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BMC Ophthalmology Mar 2015Vitrectomy for symptomatic vitreous floaters carries significant risks. Justification of surgery is difficult, particularly in healthy eyes with normal visual acuity and...
BACKGROUND
Vitrectomy for symptomatic vitreous floaters carries significant risks. Justification of surgery is difficult, particularly in healthy eyes with normal visual acuity and without a posterior vitreous detachment. This is the first reported case of optical coherence tomography being utilized to objectively assess the impact of a vitreous opacity on the macula.
CASE PRESENTATION
A 37-year-old Caucasian female complained of the sudden onset of a ring-like floater in the central visual field of her left eye. Visual acuity was 20/20, there was no intraocular inflammation and the posterior vitreous was not detached. Complete blood count with differential, serology screen (including cysticercosis and echinococcus), chest x-ray and abdominal ultrasound found no evidence of systemic infective or cystic disease. A color photograph and B-scan ultrasound confirmed a 4.31 mm free-floating semi-translucent vitreous cyst with a hyperechogenic, pigmented surface and faint internal strands suspended in the mid-vitreous cavity, in the visual axis. The cyst moved with ocular movements, but only within the vitreous lacuna it resided in. Humphrey and Goldmann visual fields were normal. However, spectral domain optical coherence tomography (OCT) demonstrated shadowing on either side of the fovea, consistent with the ring-like scotoma described by the patient. Removing the retinal layers from the 3D-reconstructed macular cube OCT revealed a circular shadow on the macula. The patient elected for conservative management and at 3-month follow-up her symptoms had almost fully resolved as the cyst migrated to the inferior vitreous cavity, no longer casting a shadow on the macula.
CONCLUSION
To our knowledge, this is the first description of using OCT as an objective, qualitative assessment of symptoms caused by large vitreous opacities and may provide a simple yet useful adjunctive tool in evaluating the risk-benefit ratio of vitrectomy in patients with large symptomatic vitreous floaters.
Topics: Adult; Cysts; Eye Diseases; Female; Fluorescein Angiography; Humans; Microscopy, Acoustic; Tomography, Optical Coherence; Visual Acuity; Visual Fields; Vitreous Body
PubMed: 25884156
DOI: 10.1186/s12886-015-0003-5 -
Acta Ophthalmologica Aug 2019Unremoved vitreoschisis-induced vitreous cortex remnants (VCR) are associated with macular pathology. When present on the retinal periphery, they may play a role in...
PURPOSE
Unremoved vitreoschisis-induced vitreous cortex remnants (VCR) are associated with macular pathology. When present on the retinal periphery, they may play a role in proliferative vitreoretinopathy and retinal detachment after vitrectomy. Existing instruments for their removal involve substantial risk of iatrogenic retinal damage. Purpose of this study was to evaluate the use of a new technique, Vitreous Wiping, for removal of VCR during vitrectomy.
METHODS
Proof-of-concept case series of six eyes (six patients) treated with vitrectomy for various pathologies (macula-on and macula-off retinal detachment, macular hole, macular pucker and vitreous floaters). Vitreous cortex remnants on the surface of the retina were visualized with triamcinolone and removed by Vitreous Wiping with a rectangular piece of polyvinyl alcohol (PVA) held with intra-ocular forceps. Visual acuity and clinical course were assessed during a follow-up of 6 months. All eyes underwent postoperative macular optical coherence tomography. Eyes without preoperative macular pathology, underwent retinal sensitivity testing and eyes without paracentral pathology underwent visual field analysis.
RESULTS
Vitreous cortex remnants could be removed completely in all eyes. There were no intra- or postoperative complications. We observed that PVA is soft like a sponge and vitreous sticks to it, making Vitreous Wiping easier and safer, compared to alternative instruments. Visual acuity improved in all eyes. Microperimetry and visual field analysis revealed no abnormalities related to Vitreous Wiping.
CONCLUSION
Vitreoschisis-induced VCR can be removed effectively and safely from the retinal surface by Vitreous Wiping. Larger studies are needed to confirm this promising finding and its potential impact.
Topics: Aged; Female; Follow-Up Studies; Humans; Macula Lutea; Male; Middle Aged; Retinal Diseases; Time Factors; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy; Vitreous Body
PubMed: 30536726
DOI: 10.1111/aos.13991 -
Journal of Ophthalmology 2017To report the surgical outcomes of 27-gauge pars plana vitrectomy (PPV) for symptomatic vitreous floaters.
PURPOSE
To report the surgical outcomes of 27-gauge pars plana vitrectomy (PPV) for symptomatic vitreous floaters.
