from the surface of the retina. Eighteen eyes (28.6%) had no PVD. The mean age of the individuals without PVD was significantly younger than those with PVD (P = 0.008). The spatial distribution of PVD initiation was highest in the superior quadrants, with the nasal, inferior, septum papillomaculae, and temporal quadrants following in descending order of frequency (P < 0.001). PVD was observed to begin anterior to the premacular liquefied lacuna, where the vitreous gel directly adheres to the vitreoretinal interface. In the majority of subjects (80.6%), PVD was initiated anterior to the vascular arcades.

Conclusions: PVD can be observed by OCT to begin in the first and second decade of life. It begins in the mid-peripheral vitreous, most frequently in the superior quadrants anterior to the vascular arcades. In this study, all PVDs originated outside of the macular liquefied lacunae, where the vitreous gel adheres directly to the retina.

Figure 1.

Wide-angle montaged OCT images of horizontal (A) and vertical (B) vitreoretinal cross-sections in an eye of a 6-year-old girl with stage 0 PVD. A highly magnified image of an inset in A corresponds to C, and the image in B corresponds to D. There was no PVD in either the horizontal or vertical section, but the premacular liquefied lacuna was clearly delineated. Noted were granular hyperreflections in the posterior vitreous cortex (asterisks in C and D).

Figure 2.

Wide-angle OCT images of vertical cross-sections of left (A) and right (B) eye of a 12-year-old girl with stage 0 PVD. A highly magnified image of an inset in A corresponds to C, and the image in B corresponds to D. Both eyes were in the process of progressing to stage 1a PVD. The confined and very narrow, but distinct, stratifications of the posterior vitreous cortex, defined as “discontinuous vitreoschisis,” were consistently distributed anterior to the vascular arcade (arrowheads in C). In the right eye (D), areas of discontinuous vitreoschisis (arrowheads) later connected with and became contiguous vitreoschisis (arrows). A prevascular vitreous fissure was also present (asterisk in D).

Figure 3.

Wide-angle montaged images of horizontal (A) and vertical (B) vitreoretinal cross-sections in an eye of a 10-year-old boy with stage 1a PVD. A highly magnified image of an inset in A corresponds to C, and the image in B corresponds to D. Arrows indicate PVD lines in the nasal and superior quadrants and septum papillomaculae. Noted were granular hyperreflectivity and vitreous fibers connected to the posterior cortical vitreous perpendicularly (asterisks in A and C). PVD in the superior quadrant was located within the mid-periphery anterior to the arcade vessel (arrowhead in D).

Figure 4.

A wide-angle montaged image of vertical (A) vitreoretinal cross-sections in an eye of 14-year-old girl with stage 1a PVD. A highly magnified image of an inset in the superior quadrant corresponds to B and in the inferior quadrant to C. Arrows indicate contiguous lines of posterior cortical vitreous separated from the retinal surface in both superior and inferior quadrants. PVD expanded beyond the arcade vessels to the margin of the premacular liquefied lacuna (arrowheads).

Figure 5.

Geographic distribution of stage 1a PVD. There was a significant difference in the location of the PVD quadrant of origin. **P < 0.01, ***P < 0.001.