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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 -
Klinische Monatsblatter Fur... Apr 2011The aim of this study was to evaluate the role of vitrectomy in patients with visually disturbing vitreous opacities.
BACKGROUND
The aim of this study was to evaluate the role of vitrectomy in patients with visually disturbing vitreous opacities.
PATIENTS AND METHODS
A retrospective analysis of the patient characteristics and the outcome of all pseudophacic eyes, which consecutively received in the decade 1996 to 2005 20 G pars plana vitrectomy for visually disturbing floaters, was carried out at the Mainz University Eye Clinic.
RESULTS
Forty-one eyes of 32 patients (63 % university graduates, median age: 64 years) were included in the study. The mean axial length of the globe was 25.3 mm (range: 22.8 to 28.9 mm). Additional pathologies having influence on the vitreous condition were history of laser or cryo retinopexy (12 ×), buckle surgery (5 ×), complicated cataract surgery (16 ×) and Nd:YAG laser capsulotomy (4 ×). Vitreous floaters were considered to be the result of posterior vitreous detachment alone in 61 %, of asteroid hyalosis accompanied by posterior vitreous detachment in 17 %, and vitreous syneresis in 15 % of the eyes. Intraoperatively retinopexy with endolaser or cryo was performed in 6 % of cases. A secondary retinal detachment occurred in one eye (2 %). Thirty-one of 32 patients reported to be very satisfied with the postoperative result. Objectively, their visual acuity was better than or equal to preoperative acuity in 95 % of the eyes.
CONCLUSION
Pars plana vitrectomy provides a highly effective treatment for visually disturbing vitreous floaters. In an era in which the expectations and demands of individuals on the quality of vision and life have increased significantly, with careful case selection the benefits of the surgical intervention may outweigh the surgical risks.
Topics: Female; Humans; Male; Pseudophakia; Treatment Outcome; Vision Disorders; Vitrectomy; Vitreous Body
PubMed: 21484632
DOI: 10.1055/s-0031-1273209 -
The British Journal of Ophthalmology Aug 1993Fifteen cases of vitreous floaters with serious psychological reactions have been collected. By using a direct ophthalmoscope, causal vitreous opacities were detected....
Fifteen cases of vitreous floaters with serious psychological reactions have been collected. By using a direct ophthalmoscope, causal vitreous opacities were detected. The opacities were photodisrupted with neodymium YAG laser, using energy levels of 5 to 7.1 mJ and total energy 71 to 742.0 mJ. Symptoms completely disappeared immediately after treatment in all 15 cases. There were no intraoperative or postoperative complications noted during a follow up period of at least 1 year. To our knowledge, the use of neodymium YAG laser to treat vitreous floaters has not been previously described. Our initial experience indicates that the treatment is simple, safe, and effective.
Topics: Adult; Aged; Eye Diseases; Female; Follow-Up Studies; Fundus Oculi; Humans; Laser Therapy; Male; Middle Aged; Ophthalmoscopy; Vitreous Body
PubMed: 8025044
DOI: 10.1136/bjo.77.8.485 -
Retina (Philadelphia, Pa.) Jun 2015To evaluate the effect of vitreous floaters on intraocular straylight.
PURPOSE
To evaluate the effect of vitreous floaters on intraocular straylight.
METHODS
Records of bilaterally phakic patients with unilateral complaint of floaters as the main symptom were identified from an electronic database. Patients who underwent straylight measurements on both affected and unaffected eyes using a C-Quant straylight meter were selected. Data were collected on age, sex, visual acuity, straylight measurements, and optical coherence tomography. The unaffected eye served as a control.
RESULTS
Fifteen cases were included (7 women and 8 men; mean age, 54.3 years; age range, 24-71 years). Visual acuity was not correlated with the complaint of floaters. Average straylight value in eyes with floaters was 1.426 log(s) (±0.23 SD) with a median value of 1.52 log(s). The mean value for fellow eyes was 1.275 (±0.23 SD) with a median of 1.25 log(s). The differences between both groups using a Wilcoxon matched-pair signed-rank test was statistically significant at P = 0.0009. On optical coherence tomography, most patients had a confirmed or probable posterior vitreous detachment. However, in four patients, a posterior vitreous detachment was absent in the affected eyes. Vitreous floaters were inconsistently imaged by optical coherence tomography, with only a few patients presenting appreciable condensations close to the retinal surface. These were present in both affected and unaffected eyes.