METHODS
47 eyes of 47 patients (39 males, 83.0%) with symptomatic vitreous floaters who underwent 27-gauge PPV and followed up for more than 6 months were included. The mean age was 34.7 ± 13.5 years.
RESULTS
No operative complication occurred. At first day postoperatively, the intraocular pressure (IOP) was significantly lower than that at other time points (8.6 ± 2.7 mmHg, < 0.001). 28 (59.6%) eyes had transient hypotony (IOP < 8 mmHg). All were recovered within 1 week postoperatively. The BCVA of 41 eyes (41/47, 87.2%) remained unchanged or improved. Postoperative complications occurred in two eyes: one (2.1%) had endophthalmitis and one (2.1%) had retinal detachment. No clinical significant cataract was observed in the 42 postoperative phakic eyes. 91.5% of the patients were satisfied with the surgery outcome. Besides, 91.3% of the patients felt that the floaters were removed completely or only had an acceptable residual.
CONCLUSION
Visual acuity of most patients remained unchanged or improved following 27-gague pars plana vitrectomy for symptomatic vitreous floaters, resulting in high patient satisfaction. However, this treatment should be performed with great caution since severe postoperative complications may still occur. This trial is registered with NCT03049163.
PubMed: 29318039
DOI: 10.1155/2017/5496298 -
JAMA Ophthalmology Sep 2017Vitreous floaters are common and can worsen visual quality. YAG vitreolysis is an untested treatment for floaters. (Comparative Study)
Comparative Study Randomized Controlled Trial
IMPORTANCE
Vitreous floaters are common and can worsen visual quality. YAG vitreolysis is an untested treatment for floaters.
OBJECTIVE
To evaluate YAG laser vitreolysis vs sham vitreolysis for symptomatic Weiss ring floaters from posterior vitreous detachment.
DESIGN, SETTING, AND PARTICIPANTS
This single-center, masked, sham-controlled randomized clinical trial was performed from March 25, 2015, to August 3, 2016, in 52 eyes of 52 patients (36 cases and 16 controls) treated at a private ophthalmology practice.
INTERVENTIONS
Patients were randomly assigned to YAG laser vitreolysis or sham YAG (control).
MAIN OUTCOMES AND MEASURES
Primary 6-month outcomes were subjective change measured from 0% to 100% using a 10-point visual disturbance score, a 5-level qualitative scale, and National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25). Secondary outcomes included objective change assessed by masked grading of color fundus photography and Early Treatment Diabetic Retinopathy Study best-corrected visual acuity.
RESULTS
Fifty-two patients (52 eyes; 17 men and 35 women; 51 white and 1 Asian) with symptomatic Weiss rings were enrolled in the study (mean [SD] age, 61.4 [8.0] years for the YAG laser group and 61.1 [6.6] years for the sham group). The YAG laser group reported greater symptomatic improvement (54%) than controls (9%) (difference, 45%; 95% CI, 25%-64%; P < .001). In the YAG laser group, the 10-point visual disturbance score improved by 3.2 vs 0.1 in the sham group (difference, -3.0; 95% CI, -4.3 to -1.7; P < .001). A total of 19 patients (53%) in the YAG laser group reported significantly or completely improved symptoms vs 0 individuals in the sham group (difference, 53%; 95% CI, 36%-69%, P < .001). Compared with sham, NEI VFQ-25 revealed improved general vision (difference, 16.3; 95% CI, 0.9-31.7; P = .04), peripheral vision (difference, 11.6; 95% CI, 0.8-22.4; P = .04), role difficulties (difference, 17.3; 95% CI, 8.0-26.6; P < .001), and dependency (difference, 5.6; 95% CI, 0.5-10.8; P = .03) among the YAG laser group. Best-corrected visual acuity changed by -0.2 letters in the YAG laser group and by -0.6 letters in sham group (difference, 0.4; 95% CI, -6.5 to 5.3; P = .94). No differences in adverse events between groups were identified.
CONCLUSIONS AND RELEVANCE
YAG laser vitreolysis subjectively improved Weiss ring-related symptoms and objectively improved Weiss ring appearance. Greater confidence in these outcomes may result from larger confirmatory studies of longer duration.
TRIAL REGISTRATION
clinicaltrials.gov NCT02897583.
