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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 -
PloS One 2020To investigate the prevalence of focal lamina cribrosa (LC) defects in patients with unilateral branch retinal vein occlusion (BRVO) and to compare ocular...
PURPOSE
To investigate the prevalence of focal lamina cribrosa (LC) defects in patients with unilateral branch retinal vein occlusion (BRVO) and to compare ocular characteristics between eyes with and without focal LC defect and those eyes with normal-tension glaucoma (NTG).
METHODS
This retrospective, cross-sectional study included 121 patients. Thirty-nine patients had unilateral BRVO (BRVO group), 36 patients had NTG (NTG group), and 36 patients had vitreous floaters, but no other ocular diseases (control group). In addition to baseline characteristics such as age, sex, refractive errors, the ocular characteristics such as peripapillary choroidal thickness (PCT), retinal nerve fiber layer thickness, and subfoveal choroidal thickness were retrospectively analyzed.
RESULTS
Focal LC defects were detected in 20 eyes of 14 patients (38.9%) in the BRVO group, 24 eyes of 15 patients (41.7%) in the NTG group, and none in the control group (P<0.001). In the BRVO-affected eyes, the mean PCT was 102.7±31.1 μm in the eyes with focal LC defects, and 163.1±70.1 μm in the eyes without LC defects (P = 0.009). In the BRVO-affected eyes, the mean PCT was 102.7±31.1 μm in the eyes with focal LC defects, and 163.1±70.1 μm in the eyes without LC defects (P = 0.009). In the NTG group, the mean PCT was 133.1±48.9 μm in the eyes with focal LC defects and 170.8±81.9 μm in those without (P = 0.042). The other baseline and ocular characteristics were not significantly different between the eyes with and without focal LC defects in both the BRVO group and the NTG group.
CONCLUSIONS
About 40% of the patients with unilateral BRVO had focal LC defect in the BRVO-affected eyes and unaffected fellow eyes, similar prevalence to the patients with NTG. The mean PCT was significantly thinner in the eyes with focal LC defect than those without in the patients with BRVO and those with NTG, suggesting possible pathophysiologic correlation between these two diseases.
Topics: Adult; Aged; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Nerve Fibers; Optic Nerve Diseases; Retinal Vein Occlusion; Retrospective Studies
PubMed: 32163496
DOI: 10.1371/journal.pone.0230293 -
Asia-Pacific Journal of Ophthalmology... 2020Vitreous floaters are a common cause for presentation to ophthalmologists, and may significantly affect visual function. In the absence of some more serious underlying... (Review)
Review
Vitreous floaters are a common cause for presentation to ophthalmologists, and may significantly affect visual function. In the absence of some more serious underlying pathology such as uveitis, many patients may not experience significant persistent visual impairment from floaters. For some patients, the symptomatic effects of floaters may persist. For these patients, treatment options are available, of which the most commonly reported is vitrectomy. Other treatment modalities have also become more common, notably YAG vitreolysis. Selection of appropriate patients for surgery is often difficult, in part due to the relative lack of objective outcomes with which to measure both visual impairment and improvement post-procedure. Although well-tolerated, vitrectomy does carry with it risks, including iatrogenic retinal breaks, retinal detachment, and in phakic patients, subsequent cataract formation. Techniques such as small gauge vitrectomy, intraoperative examination and treatment of breaks or other worrying lesions, and careful consideration of the need for posterior vitreous detachment induction may help limit the incidence of these adverse events. For other treatment options such as YAG vitreolysis, research and clinical experience remain more limited, and as such the long-term efficacy and risks of these therapies are still unclear. Here, we review the evidence surrounding the role of vitrectomy and YAG vitreolysis in the treatment of vitreous floaters and potential means to minimize therapeutic complications.
Topics: Eye Diseases; Humans; Laser Therapy; Lasers, Solid-State; Vitrectomy; Vitreous Body
PubMed: 32097127
DOI: 10.1097/APO.0000000000000276 -
Advances in Therapy Apr 2020Emerging evidence has suggested that the entoptic phenomena associated with vitreous opacities (i.e. vitreous floaters) are more bothersome than previously believed. In... (Review)
Review
Emerging evidence has suggested that the entoptic phenomena associated with vitreous opacities (i.e. vitreous floaters) are more bothersome than previously believed. In addition, the prevalence of vitreous floaters is likely increasing due to the evolving global pandemic of myopia. The use of YAG laser vitreolysis for the treatment of annoying vitreous floaters has attracted significant attention in recent years as the technique offers a number of potential advantages. Unfortunately, the currently available evidence that is needed to guide clinical practice is both very limited and contradictory. As a consequence, the technique remains highly controversial. A review of the existing literature sheds light on patient- and treatment-related factors that may significantly affect both the effectiveness and the safety of the procedure. The current article discusses important aspects of key publications on the topic, offers suggestions for clinical practice, and highlights unmet needs that should be addressed by future research.
