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International Journal of Retina and... 2020To objectively evaluate YAG laser vitreolysis for symptomatic vitreous floaters using color photo imaging.
BACKGROUND
To objectively evaluate YAG laser vitreolysis for symptomatic vitreous floaters using color photo imaging.
METHODS
In this interventional and prospective study, 32 eyes of 32 patients with symptomatic vitreous floaters secondary to posterior vitreous detachment (PVD) were treated with a single session of yttrium aluminum garnet (YAG) laser. Primary outcomes were objective and subjective changes measured by masked grading of color fundus photographs and National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25), respectively. Secondary outcomes included Early Treatment Diabetic Retinopathy Study (ETDRS), best-corrected visual acuity (BCVA) and adverse events. Wilcoxon signed-rank test was used to analyze the results of the objective and subjective assessments at each time point. P < 0.05 was considered statistically significant.
RESULTS
Thirty-two patients (32 eyes; 13 men and 19 women) with symptomatic vitreous floaters were enrolled in this study (mean age: 59.4 years). All study patients were followed up for 6 months. Following the laser vitreolysis, there was a statistically significant improvement in both the near visual function (z = - 2.97; p = 0.003; r = 0.633) and visual disturbance rate (z = - 3.97; p < 0.001; r = 0.84). Distance visual function did not show statistically significant difference after the laser procedure (p = 1.00). Color fundus photograph did reveal vitreous opacity improvement over time in 93.7% of study eyes (partial improvement in 37.5% and total improvement in 56.2% of study eyes). During the follow-up period, recurrence of vitreous floaters, BCVA deterioration and adverse events were not observed.
CONCLUSIONS
YAG laser vitreolysis decreased the amount of vitreous floaters opacities seen on color fundus imaging and improved related symptoms according to the NEI VFQ-25 responses.
PubMed: 31988795
DOI: 10.1186/s40942-019-0205-8 -
Retina (Philadelphia, Pa.) Jul 2023Limited vitrectomy improves vision degrading myodesopsia, but the incidence of recurrent floaters postoperatively is not known. We studied patients with recurrent...
PURPOSE
Limited vitrectomy improves vision degrading myodesopsia, but the incidence of recurrent floaters postoperatively is not known. We studied patients with recurrent central floaters using ultrasonography and contrast sensitivity (CS) testing to characterize this subgroup and identify the clinical profile of patients at risk of recurrent floaters.
METHODS
A total of 286 eyes (203 patients, 60.6 ± 12.9 years) undergoing limited vitrectomy for vision degrading myodesopsia were studied retrospectively. Sutureless 25G vitrectomy was performed without intentional surgical posterior vitreous detachment (PVD) induction. CS (Freiburg Acuity Contrast test: Weber index, %W) and vitreous echodensity (quantitative ultrasonography) were assessed prospectively.
RESULTS
No eyes (0/179) with preoperative PVD experienced new floaters. Recurrent central floaters occurred in 14/99 eyes (14.1%) without complete preoperative PVD (mean follow-up = 39 months vs. 31 months in 85 eyes without recurrent floaters). Ultrasonography identified new-onset PVD in all 14 (100%) recurrent cases. Young (younger than 52 years; 71.4%), myopic (≥-3D; 85.7%), phakic (100%) men (92.9%) predominated. Reoperation was elected by 11 patients, who had partial PVD preoperatively in 5/11 (45.5%). At study entry, CS was degraded (3.55 ± 1.79 %W) but improved postoperatively by 45.6% (1.93 ± 0.86 %W, P = 0.033), while vitreous echodensity reduced by 86.6% ( P = 0.016). New-onset PVD postoperatively degraded CS anew, by 49.4% (3.28 ± 0.96 %W; P = 0.009) in patients electing reoperation. Repeat vitrectomy normalized CS to 2.00 ± 0.74%W ( P = 0.018).
CONCLUSION
Recurrent floaters after limited vitrectomy for vision degrading myodesopsia are caused by new-onset PVD, with younger age, male sex, myopia, and phakic status as risk factors. Inducing surgical PVD at the primary operation should be considered in these select patients to mitigate recurrent floaters.
Topics: Humans; Male; Female; Vitrectomy; Retrospective Studies; Visual Acuity; Vitreous Detachment; Myopia
PubMed: 36940362
DOI: 10.1097/IAE.0000000000003781 -
Investigative Ophthalmology & Visual... Jan 2015Clinical evaluation of floaters lacks quantitative assessment of vitreous structure. This study used quantitative ultrasound (QUS) to measure vitreous opacities. Since...
PURPOSE
Clinical evaluation of floaters lacks quantitative assessment of vitreous structure. This study used quantitative ultrasound (QUS) to measure vitreous opacities. Since floaters reduce contrast sensitivity (CS) and quality of life (Visual Function Questionnaire [VFQ]), it is hypothesized that QUS will correlate with CS and VFQ in patients with floaters.
