The role of ultra-widefield imaging with navigated central and peripheral cross-sectional and three-dimensional swept source optical coherence tomography in ophthalmology: Clinical applications.

PURPOSE: To assess central and peripheral retinal and choroidal diseases using ultra-widefield (UWF) fundus imaging in combination with navigated central and peripheral cross-sectional and three-dimensional (3D) swept source optical coherence tomography (SS-OCT) scans. METHODS: Retrospective study involving 332 consecutive patients, with a nearly equal distribution of males and females. The mean age of patients was 52 years (range 18-92 years). Average refractive error was -3.80 D (range +7.75 to -20.75 D). RESULTS: The observations in this study demonstrate the efficacy of peripheral navigated SS-OCT in assessing various ocular conditions. The technology provides high-quality images of the peripheral vitreous, vitreoretinal interface, retina, and choroid, enabling visualization of vitreous floaters and opacities, retinal holes and tears, pigmented lesions, and peripheral retinal degenerations. 3D OCT scans enhance the visualization of these abnormalities and improve diagnostic and therapeutic decisions. CONCLUSION: Navigated central and peripheral cross-sectional and 3D SS-OCT scans offer significant complementary benefits in the assessment and management of retinal diseases. Their addition to UWF imaging provides a comprehensive view of central and peripheral ocular structures, aiding in early detection, precise anatomical measurements, and objective monitoring of disease progression. In addition, this technology serves as a valuable tool for patient education, a teaching tool for trainees, and documentation for medico-legal purposes.

Peripheral Lattice Degeneration Imaging with Ultra-Widefield Swept-Source Optical Coherence Tomography.

PURPOSE: To investigate a series of peripheral lattice degeneration cases using an ultra-widefield (UWF) swept-source optical coherence tomography (SS-OCT) system. METHODS: From August 1, 2022 to July 31, 2023, 19 eyes from 16 patients with peripheral lattice degeneration were included. They all underwent a UWF SS-OCT examination. Anatomy of retina, vitreous, and associated pathologic changes were assessed. RESULTS: UWF SS-OCT showed various anatomical changes of retina and vitreous in patients with lattice degeneration. Of 15 eyes from 12 patients whose UWF SS-OCT images were clearly obtained, eight eyes showed regional retinal thinning, seven eyes showed vitreous traction, two eyes showed detached vitreous, and three eyes showed retinal break. CONCLUSIONS: UWF SS-OCT can be a useful tool to understand anatomical changes and pathophysiology of peripheral lattice degeneration.

Spotlight on Lattice Degeneration Imaging Techniques.

Lattice degeneration (LD), routinely diagnosed with indirect ophthalmoscopy, is one of the most common and clinically significant peripheral retinal findings. In this review, we have summarized the data on currently available imaging techniques which help to improve diagnosis and our understanding of LD pathogenesis. Ultra-wide field imaging provides reliable color fundus capturing for the primary diagnosis of LD and may also be used as a screening tool. Wide-field imaging can be used for targeted documentation of LD lesions using true colors and with minimal optical distortions. Information on the status of the vitreoretinal interface, including detection of retinal holes, detachments, and vitreous tractions, can be obtained with peripheral structural optical coherence tomography (OCT) or scanning laser ophthalmoscopy in retro-mode. These techniques clarify the associated risks of rhegmatogenous retinal detachment. Fundus autofluorescence can provide details on atrophic changes. However, the risk of retinal detachment by means of this technique requires further investigation. OCT angiography may be successfully performed for some lesions. Taken together, OCT and OCT angiography demonstrate thinning of the choroid, alteration of local choroidal microcirculation, and, in severe lesions, involvement of the sclera. OCT angiography confirms loss of retinal microcirculation within LD lesion, which was previously shown with fluorescein angiography. In conclusion, despite relatively simple primary diagnosis, imaging of LD lesions remains challenging due to their peripheral localization. However, several new strategies, including ultra-wide field imaging, peripheral OCT, and scanning laser ophthalmoscopy, make LD imaging possible on a routine basis, improving diagnosis and understanding of LD pathogenesis.

Incidence and Risk Factors for Retinal Detachment and Retinal Tear after Cataract Surgery: IRIS® Registry (Intelligent Research in Sight) Analysis.

