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Investigative Ophthalmology & Visual... May 2024Vision-degrading myodesopsia (VDM) from vitreous floaters significantly degrades vision and impacts visual quality of life (VQOL), but the relationship to light...
PURPOSE
Vision-degrading myodesopsia (VDM) from vitreous floaters significantly degrades vision and impacts visual quality of life (VQOL), but the relationship to light scattering is poorly understood. This study compared in vitro measures of light scatter and transmission in surgically excised human vitreous to preoperative indexes of vitreous structure, visual function, and VQOL.
METHODS
Pure vitreous collected during vitrectomy from 8 patients with VDM had wide-angle straylight measurements and dark-field imaging, performed within 36 hours of vitrectomy. Preoperative VQOL assessment with VFQ-25, contrast sensitivity (CS) measurements with Freiburg acuity contrast testing, and quantitative ultrasonography were compared to light scattering and transmission in vitro.
RESULTS
All indices of vitreous echodensity in vivo correlated positively with straylight at 0.5° (R = 0.708 to 0.775, P = 0.049 and 0.024, respectively). Straylight mean scatter index correlated with echodensity (R = 0.71, P = 0.04) and VQOL (R = -0.82, P = 0.0075). Dark-field measures in vitro correlated with degraded CS in vivo (R = -0.69, P = 0.04). VQOL correlated with straylight mean scatter index (R = -0.823, P = 0.012).
CONCLUSIONS
Increased vitreous echodensity in vivo is associated with more straylight scattering in vitro, validating ultrasonography as a clinical surrogate for light scattering. Contrast sensitivity in vivo is more degraded in the presence of dark-field scattering in vitro and VQOL is decreased in patients whose vitreous has increased light scattering. These findings could form the basis for the development of optical corrections for VDM or support new laser treatments, as well as novel pharmacotherapy.
Topics: Humans; Vitreous Body; Female; Male; Scattering, Radiation; Middle Aged; Light; Visual Acuity; Vitrectomy; Contrast Sensitivity; Aged; Quality of Life; Vision Disorders; Adult; Ultrasonography; Eye Diseases
PubMed: 38727692
DOI: 10.1167/iovs.65.5.20 -
International Ophthalmology May 2024To evaluate the levels of anxiety and depression in patients with symptomatic vitreous floaters and to determine the possible correlations of psychological implications...
PURPOSE
To evaluate the levels of anxiety and depression in patients with symptomatic vitreous floaters and to determine the possible correlations of psychological implications with the symptoms duration and possible improvement, the degree of posterior vitreous detachment, and the discomfort severity.
METHODS
Ninety patients complaining for floaters and fifty-seven age- and gender-matched healthy-control subjects were recruited. Every participant underwent a complete ophthalmological examination, including funduscopy and optical coherence tomography scans, while clinical and demographic data were also gathered. The Patient Health Questionnaire-9 (PHQ-9), the Zung Depression Inventory-Self-Rating Depression Scale (Zung SDS), and the Hospital Anxiety and Depression Scale (HADS) were completed by everyone.
RESULTS
Between the studied groups, no significant differences were detected regarding the clinical and demographic data (p > 0.05). The patients with floaters had significantly higher scores of PHQ-9, Zung SDS, HADS Anxiety, and HADS Depression (p < 0.001). After adjustment for several confounders, PHQ-9 (p = 0.041), Zung SDS (p = 0.003), and HADS Anxiety (p = 0.036) values remained significantly impaired. Among the patients, PHQ-9 and Zung SDS scores were significantly elevated in the patients with floaters duration less than 4 weeks (p < 0.05). Finally, anxiety and depression were significantly correlated with the symptoms duration and intensity, with the floater-associated discomfort, and with the stage of posterior vitreous detachment.
CONCLUSION
Vitreous floaters have a negative impact on patients' psychological status, by the terms of enhanced depressive and anxiety levels. To the best of our knowledge, our study is the first in the literature to elaborate the aforementioned association, by assessing three different questionnaires simultaneously.