METHODS
Twenty-two eyes (22 subjects; age = 57 ± 19 years) with floaters were evaluated with Freiburg acuity contrast testing (FrACT; %Weber) and VFQ. Ultrasonography used a customized probe (15-MHz center frequency, 20-mm focal length, 7-mm aperture) with longitudinal and transverse scans taken in primary gaze and a horizontal longitudinal scan through premacular vitreous in temporal gaze. Each scan set had 100 frames of log-compressed envelope data. Within each frame, two regions of interest (ROIs) were analyzed (whole-central and posterior vitreous) to yield three parameters (energy, E; mean amplitude, M; and percentage of vitreous filled by echodensities, P50) averaged over the entire 100-frame dataset. Statistical analyses evaluated E, M, and P50 correlations with CS and VFQ.
RESULTS
Contrast sensitivity ranged from 1.19%W (normal) to 5.59%W. All QUS parameters in two scan positions within the whole-central ROI correlated with CS (R > 0.67, P < 0.001). P50 in the nasal longitudinal position had R = 0.867 (P < 0.001). Correlations with VFQ ranged from R = 0.52 (P < 0.013) to R = 0.65 (P < 0.001).
CONCLUSIONS
Quantitative ultrasound provides quantitative measures of vitreous echodensity that correlate with CS and VFQ, providing objective assessment of vitreous structure underlying the functional disturbances induced by floaters, useful to quantify vitreous disease severity and the response to therapy.
Topics: Adult; Aged; Aged, 80 and over; Contrast Sensitivity; Eye Diseases; Female; Humans; Male; Middle Aged; Quality of Life; Statistics as Topic; Surveys and Questionnaires; Ultrasonography; Visual Acuity; Vitreous Body
PubMed: 25613948
DOI: 10.1167/iovs.14-15414 -
Ophthalmology Nov 2019Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser treatment is performed on vitreous floaters, but studies of structural and functional effects with objective outcome... (Comparative Study)
Comparative Study
PURPOSE
Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser treatment is performed on vitreous floaters, but studies of structural and functional effects with objective outcome measures are lacking. This study evaluated Nd:YAG laser effects by comparing participants with vitreous floaters who previously underwent laser treatment with untreated control participants and healthy persons without vitreous floaters using quantitative ultrasonography to evaluate vitreous structure and by measuring visual acuity and contrast sensitivity function to assess vision.
DESIGN
Retrospective, comparative study.
PARTICIPANTS
One eye was enrolled for each of 132 participants: 35 control participants without vitreous floaters, 59 participants with untreated vitreous floaters, and 38 participants with vitreous floaters previously Nd:YAG-treated. Of these, 25 were dissatisfied and sought vitrectomy; 13 were satisfied with observation.
METHODS
The 39-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-39) to assess participant visual well-being, quantitative ultrasonography (QUS) to measure vitreous echodensity, and best-corrected visual acuity (BCVA) and contrast sensitivity function (CSF) to evaluate vision.
MAIN OUTCOME MEASURES
Results of NEI-VFQ-39, QUS, BCVA, and CSF.
RESULTS
Compared with control participants without vitreous floaters, participants with untreated vitreous floaters showed worse NEI-VFQ-39 results, 57% greater vitreous echodensity, and significant (130%) CSF degradation (P < 0.001 for each). Compared with untreated eyes with vitreous floaters, Nd:YAG-treated eyes had 23% less vitreous echodensity (P < 0.001), but no differences in NEI-VFQ-39 (P = 0.51), BCVA (P = 0.42), and CSF (P = 0.17) results. Of 38 participants with vitreous floaters who previously were treated with Nd:YAG, 25 were dissatisfied and seeking vitrectomy, whereas 13 were satisfied with observation. Participants seeking vitrectomy showed 24% greater vitreous echodensity (P = 0.018) and 52% worse CSF (P = 0.006). Multivariate linear regression models confirmed these findings.
CONCLUSIONS
As a group, participants previously treated with Nd:YAG laser for bothersome vitreous floaters showed less dense vitreous, but similar visual function as untreated control participants with vitreous floaters. Because some treated eyes showed less dense vitreous and better visual function than those of untreated control participants, a prospective randomized study of Nd:YAG laser treatment of vitreous is warranted, using uniform laser treatment parameters and objective quantitative outcome measures.
Topics: Adult; Aged; Contrast Sensitivity; Eye Diseases; Female; Humans; Lasers, Solid-State; Male; Middle Aged; Ophthalmoscopy; Patient Satisfaction; Retrospective Studies; Sickness Impact Profile; Surveys and Questionnaires; Ultrasonography; Visual Acuity; Vitrectomy; Vitreous Body
PubMed: 31471088
DOI: 10.1016/j.ophtha.2019.06.021 -
Journal of Ophthalmology 2017To evaluate the degree of psychological distress in symptomatic vitreous floater patients and to evaluate whether these psychological factors are associated with the...