Topics: Eye Diseases; Humans; Laser Therapy; Lasers, Solid-State; Risk Factors; Vitrectomy; Vitreous Body
PubMed: 32086749
DOI: 10.1007/s12325-020-01261-w -
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 -
Severe intraocular lens opacification after scleral suturing in a patient with retinitis pigmentosa.Romanian Journal of Ophthalmology 2019To report a case of late intraocular lens (IOL) opacification after scleral suturing in a patient with retinitis pigmentosa. A 36-year-old man presented with visual...
To report a case of late intraocular lens (IOL) opacification after scleral suturing in a patient with retinitis pigmentosa. A 36-year-old man presented with visual impairment increasing gradually over the preceding three months. Seven years earlier, he underwent bilateral phacoemulsification cataract surgery with implantation of a Rayner 620H IOL in the left eye, and a Quatrix P12 IOL in the right eye. Five months prior to admission, scleral suturing of the subluxated IOL in the left eye was performed due to subluxation. Slit lamp examination revealed significant opacities within the IOL and marked vitreous floaters in the left eye. The previous diagnosis of retinitis pigmentosa and rotary nystagmus were confirmed. Subsequently, he underwent 25-gauge vitrectomy with IOL removal in his left eye. Light microscopy of the explanted IOL revealed unevenly distributed microvacuoles. Subsequently, vitrectomy with IOL removal was performed after 3 months in the right eye. The patient had a good recovery of vision, with a visual acuity of 20/200 in both eyes with contact lenses. The presented case demonstrated a significant increase in IOL opacification following scleral suturing. The presumed pathogenesis includes IOL microdeformation with development of IOL matrix cavities and intense inflammatory response related to scleral suturing.
Topics: Adult; Cataract; Device Removal; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Male; Phacoemulsification; Postoperative Complications; Prosthesis Failure; Reoperation; Retinitis Pigmentosa; Sclera; Suture Techniques; Visual Acuity; Vitrectomy
PubMed: 31915739
DOI: No ID Found -
Neurophotonics Oct 2019Age-related macular degeneration (AMD) is a vision-threatening disease that affects the outer retina and choroid of elderly adults. Because photoreceptors are found in...
Age-related macular degeneration (AMD) is a vision-threatening disease that affects the outer retina and choroid of elderly adults. Because photoreceptors are found in the outer retina and rely primarily on the trophic support of the underlying choriocapillaris, imaging of flow or lack thereof in choriocapillaris by optical coherence tomography angiography (OCTA) has great clinical potential in AMD assessment. We introduce a metric using OCTA, named "focal perfusion loss" (FPL) to describe the effects of age and non-neovascular AMD on choriocapillaris flow. Because OCTA imaging of choriocapillaris is vulnerable to artifacts-namely motion, projections, segmentation errors, and shadows-they are removed by postprocessing software. The shadow detection software is a machine learning algorithm recently developed for the evaluation of the retinal circulation and here adapted for choriocapillaris analysis. It aims to exclude areas with unreliable flow signal due to blocking of the OCT beam by objects anterior to the choriocapillaris (e.g., drusen, retinal vessels, vitreous floaters, and iris). We found that both the FPL and the capillary density were able to detect changes in the choriocapillaris of AMD and healthy age-matched subjects with respect to young controls. The dominant cause of shadowing in AMD is drusen, and the shadow exclusion algorithm helps determine which areas under drusen retain sufficient signal for perfusion evaluation and which areas must be excluded. Such analysis allowed us to determine unambiguously that choriocapillaris density under drusen is indeed reduced.
PubMed: 31528658
DOI: 10.1117/1.NPh.6.4.041108 -
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 -
Biomedical Optics Express Jul 2019The capillary nonperfusion area (NPA) is a key quantifiable biomarker in the evaluation of diabetic retinopathy (DR) using optical coherence tomography angiography...
The capillary nonperfusion area (NPA) is a key quantifiable biomarker in the evaluation of diabetic retinopathy (DR) using optical coherence tomography angiography (OCTA). However, signal reduction artifacts caused by vitreous floaters, pupil vignetting, or defocus present significant obstacles to accurate quantification. We have developed a convolutional neural network, MEDnet-V2, to distinguish NPA from signal reduction artifacts in 6×6 mm OCTA. The network achieves strong specificity and sensitivity for NPA detection across a wide range of DR severity and scan quality.
PubMed: 31360599
DOI: 10.1364/BOE.10.003257 -
Biomedical Optics Express Mar 2019Frequently, when imaging retinal vasculature with optical coherence tomography angiography (OCTA) in diseased eyes, there are unavoidable obstacles to the propagation of...
Frequently, when imaging retinal vasculature with optical coherence tomography angiography (OCTA) in diseased eyes, there are unavoidable obstacles to the propagation of light such as vitreous floaters or the pupil boundary. These obstacles can block the optical coherence tomography (OCT) beam and impede the visualization of the underlying retinal microcirculation. Detecting these shadow artifacts is especially important in the quantification of metrics that assess retinal disease progression because they might masquerade as regional perfusion loss. In this work, we present an algorithm to identify shadowed areas in OCTA of healthy subjects as well as patients with diabetic retinopathy, uveitis and age-related macular degeneration. The aim is to exclude these areas from analysis so that the overall OCTA parameters are minimally affected by shadow artifacts.
PubMed: 30891364
DOI: 10.1364/BOE.10.001514