Topics: Adult; Aged; Double-Blind Method; Eye Diseases; Female; Humans; Laser Therapy; Lasers, Solid-State; Male; Middle Aged; Sickness Impact Profile; Surveys and Questionnaires; Visual Acuity; Vitrectomy; Vitreous Body; Vitreous Detachment
PubMed: 28727887
DOI: 10.1001/jamaophthalmol.2017.2388 -
Arquivos Brasileiros de Oftalmologia 2022This study aimed to evaluate the long-term safety and efficacy of neodymium-doped yttrium aluminum garnet (Nd:YAG) vitreolysis for symptomatic vitreous floaters as it... (Randomized Controlled Trial)
Randomized Controlled Trial Observational Study
PURPOSE
This study aimed to evaluate the long-term safety and efficacy of neodymium-doped yttrium aluminum garnet (Nd:YAG) vitreolysis for symptomatic vitreous floaters as it remains a controversial procedure due to insufficient robust evidence in the literature for the maintenance of the results and absence of adverse effects.
METHODS
This is an observational extension to the previously presented prospective, randomized, double-blind clinical trial. Eight of thirteen subjects who underwent vitreolysis with YAG laser returned for a late reevaluation, 18 months after the procedure, to evaluate the efficacy and safety of the procedure.
RESULTS
All patients maintained the improvement in symptomatology noted after the procedure, with 25% showing complete improvement and a similar proportion (37.5%) reporting significant or partial improvement. Objective improvement in opacity was similar to that found at 6 months follow-up. The NEI-VFQ 25 quality of life questionnaire showed no statistically significant difference in responses between the 6th and 18th month. No adverse effects were noted on clinical examination or reported by patients.
CONCLUSION
Vitreolysis efficacy observed at 6 months of follow-up was maintained until the eighteenth month, with all patients reporting improvement from the pre-procedure state. No late adverse effects were noted. A larger randomized clinical trial is needed to confirm the safety of the procedure.
Topics: Humans; Vitreous Body; Eye Diseases; Lasers, Solid-State; Quality of Life; Prospective Studies
PubMed: 36169439
DOI: 10.5935/0004-2749.2021-0395 -
Case Reports in Ophthalmology 2022This study aimed to report the risk factors and treatment outcomes of visually disturbing vitreous opacities after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser...
This study aimed to report the risk factors and treatment outcomes of visually disturbing vitreous opacities after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy. This was a retrospective observational case series study that included 6 patients who underwent vitrectomy for vitreous opacities after Nd:YAG laser capsulotomy. The patients' medical records from January 2017 to June 2020 were reviewed. Seven eyes of 6 patients who underwent pars plana vitrectomy for visually disturbing vitreous opacities were included in this study. The mean duration between Nd:YAG capsulotomy and vitrectomy was 8.57 ± 1.27 months. The posterior capsule opacification was proliferative with a pearl form in all patients. Visual acuity improved significantly after vitrectomy. Nd:YAG laser causes visually disturbing vitreous opacities. Vitrectomy was an effective treatment for these opacities.
PubMed: 35950022
DOI: 10.1159/000525335 -
Case Reports in Ophthalmological... 2023To report the outcomes of phacoemulsification combined with vitrectomy in eyes with extreme myopia (-30 diopters or more). . Three patients with cataract, vitreous...
BACKGROUND
To report the outcomes of phacoemulsification combined with vitrectomy in eyes with extreme myopia (-30 diopters or more). . Three patients with cataract, vitreous opacities, and extreme myopia of more than -30 diopters underwent a combined surgical procedure of cataract extraction combined with vitrectomy. Postoperative refractive correction of the three cases ranged from -1.0 D to -2.5 D spherical equivalent. There was an obvious hyperopic shift of all cases. All patients noted a significant improvement in uncorrected and best-corrected visual acuity from 0.4 to 0.8 in case 1, from CF/70 cm to 1.0 in case 2, and from 0.12 to 0.5 in the right eye and 0.15 to 0.2 in the left eye in case 3. Vitreous floaters disappeared in all cases. No complications were noted during follow-up.
CONCLUSIONS
To the best of the authors' knowledge, these represent the first reported clinical cases of combined cataract extraction+vitrectomy surgery in eyes with extreme (>-30 D) myopia. Our results support the notion that phacoemulsification combined with vitrectomy may be a good therapeutic option for cataracts and vitreous floaters in cases with extreme myopia.
PubMed: 38022731
DOI: 10.1155/2023/7367922 -
International Journal of Environmental... May 2018Direct evidence of whether thyroid cancer patients have a higher risk of age-related macular degeneration (AMD) has yet to be investigated. Patients older than 50...