PURPOSE
To evaluate the degree of psychological distress in symptomatic vitreous floater patients and to evaluate whether these psychological factors are associated with the severity of discomfort associated with vitreous floaters.
METHODS
We recruited 61 patients with symptomatic vitreous floaters and 34 controls. The degree of posterior vitreous detachment (PVD) was evaluated using optical coherence tomography. We measured the level of depression, perceived stress, state, and trait anxiety and the degree of floater-associated discomfort with self-administered questionnaire. We compared psychological parameters between floater patients and control. We also compared clinical and psychological characteristics among different floater-associated discomfort severity groups.
RESULTS
Symptomatic vitreous floater patients showed higher rate of complete PVD and higher psychological distress compared to the control. On multiple logistic regression analysis, complete PVD ( = 0.001), depression ( = 0.001), and younger age ( = 0.037) were significantly associated with symptomatic floaters. There were no significant differences in complete PVD rate among different discomfort groups, while severe discomfort group showed higher depression, perceived stress, and state and trait anxiety compared to the other two milder symptom groups.
CONCLUSIONS
Symptomatic vitreous floater patients showed substantial level of psychological distress, and the severity of floater symptoms was significantly associated with psychological distress.
PubMed: 29375909
DOI: 10.1155/2017/3191576 -
Ophthalmology and Therapy Dec 2022This study aimed to determine the efficacy and safety of pars plana vitrectomy (PPV) as treatment for patients with primary symptomatic vitreous floaters.
INTRODUCTION
This study aimed to determine the efficacy and safety of pars plana vitrectomy (PPV) as treatment for patients with primary symptomatic vitreous floaters.
METHODS
We searched 12 databases for studies performing PPV for primary symptomatic vitreous floaters with at least 3 months follow-up. Two authors reviewed the studies and extracted data. Our main outcome of interest was patient satisfaction/reduction of symptoms/quality of life, but other measures of efficacy and safety were also extracted. Where possible, meta-analyses were performed to provide summary estimates.
RESULTS
We identified 18 eligible studies, which included 2077 eyes of 1789 patients. Studies reported that at least 90% of the patients were satisfied or had relief of symptoms. Best corrected visual acuity improved - 0.08 logMAR (95% CI - 0.10 to - 0.06 logMAR, P < 0.0001). Contrast sensitivity improved - 2.26% (95% CI - 3.26 to - 1.26%, P < 0.0001). After surgery, cataract occurred in 31.7% (95% CI 21.7-42.7%), retinal tears/breaks in 2.92% (95% CI 1.38-4.97%), vitreous hemorrhage in 1.97% (95% CI 0.83-3.54%), macular edema in 1.70% (95% CI 0.84-2.83%), retinal detachment in 1.54% (95% CI 0.62-2.82%), glaucoma in 1.04% (95% CI 0.53-1.73%), and endophthalmitis in 0.18% (95% CI 0.02-0.45%).
CONCLUSIONS
Postoperative patient satisfaction is high after PPV for primary symptomatic vitreous floaters. However, the patient should be carefully counselled as what to expect from the treatment and understand the risks associated with PPV.
PubMed: 36198880
DOI: 10.1007/s40123-022-00578-9 -
Journal of Personalized Medicine Oct 2022With the rapid development of display technology, related diseases of the human eye are also increasing day by day. Eye floaters are one of the diseases that affect...
With the rapid development of display technology, related diseases of the human eye are also increasing day by day. Eye floaters are one of the diseases that affect humans. Herein, we present a functional ophthalmic dressing that can permeate the skin tissues of the eyes through oxygen and hydrogen to improve the symptoms of floaters. In clinical tests, the symptoms of sensory floaters improved in 28 patients, and the recovery rates of mild, moderate, and severe floaters were about 70%, 66.7%, and 83.3%, respectively.
PubMed: 36294798
DOI: 10.3390/jpm12101659 -
Ophthalmology and Therapy Dec 2017The purpose of this report is to describe a case of macular hole development after vitrectomy for floaters with induction of posterior vitreous detachment.
INTRODUCTION
The purpose of this report is to describe a case of macular hole development after vitrectomy for floaters with induction of posterior vitreous detachment.