Objective: To report the incidence of and evaluate demographic, ocular comorbidities, and intraoperative factors for rhegmatogenous retinal detachment (RRD) and retinal tear (RT) after cataract surgery in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). Design: Retrospective cohort study. Participants: Patients aged ≥ 40 years who underwent cataract surgery between 2014 and 2017. Methods: Multivariable logistic regression was used to evaluate demographic, comorbidity, and intraoperative factors associated with RRD and RT after cataract surgery. Main Outcome Measures: Incidence and risk factors for RRD or RT within 1 year of cataract surgery. Results: Of the 3 177 195 eyes of 1 983 712 patients included, 6690 (0.21%) developed RRD and 5489 (0.17%) developed RT without RRD within 1 year after cataract surgery. Multivariable logistic regression odds ratios (ORs) showed increased risk of RRD and RT, respectively, among men (OR 3.15; 95% confidence interval [CI], 2.99-3.32; P < 0.001 and 1.79; 95% CI, 1.70-1.89; P < 0.001), and younger ages compared with patients aged > 70, peaking at age 40 to 50 for RRD (8.61; 95% CI, 7.74-9.58; P < 0.001) and age 50 to 60 for RT (2.74; 95% CI, 2.52-2.98; P < 0.001). Increased odds of RRD were observed for procedure eyes with lattice degeneration (LD) (10.53; 95% CI, 9.82-11.28; P < 0.001), hypermature cataract (1.61; 95% CI, 1.06-2.45; P = 0.03), complex cataract surgery (1.52; 95% CI, 1.4-1.66; P < 0.001), posterior vitreous detachment (PVD) (1.24; 95% CI, 1.15-1.34; P < 0.001), and high myopia (1.2; 95% CI, 1.14-1.27; P < 0.001). Lattice degeneration conferred the highest odds of RT (43.86; 95% CI, 41.39-46.49; P < 0.001). Conclusion: In the IRIS Registry, RRD occurs in approximately 1 in 500 cataract surgeries in patients aged > 40 years within 1 year of surgery. The presence of LD conferred the highest odds for RRD and RT after surgery. Additional risk factors for RRD included male gender, younger age, hypermature cataract, PVD, and high myopia. These data may be useful during the informed consent process for cataract surgery and help identify patients at a higher risk of retinal complications. Financial Disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Incidence and Risk Factors for Delayed Retinal Tears after an Acute, Symptomatic Posterior Vitreous Detachment.

PURPOSE: To determine the long-term incidence of and risk factors for delayed retinal tears after acute, symptomatic posterior vitreous detachment (PVD) without concurrent retinal tears. DESIGN: Retrospective, observational case series. SUBJECTS: Patients diagnosed with an acute, symptomatic PVD without concurrent retinal tears at a tertiary eye center between 2013 and 2018. METHODS: This is a retrospective, consecutive, and observational case series. Acute and symptomatic PVD was defined as experiencing flashes or floaters for 1 month or less at the time of diagnosis. Patients with a retinal tear or detachment at or before the time of diagnosis were not included. The occurrence and timing of subsequent retinal tears after initial PVD diagnosis were recorded. The age, sex, race, refractive error, lens status, lattice degeneration status, and type of physician (retina specialist vs. nonretina specialist) who saw the patient were also recorded. MAIN OUTCOME MEASURES: Time to the development of a delayed retinal tear. RESULTS: A total of 389 eyes from 389 patients had acute and symptomatic PVDs without concurrent retinal tears or detachments at diagnosis. Kaplan-Meier analysis showed that 7.39% of eyes developed delayed retinal tears by 6.24 years after initial PVD diagnosis. Of these tears, 50% occurred within 4.63 months of PVD diagnosis, and 63.46% occurred within 1 year of PVD diagnosis. Cox-Mantel log-rank analysis showed that those who were younger (age < 60 years), myopic, or had lattice degeneration were more likely to develop tears. A multivariate Cox proportional-hazards models controlling for other significant risk factors supported lattice degeneration as a likely risk factor for delayed retinal tear. CONCLUSIONS: This study demonstrates that 7.39% of patients with acute, symptomatic PVD without concurrent retinal tears develop delayed retinal tears by 6.24 years after PVD diagnosis, with many developing tears well after a typical 6-week follow-up time for PVD. Lattice degeneration is a significant risk factor for delayed tears. These findings can guide clinicians in establishing optimal follow-up protocols for patients with acute, symptomatic PVD. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Risk Factors Associated With Rhegmatogenous Retinal Detachment.