Topics: Humans; Male; Female; Middle Aged; Vitreous Body; Depression; Adult; Anxiety; Eye Diseases; Tomography, Optical Coherence; Surveys and Questionnaires; Aged; Case-Control Studies; Vitreous Detachment; Vision Disorders
PubMed: 38713290
DOI: 10.1007/s10792-024-03006-y -
Graefe's Archive For Clinical and... May 2024We investigated personality traits and symptoms of anxiety and depression in patients with primary vitreous floaters.
PURPOSE
We investigated personality traits and symptoms of anxiety and depression in patients with primary vitreous floaters.
METHODS
A U.K. sample of adult patients (> 18 years old) with vitreous floaters of a minimum of three months severe enough to seek a consultation was assessed for personality traits (The Big Five Inventory (BFI)), symptoms of depression (Patient Health Questionnaire-9), and symptoms of anxiety (Generalized Anxiety Disorder Questionnaire-7).
RESULTS
149 patients participated in the study. Compared to the general population, our sample had a significantly increased score in the domain of BFI-neuroticism (3.27 vs 2.97, ρ < 0.0001, d = 0.38) and reduced score in the domain of extraversion (2.97 vs 3.24, ρ < 0.0001, d = 0.33). Female patients scored significantly higher than male patients on BFI-neuroticism (ρ = 0.01), and on BFI-agreeableness (ρ = 0.01). Age was positively correlated with BFI-Conscientiousness (r = 0.19, ρ = 0.02) and with BFI-Agreeableness (r = 0.20, ρ = 0.01). 36% of our sample had moderate to severe symptoms of depression, and 43% had moderate to severe symptoms of anxiety.
CONCLUSIONS
Our study highlights the underlying psychological traits of patients with severe vitreous floaters and particular mental health needs that deserve further consideration by ophthalmological and vision science clinicians.
PubMed: 38700589
DOI: 10.1007/s00417-024-06477-y -
International Journal of Ophthalmology 2024To describe the clinical, electrophysiological, and genetic features of an unusual case with an homozygous pathogenic variant and reviewed the characteristics of the...
AIM
To describe the clinical, electrophysiological, and genetic features of an unusual case with an homozygous pathogenic variant and reviewed the characteristics of the patients reported with the same variant.
METHODS
The patient underwent a complete ophthalmologic examination including best-corrected visual acuity, anterior segment and dilated fundus, visual field, spectral-domain optical coherence tomography (OCT) and electroretinogram (ERG). The retinal disease panel genes were sequenced through chip capture high-throughput sequencing and Sanger sequencing was used to confirm the result. Then we reviewed the characteristics of the patients reported with the same variant.
RESULTS
A 30-year male presented with severe early retinal degeneration who complained night blindness, decreased visual acuity, vitreous floaters and amaurosis fugax. The best corrected vision was 0.04 OD and 0.12 OS, respectively. The fundus photo and OCT showed bilateral macular atrophy but larger areas of macular atrophy in the left eye. Autofluorescence shows bilateral symmetrical hypo-autofluorescence. ERG revealed that the amplitudes of a- and b-wave were severely decreased. Multifocal ERG showed decreased amplitudes in the local macular area. A homozygous missense variant c.146C>T (chr14:68191267) was found. The clinical characteristics of a total of 13 patients reported with the same pathologic variant varied.
CONCLUSION
An unusual patient with a homozygous pathogenic variant in the c.146C>T of which causes late-onset and asymmetric retinal degeneration are reported. The clinical manifestations of the patient with multimodal retinal imaging and functional examinations have enriched our understanding of this disease.
PubMed: 38371258
DOI: 10.18240/ijo.2024.02.13 -
Trials Jan 2024Vitreous floaters are a common ocular condition that affects individuals of all ages. Although vitreous floaters are typically benign, they can significantly impair...
