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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 -
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 -
Ophthalmic Surgery, Lasers & Imaging... Oct 2018Vitrectomy is an effective treatment for visually disabling vitreous opacities (floaters) but carries significant surgical risk. Nd:YAG laser vitreolysis using newer...
Vitrectomy is an effective treatment for visually disabling vitreous opacities (floaters) but carries significant surgical risk. Nd:YAG laser vitreolysis using newer technology has been shown safe and effective in treating symptomatic Weiss ring vitreous floaters. These Weiss rings, as well as amorphous opacities in the mid- to posterior vitreous, can be impossible to visualize or treat using conventional YAG lasers. In the cases presented here, undetected symptomatic amorphous type posterior vitreous floaters were confirmed with assistance of a novel optical coherence tomography application and successfully treated using a YAG laser optimized for vitreolysis. These cases suggest that with proper technology and technique, laser vitreolysis may be safer and more effective than previously recognized. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:806-811.].
Topics: Eye Diseases; Female; Humans; Laser Therapy; Lasers, Solid-State; Male; Middle Aged; Surgery, Computer-Assisted; Tomography, Optical Coherence; Visual Acuity; Vitrectomy; Vitreous Body
PubMed: 30395668
DOI: 10.3928/23258160-20181002-10 -
The Journal of International Medical... Nov 2018To examine the efficacy and safety of yttrium-aluminium garnet (YAG) laser vitreolysis for the treatment of vitreous floaters. (Clinical Trial)
Clinical Trial
OBJECTIVE
To examine the efficacy and safety of yttrium-aluminium garnet (YAG) laser vitreolysis for the treatment of vitreous floaters.
METHODS
Consecutive adult patients with symptomatic vitreous floaters who attended Chongqing General Hospital from April to December 2016 were included in this prospective study. Patients had >3 mm between the vitreous opacity and retina/lens and acceptable quality peri-papillary Optical Coherence Tomography (OCT) images (i.e., signal strength ≥5). Those with history of glaucoma, severe cataracts, vitreous haemorrhages, retinal holes and/or macular disease were excluded from the study. Best corrected visual acuity (BCVA) and non-contact intraocular pressure (IOP) were measured before and for up to 6 months post-YAG laser vitreolysis. Anterior segment photography and peripapillary retinal nerve fibre layer (RNFL) measured by OCT were taken before and 6 months post-procedure. Questionnaires on patient satisfaction were completed 6 months post-procedure.
RESULTS
No statistically significant differences in BCVA and IOP were observed before or after treatment. Anterior segment photography showed that vitreous opacities partially or completely disappeared after YAG laser treatment. The thickness of RNFL in four directions (upper, below, nasal and temporal) was not statistically significant different before or 6 months after the procedure. 75% patients reported significant improvement and 25% reported moderate improvement.
CONCLUSION
The results of this study conducted in a cohort of 30 Chinese patients showed that YAG laser vitreolysis was a well-tolerated and effective treatment for vitreous floaters. Randomised, controlled trials involving large numbers of participants monitored over an extended follow up period are required to confirm these results.
Topics: Adult; Aged; Anterior Eye Segment; Eye Diseases; Female; Humans; Intraocular Pressure; Lasers, Solid-State; Male; Middle Aged; Retina; Visual Acuity; Vitreous Body
PubMed: 30200800
DOI: 10.1177/0300060518794245 -
BMC Ophthalmology Jul 2018To compare the safety and efficacy of topical anesthesia versus retrobulbar anesthesia in 27-gauge pars plana vitrectomy (PPV) for vitreous floaters. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
To compare the safety and efficacy of topical anesthesia versus retrobulbar anesthesia in 27-gauge pars plana vitrectomy (PPV) for vitreous floaters.
METHODS
30 patients with vitreous floaters were randomized into Group T (topical anesthesia, proparacaine eye drop) and Group R (retrobulbar anesthesia), and underwent 27-gauge PPV. A 5-point visual analogue pain scale (VAPS) was used to assess patients' pain experience of anesthesia and surgery procedure (during surgery, 2 h and 1 day after surgery).
RESULTS
The VAPS of anesthesia procedure was 1.27 ± 0.59 for patients in Group R, while it was all 0 for patients in Group T (p < 0.001). There was no significant difference for VAPS during surgery (Group T: 1.13 ± 0.74, Group R: 0.67 ± 0.62, p = 0.67), 2 h (Group T: 0.80 ± 1.01, Group R: 0.67 ± 0.62, p = 0.67) and 1 day (Group T: 0.20 ± 0.41, Group R: 0.27 ± 0.46, p = 0.68) after surgery between these two groups. Only one patient (6.7%) in Group T required additional topical anesthesia during the surgery. Most of the patients reported the pain experience came from initial trocar insertion in both groups. None of the patients required post operative analgesia in both groups. No intraoperative or postoperative complications were noted in both groups.
CONCLUSION
This study suggested that topical anesthesia is a safe and effective anesthetic approach for patients with floaters who underwent 27-gauge PPV.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03049163 . Registered 8 February 2017.
Topics: Adult; Anesthesia, Local; Anesthetics, Local; Eye Diseases; Female; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Tomography, Optical Coherence; Treatment Outcome; Ultrasonography; Vitrectomy; Vitreous Body; Young Adult
PubMed: 29981573
DOI: 10.1186/s12886-018-0838-7 -
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 -
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 -
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