Background Even though significant improvements have been made in the field of ophthalmology, retinal detachment is still an ever-increasing issue in both developing and developed countries. The present study evaluated the risk factors of rhegmatogenous retinal detachment (RRD). Methodology A cross-sectional study was conducted at a tertiary care center between June 2020 and March 2021. A total of 100 patients diagnosed with RRD were enrolled in the study. Patients with inconclusive diagnoses and multiple comorbidities were excluded from the study. A detailed history was taken, including previous surgery and ocular trauma or infections. A comprehensive ocular examination was conducted by an experienced ophthalmologist, including a dilated fundus examination. The causes and type of RRD were documented. Results In the study, a majority of the patients were males, with a mean age of 37.84 (18.29) years and a range of 5-74 years. The majority of those with total RRD were males, i.e., 37%; however, the difference was statistically insignificant (p=0.476). The study revealed that most of the RRD were diagnosed in patients <45 years of age; however, the difference was not statistically significant (p<0.227). The most frequent cause of RRD was lattice degeneration. While 23% of patients with RRD had a history of ocular trauma, uncomplicated phaco was detected in 17 cases. It was found that patients aged less than 45 years more frequently reported ocular trauma as the cause of RRD (p=0.004). Similarly, the cause of RRD was also significantly associated with the type of RRD (p=0.001). Conclusion The present study concludes that lattice degeneration, ocular trauma, uncomplicated, and complicated phaco are the main predisposing factors associated with RRD. Furthermore, the majority of the patients were males in their late thirties. Age, gender, and eye involvement were not significantly associated with the type of RRD.

Lattice Degeneration Imaging with Optical Coherence Tomography Angiography.

Purpose: To describe a series of cases of lattice degeneration of the retina imaged with optical coherence tomography angiography (OCTA). Methods: Four eyes of four patients were included and evaluated with green reflectance using a confocal scanning laser ophthalmoscopy and OCTA. In each case, the microcirculation of the retina and choriocapillaris within the lesion, as well as choroidal thickness beneath the lesion, were assessed. Results: OCTA showed regional loss of retinal perfusion and rarefication of the choriocapillaris network within the lesion and the presence of venous collectors in the choroid beneath the lesion. The choroid was substantially thinner beneath the lesion compared to the adjacent normal region. Cross-sectional OCT scans showed retinal thinning, vitreal adhesion, atrophic holes, and subretinal fluid within the lesions. Conclusion: Lattice degeneration is characterized by significant local changes in retinal and choroidal microcirculation which may play an important role in the pathophysiology of lattice degeneration.

Development of a deep-learning system for detection of lattice degeneration, retinal breaks, and retinal detachment in tessellated eyes using ultra-wide-field fundus images: a pilot study.

PURPOSE: To investigate the detection of lattice degeneration, retinal breaks, and retinal detachment in tessellated eyes using ultra-wide-field fundus imaging system (Optos) with convolutional neural network technology. METHODS: This study included 1500 Optos color images for tessellated fundus confirmation and peripheral retinal lesion (lattice degeneration, retinal breaks, and retinal detachment) assessment. Three retinal specialists evaluated all images and proposed the reference standard when an agreement was achieved. Then, 722 images were used to train and verify a combined deep-learning system of 3 optimal binary classification models trained using seResNext50 algorithm with 2 preprocessing methods (original resizing and cropping), and a test set of 189 images were applied to verify the performance compared to the reference standard. RESULTS: With optimal preprocessing approach (original resizing method for lattice degeneration and retinal detachment, cropping method for retinal breaks), the combined deep-learning system exhibited an area under curve of 0.888, 0.953, and 1.000 for detection of lattice degeneration, retinal breaks, and retinal detachment respectively in tessellated eyes. The referral accuracy of this system was 79.8% compared to the reference standard. CONCLUSION: A deep-learning system is feasible to detect lattice degeneration, retinal breaks, and retinal detachment in tessellated eyes using ultra-wide-field images. And this system may be considered for screening and telemedicine.

Involvement of the Retinal Pigment Epithelium in the Development of Retinal Lattice Degeneration.

