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Eye (London, England) May 2020To evaluate the efficacy and safety of pars plana vitrectomy for symptomatic floaters.
BACKGROUND/OBJECTIVES
To evaluate the efficacy and safety of pars plana vitrectomy for symptomatic floaters.
SUBJECTS/METHODS
Forty-eight vitreoretinal surgeons from 16 countries provided information on 581 eyes who underwent vitrectomy for floaters in this retrospective survey study conducted by European VitreoRetinal Society. Percentage symptomatic improvement, incidence of retinal tears/detachment and post-vitrectomy cataract surgery, and the factors associated with satisfaction and complications were investigated.
RESULTS
Ninety-two percent were satisfied with the results, with 86.3% reporting complete resolution of daily-life symptoms. Overall satisfaction was lower in patients with smaller vitreous opacities at presentation (OR:0.4). Iatrogenic retinal breaks occurred in 29 eyes (5%). Core vitrectomy and cut rates of 1500-4000 or >4000 cuts/min were associated with lower risk of retinal breaks than complete vitrectomy (OR:0.05) and cut rates < 1500 cuts/min (OR: 0.03, 0.12, respectively). Fourteen eyes (2.4%) developed retinal detachment at a median of 3 months; and 84 (48.6%) developed cataract at a median of 16 months post-vitrectomy.
CONCLUSIONS
Pars plana vitrectomy resulted in high patient satisfaction with relatively low rate of severe complications in a large group of patients. The procedure may be safer when core vitrectomy and cut rates > 1500 cuts/min are favoured. Proper patient selection and informed consent are the most important aspects of surgery.
Topics: Humans; Postoperative Complications; Retinal Detachment; Retinal Perforations; Retrospective Studies; Vitrectomy; Vitreous Body
PubMed: 32313173
DOI: 10.1038/s41433-020-0825-0 -
International Journal of Ophthalmology 2020To investigate the depressive state among the patients with symptomatic vitreous floaters (SVF), as well as its change after SVF removal vitrectomy surgery.
AIM
To investigate the depressive state among the patients with symptomatic vitreous floaters (SVF), as well as its change after SVF removal vitrectomy surgery.
METHODS
Twenty-eight eyes of 28 patients who underwent 27-gauge pars plana vitrectomy (PPV) for SVF were included. Thirty-nine eyes of 39 age- and gender-matched healthy volunteers without SVF were also recruited as a healthy control. Center for Epidemiologic Studies Depression (CES-D) was used to assess volunteers and patients' depression (before and 1wk after PPV).
RESULTS
The CES-D score was 18.3±8.6 for patients, and was 12.4±6.0 for healthy control (=0.003). Patients were significantly more likely to be in a depressive state (53.6%, defined as CES-D score ≥16) than the healthy control (20.5%, =0.005). For patients with SVF, the CES-D score was negatively correlated with their age ( =-0.42, =0.025). After PPV, both the CES-D score (11.9±5.4 18.3±8.6, <0.001) and proportion of depressive state (18.5% 53.6%, =0.005) were significantly decreased.
CONCLUSION
This study suggests that symptoms of vitreous floaters have an apparently negative impact on patients' psychological state. The PPV can effectively relieve the depressive state for patients with SVF.
PubMed: 32309177
DOI: 10.18240/ijo.2020.03.07 -
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 -
Der Ophthalmologe : Zeitschrift Der... May 2020Degenerative vitreous opacities (also known as myodesopsia) can cause permanent and relevant visual impairment. Neodymium-YAG laser vitreolysis is an alternative...
Degenerative vitreous opacities (also known as myodesopsia) can cause permanent and relevant visual impairment. Neodymium-YAG laser vitreolysis is an alternative treatment option to pars plana vitrectomy for the treatment of disturbing degenerative vitreous opacities. This article critically discusses the different causes of vitreous opacities, the symptoms and functional impairments as well as clinical patient management. The aim is to support patient-oriented care and counselling of patients with vitreous opacities.