BACKGROUND
Vitreous floaters are a common ocular condition that affects individuals of all ages. Although vitreous floaters are typically benign, they can significantly impair visual acuity and quality of life. Laser vitreolysis, which uses an Nd: YAG laser to vaporize collagenous vitreous opacities, is increasingly being used as a treatment option. However, there is currently a lack of evidence regarding its efficacy and the appropriate timing of its application. This study aims to evaluate the efficacy and safety of early intervention with YAG laser vitreolysis in treating symptomatic vitreous floaters.
METHODS
The present study is a randomized, controlled, double-blind clinical trial. A total of 70 participants with symptomatic floaters for 1 month were prospectively recruited. These participants will be randomly assigned to two groups, with 35 individuals in each group: the early treatment group and the delayed treatment group. Participants assigned to the early treatment group will undergo YAG laser vitreolysis immediately, followed by a sham laser treatment 3 months later. On the other hand, participants assigned to the delayed treatment group will receive a sham laser treatment and then undergo YAG laser vitreolysis 3 months later. The follow-up time points will be 1, 3, 6, and 12 months from randomization. Primary outcomes will be participants' self-reported improvement in visual disturbance on a scale of 1 to 10 and their scores on the National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25). Secondary outcomes will be an objective evaluation of the effectiveness of the treatment in reducing vitreous floaters through OCT and fundus photography and tracking any adverse events related to the eyes or overall health.
DISCUSSION
This clinical trial aims to evaluate the effectiveness of YAG laser vitreolysis in treating symptomatic vitreous floaters and assess the safety of performing early intervention with YAG laser vitreolysis.
TRIAL REGISTRATION
ClinicalTrials.gov NCT05800353 . Registered on 10 March 2023.
Topics: Humans; Vitreous Body; Vitrectomy; Lasers, Solid-State; Quality of Life; Laser Therapy; Randomized Controlled Trials as Topic; Vision Disorders
PubMed: 38218919
DOI: 10.1186/s13063-024-07924-1 -
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 -
Klinische Monatsblatter Fur... Dec 2023Intermediate and posterior uveitis describes a broad variety of different types of intraocular inflammation. Before starting treatment of intermediate or posterior...
Intermediate and posterior uveitis describes a broad variety of different types of intraocular inflammation. Before starting treatment of intermediate or posterior uveitis, a differentiation between infectious or non-infectious uveitis must always be made. Pathognomonic symptoms do not exist, visual loss and vitreous floaters are the most common symptoms. The indication for therapy is influenced by the anatomical localization, the degree of inflammation, an association, complications and the activity of the inflammation. In addition to clinical ophthalmological standard examination, angiography and OCT are the most important investigations to classify and assess the course of inflammation. Macular edema is the most common complication of intermediate or posterior uveitis and should be treated at first onset, recurrence, or worsening. Oral, intravenous, or intravitreal corticosteroids are usually the primary therapy for intermediate or posterior uveitis. Systemic immunosuppression is indicated after steroid failure in non-infectious uveitis.
Topics: Humans; Uveitis, Posterior; Uveitis; Inflammation; Algorithms; Uveitis, Intermediate; Glucocorticoids
PubMed: 37977203
DOI: 10.1055/a-2193-2509 -
BMC Ophthalmology Oct 2023To investigate the diagnostic sensitivity of Optos imaging for vision degrading myodesopsia (VDM).
BACKGROUND
To investigate the diagnostic sensitivity of Optos imaging for vision degrading myodesopsia (VDM).
METHODS
A total of 420 eyes from 345 patients with VDM were collected in this cross-sectional study. All eyes were classified as having posterior vitreous detachment (PVD) or not having PVD. The sensitivity of Optos imaging for the visibility of vitreous floaters was evaluated. The associated factors with the visibility of vitreous floaters on Optos images were analyzed in univariate and multivariate logistic regression analyses.