Direct evidence of whether thyroid cancer patients have a higher risk of age-related macular degeneration (AMD) has yet to be investigated. Patients older than 50 years-old and newly diagnosed with thyroid cancer between 2000 and 2008 were identified from the national health insurance research database (NHIRD). We applied time-varying Cox proportional hazard models to assess the association between thyroid cancer and AMD. The multivariable models included conventional cardiovascular risk factors, myopia, vitreous floaters, hypothyroidism, hyperthyroidism, and treatment modality of thyroid cancer. The analysis process was stratified by age, gender, and comorbidity. In this study, 5253 patients were included in a thyroid cancer cohort (men 24.5%; median age 59.1 years (53.7⁻67.4 years), and 21,012 matched controls were included in a non-thyroid cancer cohort. The AMD incidence was 40.7 per 10,000 person/year in the thyroid cancer cohort. The thyroid cancer cohort had a higher risk (adjusted hazard ratio (aHR) = 1.38, 95% confidence interval, CI = 1.09⁻1.75) of AMD than the non-thyroid cohort. Thyroid cancer patients had a higher risk of AMD, especially the male patients (aHR = 1.92, 95% CI = 1.38⁻3.14) and the patients with comorbidities (aHR = 1.38, 95% CI = 1.09⁻1.74). In conclusion, thyroid cancer patients older than 50 years-old have increased risk of AMD.
Topics: Aged; Cohort Studies; Comorbidity; Databases, Factual; Female; Humans; Hyperthyroidism; Hypothyroidism; Incidence; Macular Degeneration; Male; Middle Aged; Myopia; National Health Programs; Proportional Hazards Models; Risk Factors; Thyroid Neoplasms
PubMed: 29751509
DOI: 10.3390/ijerph15050902 -
Vestnik Oftalmologii 2018To develop methods for evaluating effectiveness of YAG-laser vitreolysis of vitreous floaters.
PURPOSE
To develop methods for evaluating effectiveness of YAG-laser vitreolysis of vitreous floaters.
MATERIAL AND METHODS
The study included 144 patients (173 eyes) who had underwent YAG-laser vitreolysis and were under observation from 01.09.16 to 31.01.18. The patients were 34 to 86 years old (mean age 62.7±10.2 years), 28 (19.4%) patients were male, 116 (80.6%) - female. All patients underwent standard and additional examination: ultrasonography (Accutome B-scan plus, U.S.A.), optic biometry (Lenstar 900, Haag-Streit, Switzerland), spectral optical coherence tomography using RTVue XR Avanti scanner (Optovue, U.S.A.) in modes Enhanced HD Line, 3D Retina, 3D Widefield MCT, Cross Line, Angio Retina, and scanning laser ophthalmoscopy (SLO) using Navilas 577s system. Laser vitreolysis was performed using the Ultra Q Reflex laser (Ellex, Australia).
RESULTS
This paper presents methods of objective quantitative and qualitative assessment of artifactual shadows of vitreous floaters with spectral optical coherence tomographic scanner RTVue xR Avanti employing an algorithm of automatic detection of non-perfusion zones in modes Angio Retina, HD Angio Retina, as well as foveal avascular zone (FAZ) measurement with Angio Analytics® software. SLO performed with Navilas 577s was used as method of visualizing floaters and artifactual shadows in retinal surface layers prior to surgical treatment and after YAG-laser vitreolysis.
CONCLUSION
Suggested methods of quantitative and qualitative assessment of artifactual shadows of the floaters in retinal layers are promising and may prove to be highly relevant for clinical monitoring of patients, optimization of treatment indications and evaluating effectiveness of YAG-laser vitreolysis. Further research of laser vitreolysis effectiveness in patients with vitreous floaters is necessary.
Topics: Adult; Aged; Aged, 80 and over; Eye Diseases; Female; Humans; Laser Therapy; Lasers, Solid-State; Male; Middle Aged; Vitrectomy; Vitreous Body
PubMed: 29543200
DOI: 10.17116/oftalma2018134156-62 -
Case Reports in Ophthalmology 2016To report a case of endophthalmitis following 27-gauge pars plana vitrectomy for symptomatic vitreous floaters.
PURPOSE
To report a case of endophthalmitis following 27-gauge pars plana vitrectomy for symptomatic vitreous floaters.
METHODS
The clinical course and imaging findings, including fundus optomap, and spectral domain optical coherence tomography of a 24-year-old male patient were documented.
RESULTS
The patient, with a preoperative best-corrected visual acuity (BCVA) of 1.0, developed endophthalmitis following 27-gauge pars plana vitrectomy for symptomatic vitreous floaters. After a series of treatments, including emergent vitreous tap and silicone oil injection, antibiotic treatment, and silicone oil removal, the patient regained a BCVA of 0.6.
CONCLUSION
Although rare, the potential risk of endophthalmitis should be explicitly discussed with patients considering surgical intervention for vitreous floaters.
PubMed: 28101041
DOI: 10.1159/000452733