CONCLUSION
Intraocular straylight is significantly increased in eyes affected by floaters. No correlation was seen with vision or optical coherence tomography appearance. Straylight is an independent objective measure of visual perception that seems to be closely correlated to complaints expressed by patients experiencing floaters.
Topics: Adult; Aged; Eye Diseases; Female; Glare; Humans; Light; Male; Middle Aged; Scattering, Radiation; Tomography, Optical Coherence; Visual Acuity; Vitreous Body; Young Adult
PubMed: 25650709
DOI: 10.1097/IAE.0000000000000456 -
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 -
Acta Ophthalmologica Mar 2011Floaters caused by degenerative or postoperative changes in the vitreous can interfere with all aspects of visual functioning. The aim of this study is to report the...
PURPOSE
Floaters caused by degenerative or postoperative changes in the vitreous can interfere with all aspects of visual functioning. The aim of this study is to report the longterm outcome of pars plana vitrectomy (PPV) for persistent vitreous opacities.
METHODS
In a retrospective, non-randomized, interventional case study we reviewed all cases of vitreous floaters that were vitrectomized at our department between 1997 and 2006. Patient complaints and satisfaction were assessed by a questionnaire administered at the end of follow-up.
RESULTS
Seventy-three consecutive cases were included (61 patients). Mean Snellen best corrected visual acuity (BCVA) before surgery was 0.81. Overall, 85% of patients complained of severe or very severe difficulty caused by floaters. A total of 42% of eyes were pseudophakic, four of which were operated with combined PPV and phacoemulsification. Mean follow-up time was 37 months. Of the phakic eyes, 60% were operated for cataract during follow-up. One retinal detachment (RD) occurred immediately postoperatively (1.3%) and another four eyes developed RD during longterm follow-up 24-44 months after PPV (5.5% of cases). Postoperative BCVA remained mostly unchanged. Overall, 88% of patients were satisfied with the results of the operation.
CONCLUSIONS
Some patients make considerable complaints as a result of vitreous opacities and their distress does not correlate with visual acuity. Vitrectomy is a safe and effective procedure with which to help these patients. Patients should be informed about the risk of cataract progression, unexpected inflammatory reaction and an increased risk for RD several years after PPV (5.5%).
Topics: Adult; Aged; Aged, 80 and over; Eye Diseases; Female; Follow-Up Studies; Humans; Lasers, Solid-State; Male; Middle Aged; Patient Satisfaction; Phacoemulsification; Postoperative Complications; Pseudophakia; Retrospective Studies; Surveys and Questionnaires; Treatment Outcome; Vitrectomy; Vitreous Body
PubMed: 19860781
DOI: 10.1111/j.1755-3768.2009.01682.x -
Eye (London, England) Jan 2002To determine the efficacy of Nd:YAG vitreolysis and pars plana vitrectomy in the treatment of vitreous floaters.
PURPOSE OF STUDY
To determine the efficacy of Nd:YAG vitreolysis and pars plana vitrectomy in the treatment of vitreous floaters.
METHODS
This is a single centre retrospective study of 31 patients (42 eyes) who underwent 54 procedures, Nd:YAG vitreolysis or pars plana vitrectomy, for the treatment of vitreous floaters between January 1992 and December 2000. Main outcome measures were percentage symptomatic improvement following treatment and incidence of post-operative complications. Statistical analysis was performed using the Fisher exact test.
RESULTS
Posterior vitreous detachment was the primary cause of floaters in all 42 eyes with co-existing vitreous veils in three eyes and asteroid hyalosis in two eyes. Thirty-nine of 42 eyes received Nd:YAG vitreolysis. Thirty-eight percent found Nd:YAG vitreolysis moderately improved their symptoms while 61.5% found no improvement. After an average of 14.7 months follow-up no post-operative complications were recorded. Fifteen eyes underwent a pars plana vitrectomy, one with combined phacoemulsification and posterior chamber implantation and 11 following unsuccessful laser vitreolysis. Pars plana vitrectomy resulted in full resolution of symptoms in 93.3% of eyes. One patient developed a post-operative retinal detachment which was successfully treated leaving the patient with 6/5 VA.
CONCLUSION
Patients' symptoms from vitreous floaters are often underestimated resulting in no intervention. This paper shows Nd:YAG vitreolysis to be a safe but only moderately effective primary treatment conferring clinical benefit in one third of patients. Pars plana vitrectomy, while offering superior results, should be reserved for patients who remain markedly symptomatic following vitreolysis, until future studies further clarify its role in the treatment of patients with floaters and posterior vitreous detachment.