Lattice degeneration involves thinning of the retina that occurs over time. Here we performed an immunohistological study of tissue sections of human peripheral retinal lattice degeneration to investigate if retinal pigment epithelium (RPE) cells are involved in the pathogenesis of this condition. In two cases of retinal detachment with a large tear that underwent vitreous surgery, retinal lattice degeneration tissue specimens were collected during surgery. In the obtained specimens, both whole mounts and horizontal section slices were prepared, and immunostaining was then performed with hematoxylin and antibodies against glial fibrillary acidic protein (GFAP), RPE-specific protein 65 kDa (RPE65), pan-cytokeratin (pan-CK), and CK18. Hematoxylin staining showed no nuclei in the center of the degenerative lesion, thus suggesting the possibility of the occurrence of apoptosis. In the degenerative lesion specimens, GFAP staining was observed in the center, RPE65 staining was observed in the slightly peripheral region, and pan-CK staining was observed in all areas. However, no obvious CK18 staining was observed. In a monkey retina used as the control specimen of a normal healthy retina, no RPE65 or pan-CK staining was observed in the neural retina. Our findings suggest that migration, proliferation, and differentiation of RPE cells might be involved in the repair of retinal lattice degeneration.

Investigation on peripheral retinal degeneration in civil aviation pilots recruitment / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the prevalence on peripheral retinal degeneration and to provide theoretical support for the medical examination of civil aviation pilots recruitment. <p>METHODS: Two thousand four hundred and fifty prospective flight students(Four thousand nine hundred eyes)who received medical examination in Civil Aviation General Hospital from February 2018 to May 2019 were divided into three groups according to diopter after fully mydriatic with tropicamide phenylephrine eye drops(Group A: +3.00 to <-0.50D, Group B: -0.50 to <-3.00D, Group C: -3.00 to -4.50D). The prevalence of peripheral retinal degeneration in each eye was examined, and the results were statistically analyzed. <p>RESULTS:There were five hundred and seventy five students with different types of peripheral retinal degeneration in 2 450 checked students, the prevalence was 23.5%. There was statistical difference in the prevalence of peripheral retinal degeneration in different diopter groups(χ2=65.386, <i>P</i><0.01). There was statistical difference in the prevalence of different types of peripheral retinal degeneration(χ2=351.276, <i>P</i><0.01). There was statistical difference in the prevalence of peripheral retinal degeneration in different parts(χ2=563.712, <i>P</i><0.01). <p>CONCLUSION: Peripheral retinal degeneration is not rare in civil aviation recruitment. The prevalence increases with the progression of myopia, and the lesions are mostly in bitamporal quadrant. It is suggested to identify according to different types.

Coexistence of Peripheral Retinal Diseases with Macular Hole

Objectives: To investigate the frequency of retinal tear, retinal hole, and lattice degeneration in peripheral retinal examination of patients with macular hole. Materials and Methods: The files of patients who underwent pars plana vitrectomy surgery with a diagnosis of macular hole at Eskisehir Osmangazi University Department of Ophthalmology between 2008 and 2018 were retrospectively analyzed. A total of 106 patients with primary macular hole who underwent peripheral retinal examination were included in the study. The frequency of retinal tears, holes, and lattice degeneration associated with macular hole was investigated. Results: Peripheral retinal examination of 106 patients who underwent macular hole surgery revealed retinal tear in 3 patients (2.8%), retinal hole in 4 patients (3.8%), and lattice degeneration in 10 patients (9.4%). Retinal hole and lattice degeneration were observed concomitantly in 1 patient. Conclusion: This study showed that patients with macular hole have concomitant retinal tears and holes, which are also thought to arise due to vitreoretinal traction, at a frequency similar to that in the general population. This result suggests that both the anterior and posterior vitreous may have different pathologies at the same time related to these diseases.

Spectral-domain optical coherence tomography of peripheral lattice degeneration of myopic eyes before and after laser photocoagulation.