RESULTS
The mean age of all patients was 56.19 ± 13.89 years old, and 66.67% of patients were female. The vitreous floaters were visible on the ultrasound B scan in all eyes, but only in 47.62% of Optos images (55.29% in eyes with PVD and 15% in eyes without PVD). In the multiple binary logistic regression analysis, age (OR = 1.094, 95%CI = 1.063-1.125, P < 0.001), spherical equivalent (OR = 0.869, 95%CI = 0.791-0.955, P = 0.004) and the distance of the floaters from the retina (OR = 1.191, 95%CI = 1.059-1.339, P = 0.003) were significantly correlated with the visibility of vitreous floaters on Optos images. On Optos images, 25.71% of VDM eyes presented additional retinal abnormalities.
CONCLUSIONS
Optos imaging has a low sensitivity for vitreous floaters, particularly in eyes without PVD. On Optos imaging, floaters were more visible in older patients, eyes with greater myopia, and floaters that were further from the retina.
Topics: Humans; Female; Aged; Adult; Middle Aged; Male; Cross-Sectional Studies; Vitreous Body; Eye Diseases; Vitreous Detachment; Ophthalmoscopes; Lasers
PubMed: 37864149
DOI: 10.1186/s12886-023-03166-y -
JAMA Ophthalmology Nov 2023
Topics: Humans; Vitreous Body; Eye Diseases; Retina; Intravitreal Injections
PubMed: 37796511
DOI: 10.1001/jamaophthalmol.2023.4394 -
JAMA Ophthalmology Nov 2023Recently, intravitreal pegcetacoplan became the first drug to gain US Food and Drug Administration approval for the treatment of geographic atrophy associated with...
IMPORTANCE
Recently, intravitreal pegcetacoplan became the first drug to gain US Food and Drug Administration approval for the treatment of geographic atrophy associated with nonexudative age-related macular degeneration, but the administration of this medication may be associated with unanticipated posttreatment complications.
OBJECTIVE
To assess the prevalence of presumed silicone oil droplets in the vitreous cavity after intravitreal injection of pegcetacoplan.
DESIGN, SETTING, AND PARTICIPANTS
This case series study involved a retrospective record review of all 55 patients treated with intravitreal pegcetacoplan, 0.1 mL in 150-mg/mL solution, between March 24 and June 5, 2023, at a single specialty retina practice. All injections were done using needles from the kit supplied by Apellis Pharmaceuticals on a 1-mL McKesson Luer lock syringe.
MAIN OUTCOMES AND MEASURES
The presence or absence of presumed silicone bubbles detected during dilated biomicroscopic fundus examination and/or on color fundus photographs, the presence or absence of symptoms, change in visual acuity, and/or increase in intraocular pressure.
RESULTS
A total of 62 intravitreal pegcetacoplan injections were given to 55 patients (mean [SD] age, 83.8 [7.8] years; 33 women [60%]) from March 24 to June 5, 2023. Of the 55 patients, 16 (29%; mean [SD] age, 83.8 [7.4] years; 9 women [56%]) had presumed intravitreal silicone droplets discovered 2 to 4 weeks after treatment, 3 of which were documented on color fundus photographs. Of the 16 patients, 14 (88%) were symptomatic for new floaters that they described as persistent, while 2 (13%) were asymptomatic. There were no signs of inflammation or infection, no increases in intraocular pressure, and no changes in visual acuity for all 16 patients.
CONCLUSIONS AND RELEVANCE
A substantial percentage of patients had symptomatic floaters from presumed intravitreal silicone oil droplets after injections of pegcetacoplan using a McKesson 1-mL Luer lock syringe. These findings support consideration of informing patients of this potential adverse effect, avoiding use of the McKesson syringe, and considering use of silicone-free syringes for pegcetacoplan injections.
Topics: Humans; Female; Aged, 80 and over; Intravitreal Injections; Silicone Oils; Silicones; Retrospective Studies; Eye Diseases; Retina; Geographic Atrophy
PubMed: 37796497
DOI: 10.1001/jamaophthalmol.2023.4326