Topics: Adult; Aged; Aged, 80 and over; Eye Diseases; Female; Humans; Laser Therapy; Male; Middle Aged; Refractive Errors; Retrospective Studies; Treatment Outcome; Vitrectomy; Vitreous Body; Vitreous Detachment
PubMed: 11913884
DOI: 10.1038/sj.eye.6700026 -
Journal of Ophthalmology 2019Vitreous floater is a physically common phenomenon with aging and is related to visual impairment and decrease of quality of life. Nd:YAG vitreolysis is supposed to be...
BACKGROUND
Vitreous floater is a physically common phenomenon with aging and is related to visual impairment and decrease of quality of life. Nd:YAG vitreolysis is supposed to be an option for resolving floaters, but its clinical efficacy is undefined. We aimed to evaluate the efficacy of Nd:YAG vitreolysis in treating floater semiquantifiably by determining changes of floater areas on infrared fundus photography (IR).
METHODS
Patients with floaters and those who underwent Nd:YAG vitreolysis were retrospectively summarized from June 2015 to Nov 2017. Intraocular pressure, visual acuity, visual function questionnaire (VFQ-25) scores, and floater areas calculated using Image J software were recorded preoperatively and 6 months after YAG lasers.
RESULTS
50 patients (25 female/25 male, with an average age of 60.34 years) with 55 eyes (29 OD and 26 OS) presenting floaters and underwent YAG vitreolysis treatment were included. Severe symptoms were reported in 17 eyes, moderate in 21 and mild in 17 eyes. No severe Nd:YAG vitreolysis procedure-related complications occurred in all patients except one mild retinal injury. There were no significant changes in intraocular pressure and visual acuity after the laser treatment. 43 eyes had improved symptoms; in 8, floaters had disappeared; and 4 had no changes according to VFQ-25 scores. The median of shadow areas of floaters before operation was 1.41 (0.29-12.85) cm, which decreased to 0.12 (0-2.77) cm after the operations (=5.849, =0.001). The mean VFQ-25 scores increased to 88.54 ± 12.74 from the baseline 71.44 ± 12.77 (=11.82, =0.001). Pearson correlation analysis showed that the shadow areas of floaters were negatively correlated to VFQ-25 scores before (=-0.73, =0.001) and after (=-0.72, =0.001) treatments.
CONCLUSION
Nd:YAG vitreolysis was effective and safe in alleviating the visual symptoms induced by floaters. Quantification of floater shadow areas on infrared fundus photography could serve as an objective index for assessing treatment efficacy of Nd:YAG vitreolysis.
PubMed: 30809388
DOI: 10.1155/2019/8956952 -
The British Journal of Ophthalmology Jun 2017Neodymium-yttrium-aluminium-garnet (Nd:YAG) laser vitreolysis has been proposed as a treatment modality for symptomatic vitreous floaters. The purpose of this paper is...
BACKGROUND
Neodymium-yttrium-aluminium-garnet (Nd:YAG) laser vitreolysis has been proposed as a treatment modality for symptomatic vitreous floaters. The purpose of this paper is to report two cases of cataracts associated with posterior capsular compromise, induced by Nd:YAG laser vitreolysis for symptomatic vitreous floaters.
METHOD
Case series.
RESULTS
Two patients who underwent ND:YAG laser vitreolysis for symptomatic floaters, presented with decline in visual acuity in the treated eye after the laser procedure. At the slit-lamp biomicroscope, each patient was found to have a posterior subcapsular cataract in the treated eye, with obvious loss of integrity of the posterior capsule. These two patients underwent cataract extraction by the same surgeon via phacoemulsification. Both eyes were found to have a defect in the posterior capsule intraoperatively. In both cases, a three-piece acrylic intraocular lens implant was placed in the sulcus, achieving optic capture. The best-corrected visual acuity (BCVA) was 20/20 in both patients, at 1 month following the surgery. At 2 months, one patient had a BCVA of 20/15. The second patient maintained a BCVA of 20/20 at 3 months.
CONCLUSIONS
Secondary cataract formation accompanied by loss of integrity of the posterior capsule is a potential complication of Nd:YAG laser vitreolysis for symptomatic floaters.
Topics: Aged; Cataract; Eye Diseases; Female; Humans; Laser Therapy; Lasers, Solid-State; Male; Microscopy, Acoustic; Middle Aged; Postoperative Complications; Visual Acuity; Vitreous Body
PubMed: 27574177
DOI: 10.1136/bjophthalmol-2016-309005 -
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