PURPOSE: To investigate the microstructural characteristics of lattice degenerations before and after laser photocoagulation in myopic eyes by spectral-domain optical coherence tomography (SD-OCT). METHODS: Twenty-five eyes of 25 consecutive patients at the High Myopia Clinic of the National Taiwan University Hospital were retrospectively reviewed. Myopic eyes with peripheral lattice degeneration were enrolled in the study. Best-corrected visual acuity (BCVA), axial length measurement, color fundus photography was performed. SD-OCT analyses on the lattice degeneration were performed before and after prophylactic laser photocoagulation. All patients were followed for at least 6 months. RESULTS: In total, 25 myopic eyes with peripheral lattice degenerations were studied. The mean refractive error was -9.92 ± 4.77 Diopters (D) with 21 (84%) of the eye being highly myopic (Over -6.0 D). The average axial length was 27.7 ± 1.86 mm. In these myopic eyes, retinal thinning was the most common finding (92%), followed by vitreoretinal traction (72%), retinoschisis (44%), vitreous membrane with deposits (36%), and retinal break with subretinal fluid (4%). A blunting effect of the vitreoretinal tractions was found after laser photocoagulation. CONCLUSION: To our knowledge we firstly investigated the pre- and post-laser photocoagulation microstructural changes using SD-OCT. It demonstrated a beneficial effect of retinoplasty, which released vitreoretinal tractions after laser photocoagulation. Combined with the findings of subtle microstructural retinal breaks and subretinal fluid, early prophylactic laser treatment warrants sincere consideration in these myopic eyes.

A deep learning system for identifying lattice degeneration and retinal breaks using ultra-widefield fundus images.

BACKGROUND: Lattice degeneration and/or retinal breaks, defined as notable peripheral retinal lesions (NPRLs), are prone to evolving into rhegmatogenous retinal detachment which can cause severe visual loss. However, screening NPRLs is time-consuming and labor-intensive. Therefore, we aimed to develop and evaluate a deep learning (DL) system for automated identifying NPRLs based on ultra-widefield fundus (UWF) images. METHODS: A total of 5,606 UWF images from 2,566 participants were used to train and verify a DL system. All images were classified by 3 experienced ophthalmologists. The reference standard was determined when an agreement was achieved among all 3 ophthalmologists, or adjudicated by another retinal specialist if disagreements existed. An independent test set of 750 images was applied to verify the performance of 12 DL models trained using 4 different DL algorithms (InceptionResNetV2, InceptionV3, ResNet50, and VGG16) with 3 preprocessing techniques (original, augmented, and histogram-equalized images). Heatmaps were generated to visualize the process of the best DL system in the identification of NPRLs. RESULTS: In the test set, the best DL system for identifying NPRLs achieved an area under the curve (AUC) of 0.999 with a sensitivity and specificity of 98.7% and 99.2%, respectively. The best preprocessing method in each algorithm was the application of original image augmentation (average AUC =0.996). The best algorithm in each preprocessing method was InceptionResNetV2 (average AUC =0.996). In the test set, 150 of 154 true-positive cases (97.4%) displayed heatmap visualization in the NPRL regions. CONCLUSIONS: A DL system has high accuracy in identifying NPRLs based on UWF images. This system may help to prevent the development of rhegmatogenous retinal detachment by early detection of NPRLs.

Risk factors for retinal breaks during macular hole surgery.

PURPOSE: To identify risk factors for retinal breaks during macular hole (MH) surgery. PATIENTS AND METHODS: This retrospective, observational, comparative study included the medical records of 364 consecutive patients (382 eyes) who underwent vitrectomy for MH at Toho University Sakura Medical Center between January 2012 and May 2017. The patients comprised 135 men and 229 women with mean age 67.6±8.0 years. Six eyes with a pre-existing retinal tear treated by laser photocoagulation before MH surgery were excluded. Data on sex, age, presence or absence of lattice degeneration, axial length (measured using an IOL Master®), preoperative refraction, whether or not combined lens extraction/vitrectomy had been performed, whether or not the lens was pseudophakic before vitrectomy, and whether or not a posterior vitreous detachment had been created intraoperatively were collected. The lattice degeneration status was classified as none (0), treated using laser photocoagulation (1), or untreated (2). RESULTS: The only item identified in logistic regression analysis with the backward elimination method to be a significant risk factor for retinal breaks during MH surgery was the presence of lattice degeneration (P<0.001). CONCLUSION: Ophthalmologists should be aware of the increased risk of retinal breaks during MH surgery in eyes with lattice degeneration. Intraoperative retinal breaks may be less likely to occur in eyes with lattice degeneration treated by photocoagulation preoperatively.