Topics: Eye Diseases; Humans; Laser Therapy; Lasers, Solid-State; Vision Disorders; Vitrectomy; Vitreous Body
PubMed: 32291480
DOI: 10.1007/s00347-020-01094-6 -
Medical Hypotheses Jun 2020At present, researchers are still debating the effect of blue light on the eyes.Studies have shown thatwhile blue lighthelpsto maintain normal biological...
At present, researchers are still debating the effect of blue light on the eyes.Studies have shown thatwhile blue lighthelpsto maintain normal biological rhythms,excessive blue light radiation mayinduce fundus lesions. The preliminary survey shows that the incidence of vitreous floaters is high among digital device users, electronic screens such as smart phones, iPad, and liquidcrystal displays (LCDs) emit blue light that may accelerates vitreous degeneration, resulting in vitreous opacity and increased floaters. Further research is needed to clarify the effects of blue light on the vitreous.
Topics: Fundus Oculi; Humans; Incidence; Light; Vision Disorders; Vitreous Body
PubMed: 32244150
DOI: 10.1016/j.mehy.2020.109698 -
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 -
Progress in Retinal and Eye Research Nov 2020Macromolecules comprise only 2% of vitreous, yet are responsible for its gel state, transparency, and physiologic function(s) within the eye. Myopia and aging alter... (Review)
Review
Macromolecules comprise only 2% of vitreous, yet are responsible for its gel state, transparency, and physiologic function(s) within the eye. Myopia and aging alter collagen and hyaluronan association causing concurrent gel liquefaction and fibrous degeneration. The resulting vitreous opacities and collapse of the vitreous body during posterior vitreous detachment are the most common causes for the visual phenomenon of vitreous floaters. Previously considered innocuous, the vitreous opacities that cause floaters sometimes impact vision by profoundly degrading contrast sensitivity function and impairing quality-of-life. While many people adapt to vitreous floaters, clinically significant cases can be diagnosed with Vision Degrading Myodesopsia based upon echographic assessment of vitreous structure and by measuring contrast sensitivity function. Perhaps due to the ubiquity of floaters, the medical profession has to date largely ignored the plight of those with Vision Degrading Myodesopsia. Improved diagnostics will enable better disease staging and more accurate identification of severe cases that merit therapy. YAG laser treatments may occasionally be slightly effective, but vitrectomy is currently the definitive cure. Future developments will usher in more informative diagnostic approaches as well as safer and more effective therapeutic strategies. Improved laser treatments, new pharmacotherapies, and possibly non-invasive optical corrections are exciting new approaches to pursue. Ultimately, enhanced understanding of the underlying pathogenesis of Vision Degrading Myodesopsia should result in prevention, the ultimate goal of modern Medicine.
Topics: Contrast Sensitivity; Humans; Myopia; Quality of Life; Visual Acuity; Vitrectomy; Vitreous Body
PubMed: 32151758
DOI: 10.1016/j.preteyeres.2020.100847 -
Survey of Ophthalmology 2020Vitreous floaters are common, related to age, myopia, genetic predisposition, and infiltration of the vitreous body. A subset of patients report symptoms impacting their... (Review)
Review
Vitreous floaters are common, related to age, myopia, genetic predisposition, and infiltration of the vitreous body. A subset of patients report symptoms impacting their quality of vision. Treatment with laser vitreolysis, the use of an Nd:YAG laser to vaporize the collagenous vitreous opacities appears to be used more frequently; however, data regarding long-term safety and effectiveness are lacking. We present currently available data regarding efficacy and safety, as well as additional considerations. Laser vitreolysis of symptomatic floaters should not be routinely performed without additional studies documenting its safety and long-term efficacy. Ideally, the procedure would be effective in most patients and be approved by the Food and Drug Administration based on the results of a Food and Drug Administration registration trial before widespread adoption.
Topics: Eye Diseases; Humans; Laser Therapy; Lasers, Solid-State; Visual Acuity; Vitrectomy; Vitreous Body
PubMed: 32135173
DOI: 10.1016/j.survophthal.2020.02.007 -
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