CASE REPORT
A 44-year-old otherwise healthy man presented with visually debilitating floaters in his right eye; these had been present for more than 2 years. Preoperative examination was unremarkable in both eyes, apart from some degree of vitreous degeneration in the right eye. Preoperative visual acuity was 20/20 bilaterally. A 25-gauge transconjunctival sutureless pars plana complete vitrectomy with induction of posterior vitreous detachment was performed in the right eye. Upon examination 1 month after surgery, a small full-thickness macular hole was detected in the right eye. Visual acuity was diminished to 20/80. The macular hole was closed after a second vitrectomy with internal limiting membrane peeling and gas tamponade.
CONCLUSION
Macular hole development should be listed as a possible complication of vitrectomy for visually debilitating floaters when a posterior vitreous detachment is induced during surgery.
PubMed: 29022285
DOI: 10.1007/s40123-017-0111-9 -
BMC Ophthalmology Apr 2020Modern laser surgery uses Nd:YAG laser capsulotomy for posterior capsule opacification (PCO) and Nd:YAG laser vitreolysis for symptomatic vitreous floaters (VF). We...
BACKGROUND
Modern laser surgery uses Nd:YAG laser capsulotomy for posterior capsule opacification (PCO) and Nd:YAG laser vitreolysis for symptomatic vitreous floaters (VF). We report a case of acute retinal detachment seven days after Nd:YAG laser capsulotomy combined with Nd:YAG laser vitreolysis and analyze the cause of this complication.
CASE PRESENTATION
A 58-year-old myopic woman complained of decreased visual acuity and symptomatic floaters with her left eye for 3 months. We found she had significant PCO and VF in the posterior vitreous. She underwent neodymium-doped yttrium aluminum (Nd:YAG) laser vitreolysis immediately after Nd:YAG capsulotomy. After 7 days, she complained of rapid vision decline and dark shadows in her treated eye. We found she had a acute severe rhegmentogenous retinal detachment (RD) involving the macula. Then she underwent vitrectomy, retinal reattchment and silicone oil tamponade surgery immediately. Six months later, silicone oil was removed and the best corrected visual acuity (BCVA) of her left eye gradually improved to 10/20 and maintained during a 1-year follow-up period.
CONCLUSION
As myopic patients are at risk of developing retinal detachment, Nd:YAG vitreolysis and capsulotomy should be performed with caution. The laser energy should be as low as possible and careful focus is necessary to reduce interference to the retina.
Topics: Capsule Opacification; Female; Humans; Laser Therapy; Lasers, Solid-State; Middle Aged; Postoperative Complications; Retinal Detachment; Visual Acuity; Vitrectomy; Vitreous Body
PubMed: 32306922
DOI: 10.1186/s12886-020-01428-7 -
Ophthalmic Surgery, Lasers & Imaging... Jun 2021To evaluate the safety and efficacy of 1.0 mg risuteganib in subjects with nonexudative age-related macular degeneration (AMD). (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND OBJECTIVE
To evaluate the safety and efficacy of 1.0 mg risuteganib in subjects with nonexudative age-related macular degeneration (AMD).
PATIENTS AND METHODS
This was a phase 2a, prospective, double-masked, sham-controlled study. Eyes with nonexudative (dry) AMD and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) between 20/40 and 20/200 were included. Subjects were randomized to intravitreal 1.0 mg risuteganib or sham injection. At Week 16, subjects in the risuteganib group received a second 1.0-mg dose and the sham group crossed over to receive a dose of 1.0 mg risuteganib and were evaluated at Week 28. The primary endpoint was proportion of subjects with 8 letters ETDRS or more BCVA gain from baseline to Week 28 in the risuteganib group versus baseline to Week 12 for the sham group. BCVA was tested and subjects were observed for adverse events (AEs) every 4 weeks until completion of the study at 32 weeks.
RESULTS
Forty-five subjects (risuteganib, n = 29; sham, n = 16) were enrolled in the study, of whom 39 (risuteganib, n = 25; sham, n = 14) completed the study and were included in the per protocol efficacy analysis. At baseline, mean age was 78.8 and 75.9 years and mean BCVA was 67.1 and 64.4 letters in the sham and risuteganib groups, respectively. The primary endpoint was met by 48% of the risuteganib group at Week 28 and 7% of the sham group at Week 12 ( = .013). Of the risuteganib subjects, 20% gained 15 letters or more at Week 28, whereas no patients in the sham group at Week 12 achieved this visual acuity gain. The only ocular treatment-related treatment-emergent AE was vitreous floaters, which spontaneously recovered without sequelae. No drug-related serious AE was reported.
CONCLUSIONS
Risuteganib demonstrated significant BCVA improvement in patients with non-exudative AMD. No drug-related AEs were seen during a 32-week observation period. .
Topics: Angiogenesis Inhibitors; Diabetic Retinopathy; Double-Blind Method; Humans; Intravitreal Injections; Prospective Studies; Treatment Outcome; Visual Acuity
PubMed: 34185587
DOI: 10.3928/23258160-20210528-05