Peripheral retinal changes in highly myopic young Asian eyes.

PURPOSE: To determine the type and prevalence of peripheral retinal changes and its relationship with axial length (AL) in a population of young Asian adult males. METHODS: This was a cross-sectional study of male subjects aged between 19 and 25 years old. High myopes [spherical equivalent refraction, (SER) < -6.00 D] were recruited and underwent further ocular investigations including dilated retinal photography and binocular indirect ophthalmoscopy by two trained ophthalmologists. The frequency of peripheral retinal changes within high myopes was correlated with axial length and also compared with a group of emmetropes (SER between -0.50 D and +1.00 D). RESULTS: A total of 593 high myopes and 156 emmetropes were recruited. White without pressure (WWOP; n = 458, 46.5%) and lattice degeneration (LD; n = 109, 14.6%) were the commonest findings, and their prevalence was significantly higher among high myopes (LD, 16.9% versus 5.8%; WWOP, 57.2% versus 5.8%; both p < 0.001). Among high myopes, temporal LD was more common (71%) and 35% had more than one area in the same eye. Increasing AL was associated with LD (odds ratio 1.28, p = 0.01) and retinal holes (odd's ratio 1.44, p = 0.02) on multivariate analysis. CONCLUSION: White without pressure (WWOP) and LD were the commonest peripheral retinal changes. One-third of high myopes with LD had more than one area in the same eye. Increasing AL was associated with LD and retinal holes. Studies in older adults should be conducted to develop clinical guidelines for the management of high myopes.

Total retinal detachment occurring after minor head trauma.

The objective of this article is to present the case of a patient with a severe decrease of visual acuity that occurred after an apparently minor head injury. Following the investigations, the patient was diagnosed with rhegmatogenous retinal detachment that was triggered by a fall from the same level and which occurred on a background of lattice degeneration. In this case, a minor trauma caused a severe complication because the patient had a contributing factor for the complication. The patient was operated and the end result was satisfactory.

[Degenerative lesions of the peripheral retina]. / Lésions dégénératives de la périphérie rétinienne.

Degenerative lesions of the peripheral retina are present from teenage years onwards and increase with age. These abnormabilities are frequent, some of them being benign while others predispose to retinal tears and detachment. In the latter case, the lesions are rhegmatogenous and may justify prophylactic treatment by laser photocoagulation. We distinguish congenital lesions of the peripheral retina and intraretinal, chorioretinal and vitreoretinal degenerations. The holes and tears observed in 2% of the population consist of round atrophic holes, "horseshoe" tears, oral dialyses and giant tears.

Risk Factors for Retinal Breaks in Patients with Symptom of Floaters

PURPOSE: To identify the risk factors of retinal breaks in patients with symptoms of floaters and to determine the associations between those risk factors and retinal breaks. METHODS: A retrospective chart review of patients who visited with the symptom of vitreous floaters between July 2012 and October 2012 was performed. Patient information, such as age, sex, symptoms (e.g., multiple floaters and flashing), duration of symptoms, refractive error, and complete eye examination were recorded. The patients were divided into 2 groups: the control group had symptoms of floaters with no retinal breaks and the retinal breaks group had symptoms of floaters with retinal breaks. The chi-square test and univariate logistic regression were used for statistical analysis. RESULTS: A total of 1744 eyes were examined in this study, including 1706 eyes in the control group and 38 eyes in the retinal breaks group. Univariate analysis revealed that patients with high myopia and multiple floaters showed increased risk of retinal breaks by 3.4 and 4.4 times, respectively, when compared to patients with a single floater alone. Lattice degeneration and vitreous or retinal hemorrhage increased the risk of retinal breaks by 10.8 and 37.5 times when compared to eyes that did not have lattice degeneration or vitreous or retinal hemorrhage. During the follow-up period after laser photocoagulation, a new retinal tear was found in 2 patients (2/38, 5.3%). CONCLUSIONS: Vitreous or retinal hemorrhage, lattice degeneration, multiple floaters, and high myopia are risk factors of retinal breaks in patients with the symptom of floaters. Therefore, it is important for ophthalmologists to be aware of these risk factors and the patients at risk should be encouraged to attend follow-up examinations.