Differentials
Vitreomacular traction
SIGNS / SYMPTOMS
The posterior cortical vitreous partially separates from the retina, but contact remains with some areas and tractional forces are exerted.
May cause thickening, distortion, intraretinal cystoid changes, macular hole, and subretinal fluid in the macula.[45]
Symptoms vary depending on the severity of the traction and the resulting distortion or detachment of the macula.[45]
Patients may be asymptomatic or report impaired visual function and metamorphopsia. Symptoms may be acute or chronic.[45]
INVESTIGATIONS
Alternative diagnoses can be differentiated by slit-lamp biomicroscopy and indirect peripheral retinal exam.
Optical coherence tomography is highly sensitive for vitreomacular traction. Shows the posterior hyaloid remaining partially attached to the macula, but separated in the perimacular region.[45]
30% to 40% resolve spontaneously over 1-2 years; some require release by vitrectomy or intravitreal gas injection.[45]
Retinoschisis
SIGNS / SYMPTOMS
Degenerative (peripheral) retinoschisis and rhegmatogenous retinal detachment can coexist in the same eye. However, retinoschisis is commonly bilateral and symmetric.
INVESTIGATIONS
Indirect ophthalmoscopy with scleral indentation and slit-lamp biomicroscopy show that the fluid is intraretinal, rather than subretinal, and therefore does not shift with scleral depression. There is no pigment in the vitreous cavity and the retinal surface has a "beaten-metal" appearance.[46]
Diabetic retinopathy
SIGNS / SYMPTOMS
Usually presents symmetrically.
Exam shows bilateral microaneurysms, hemorrhages, and neovascularization on both sides of the horizontal raphe in the absence of collateral vessels. Vitreous hemorrhage is a common complication that does not differ in presentation from that seen in conjunction with an retinal detachment (RD).
INVESTIGATIONS
Clinical diagnosis.
Fluorescein angiogram shows multifocal areas of nonperfusion.
Ultrasonography may help identify the presence of a retinal break and the absence of an RD.
Retinal vein occlusion
SIGNS / SYMPTOMS
Clinical presentation may be similar (vitreous hemorrhage, sudden loss of vision).
INVESTIGATIONS
Clinical diagnosis.
Fluorescein angiogram shows focal or multifocal areas of nonperfusion.
Ultrasonography may help identify the absence of an retinal detachment.
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