Black posterior vitreous detachment: A 10-year historical cohort of pigmented uveal tumors

Pigmentary posterior vitreous detachment (PVD), referred to as “black PVD," is a rare entity describing PVD along with pigment dispersion in the vitreous. There are a few case reports describing pigmentary PVD, yet the association between pigmentary PVD and uveal and optic disc tumors was not described before. The aim of this study was to report the clinical features of patients with pigmentary PVD associated with these tumors. An 8-year retrospective cohort study. Eight patients who were diagnosed with pigmentary PVD associated with a uveal tumor or optic nerve pigmented tumors in a tertiary medical center. Demographics, clinical data, type of uveal lesion, treatment, multimodal images, and follow-up information were retrieved. The main outcome measures were tumor recurrence, vitreous spread, and the patient's prognosis. Most patients were female (5/8; 62.5 %), with a mean age of 55.8 ± 4.41 years. The right eye was more frequently involved (5/8; 62.5 %). The most prevalently associated ocular tumor was malignant choroidal melanoma (7/8; 87.5 %). A pigmentary PVD was observed on presentation in one case (1/8; 12.5 %); the remaining cases had pigmentary PVD documented during follow-up. VA was significantly worse at the end of follow-up, with a mean of 0.10 ± 0.14 logMAR at the first appointment and 1.20 ± 0.37 logMAR at the last appointment (p = 0.0101). The IOP remained stable, with a mean of 13.5 ± 0.63 mmHg at the first appointment and 14.5 ± 0.50 mmHg at the last appointment (p = 0.2328). The median follow-up duration was 63.5 months. Patients presented with a mean initial lesion thickness of 4.8 ± 1.01 mm, which remained stable throughout the follow-up with a mean thickness of 3.2 ± 0.71 (p = 0.2173). None of the cases exhibited recurrence, vitreous spread, or growth of the ocular lesion during follow-up. A pigmentary form of PVD may accompany both benign and malignant pigmented uveal tumors, affecting a wide range of patients. The dispersion of pigment from the tumor collars the vitreous in black, yet the black PVD does not necessarily indicate tumor recurrence or vitreous spread.