A Retrospective Chart Review: The Presence of Anterior Hyaloid Separation Sign in Posterior Vitreous Detachment

TL;DR

This study identifies a new eye sign called anterior hyaloid separation (AHSS) that helps diagnose posterior vitreous detachment (PVD) more easily than the traditional Weiss ring.

Contribution

The study introduces and validates the anterior hyaloid separation sign as a novel diagnostic indicator for posterior vitreous detachment.

Findings

AHSS was present in 89.7% of PVD cases, significantly higher than expected.

The presence of AHSS was strongly associated with PVD diagnosis.

AHSS is easier to visualize than the Weiss ring, offering a practical alternative for PVD confirmation.

Abstract

Background and objective

The presence of Weiss ring is classically used to aid in the diagnosis of posterior vitreous detachment (PVD) but may at times be challenging to visualize under slit-lamp biomicroscopy. The anterior hyaloid separation sign (AHSS) is a previously undescribed sign that is seen among patients with PVD as a "veil of vitreous" in the anterior vitreous cavity. AHSS is easier to visualize than Weiss ring and may prove useful in settings where Weiss ring detection is not feasible.

Methods

This study analyzed the connection between the presence of AHSS among the PVD population. A retrospective chart review of patients with established PVD (n=214) enrolled at Mason Eye Clinic (Columbia, Missouri, United States) between February 1, 2023, and October 1, 2023, was performed. All patients with a confirmed diagnosis of PVD were stratified as exhibiting AHSS or not exhibiting AHSS. Data including patient demographics, lens status, and ocular comorbidities were collected.

Results

The mean age was 70.3 years, 72% were females, and 93.9% were Caucasians. Ocular comorbidities include epiretinal membrane (17.8%), retinal tear (9.8%), proliferative diabetic retinopathy (5.1%), retinal vein occlusion (4.7%), uveitis (4.7%), rhegmatogenous retinal detachment (4.2%), and sickle cell disease (1%). Around 56.2% of cases were newly diagnosed PVD, while 43.8% were long-standing PVD. Among all PVD cases (n=214), 89.7% (n=192) presented with AHSS, whereas 10.3% (n=22) did not present with AHSS. The chi-squared goodness-of-fit test compared this study's AHSS prevalence in PVD with the general PVD population. Analysis revealed a significant prevalence between the presence and absence of AHSS in PVD patients at 84% (p=0.02).

Conclusion

The presence of AHSS has a high prevalence among patients with PVD and holds value in aiding the diagnosis and confirmation of PVD.

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