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International Ophthalmology Dec 2023To evaluate the safety of yttrium-aluminum-garnet (YAG) laser vitreolysis for intraocular tissues.
PURPOSE
To evaluate the safety of yttrium-aluminum-garnet (YAG) laser vitreolysis for intraocular tissues.
METHODS
Thirty-six New Zealand rabbits were divided as follows: Group 1000 (n = 12) treated with YAG laser of 1000 mJ (5 mJ × 200 shots), Group 2000 (n = 12) treated with YAG laser of 2000 mJ (5 mJ × 400 shots), Group 3000 (n = 12) treated with YAG laser of 3000 mJ (5 mJ × 600 shots). Either a single eye was chosen as the study eye in study groups while the other was untreated as the control group. Intraocular pressure (IOP), slit-lamp, optical coherence tomography (OCT), transmission electron microscopy (TEM), and inflammatory cytokines of aqueous humor (interleukin-1α (IL-1α), interleukin-1β (IL-1β), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α)) were performed to examine the rabbits.
RESULTS
There were no abnormalities in the study groups of IOP, slit-lamp, and OCT examinations. Group 3000 of TEM showed: neutrophils and mitochondrial swelling on day 1, and fibroblasts and neocollagen on day 14. No abnormalities were observed in Group 1000 and 2000 of TEM. Levels of IL-1α and TNF-α increased at 12 h and decreased to baseline on day 3. Levels of IL-1β increased at 12 h and decreased to baseline on day 7. Levels of IL-8 increased on day 1 and decreased to baseline on day 3.
CONCLUSION
YAG laser vitreolysis is safe when the distance is more than 2 mm from ablation point to the lens and the retina, and the total energy is less than 2000 mJ for one treatment procedure.
Topics: Rabbits; Animals; Interleukin-8; Tumor Necrosis Factor-alpha; Lasers, Solid-State; Eye Diseases; Vitrectomy; Laser Therapy; Postoperative Complications; Retina
PubMed: 37665493
DOI: 10.1007/s10792-023-02858-0 -
International Ophthalmology Oct 2023To demonstrate the methodology and efficacy of using scanning laser ophthalmoscopy (SLO) and dynamic optical coherence tomography (OCT) to identify and treat symptomatic...
PURPOSE
To demonstrate the methodology and efficacy of using scanning laser ophthalmoscopy (SLO) and dynamic optical coherence tomography (OCT) to identify and treat symptomatic vitreous floaters using yttrium-aluminum garnet laser vitreolysis (YLV).
METHODS
This is a case series highlighted from a cross sectional retrospective study conducted at the Vitreous Retina Macula Specialists of Toronto. Forty eyes from thirty-five patients were treated with YLV between November 2018 and December 2020 for symptomatic floaters and imaged with SLO and dynamic OCT. Patients were re-treated with YLV if they reported ongoing significant vision symptoms during follow-up which correlated to visible opacities on exam and or imaging. Three cases will be highlighted to present the practical applications of SLO and dynamic OCT imaging for YLV treatment.
RESULTS
Forty treated eyes were enrolled in this study, with twenty-six eyes (65%) requiring at least one repeat YLV treatment following the first treatment due to ongoing symptomatic floaters. Following the first YLV, there was a significant improvement in overall mean best corrected visual acuity compared to before treatment (0.11 ± 0.20 LogMAR units vs. 0.14 ± 0.20 LogMAR units, p = 0.02 (paired t test)). Case 1 demonstrates a dense, solitary vitreous opacity that has been localized with dynamic OCT imaging to track its movements and retinal shadowing with the patient's eye movements. Case 2 shows the utility of adjusting the fixation target to monitor the movement of vitreous opacities in real-time. Case 3 exhibits an association between decreased symptom burden and vitreous opacity density after YLV.
CONCLUSION
Image-guided YLV facilitates the localization and confirmation of vitreous opacities. SLO and dynamic OCT of the vitreous can provide a real-time evaluation of floater size, movement, and morphology, to help clinicians target treatment and monitoring of symptomatic floaters.
Topics: Humans; Retrospective Studies; Cross-Sectional Studies; Vitrectomy; Eye Diseases; Vitreous Body; Vision Disorders; Tomography, Optical Coherence
PubMed: 37402010
DOI: 10.1007/s10792-023-02765-4 -
Survey of Ophthalmology 2023Seeking treatment for bothersome vitreous floaters is patient driven. To measure the impact of floaters and treatment on an individual's quality of life,... (Review)
Review
Seeking treatment for bothersome vitreous floaters is patient driven. To measure the impact of floaters and treatment on an individual's quality of life, patient-reported outcome measurements (PROMs) are essential. We review all studies using a PROM for patients with floaters. We evaluated content coverage against quality-of-life domains previously identified in other ophthalmic disorders, and against a qualitative study investigating quality-of-life issues in patients with floaters. We assessed measurement properties of PROMs using an extensive range of psychometric quality criteria. We identified 59 studies using 28 different PROMs. Many PROMs were not specifically developed for patients with floaters. Floater-specific PROMs were mostly based on content validation from an ophthalmologist or researcher perspective; two included a patient perspective. Using the outcomes of the qualitative study, we found that the floater-specific PROMs were narrow in their content coverage, with most items relating to visual symptoms and activity limitations. Testing the psychometric quality of PROMs was rare, and when employed mostly limited to responsiveness and known group validity. The remarkable high number of floater-specific PROMs reveals a need for such measurements in ophthalmology. Unfortunately, reporting on psychometric quality is limited, and content development is most often done without patient involvement.
PubMed: 37315741
DOI: 10.1016/j.survophthal.2023.06.003 -
Ophthalmic Surgery, Lasers & Imaging... May 2023To introduce VFO and SK VFO Test: new, more representative terminology for symptoms of vitreous floaters/opacities (VFO) and new standardized kinetic (SK)...
New Terminology and Methodology for the Assessment of the Vitreous, Its Floaters and Opacities, and Their Effect on Vision: Standardized and Kinetic Anatomical and Functional Testing of Vitreous Floaters and Opacities (SK VFO Test).
OBJECTIVE
To introduce VFO and SK VFO Test: new, more representative terminology for symptoms of vitreous floaters/opacities (VFO) and new standardized kinetic (SK) anatomical-functional assessment.
MATERIALS AND METHODS
Eight eyes underwent before-after limited vitrectomy (LV): best-corrected visual acuity, low-luminance visual acuity, Minnesota Low Vision Reading Chart near visual acuity in logMAR, contrast sensitivity function (CV1000E), and straylight measurements (SM) (HDA/LDA/C-Quant). SK infrared confocal scanning laser ophthalmoscopy (SK IRcSLO) and swept-source widefield optical coherence tomography (SS-WF-OCT) identified VFO and posterior vitreous detachment (PVD). SK IRcSLO was performed with gaze directed towards the extreme superior, inferior, and lateral directions.
RESULTS
Anatomical-functional results after LV improved in 7 eyes (87.5%): objective scatter index (27.34%), disturbance index (47.97%) and C-Quant Log units (2.26%). Pre-LV SK IRcSLO and SS-WFOCT imaging identified dynamic well-defined VFO and PVD status (100%). A residual asymptomatic anterior cortical vitreous-induced shadowing ripple effect was detected post-LV.
CONCLUSIONS
This is the first objective-standardized test accounting for VFO kinesis and intermittent effect. There is potential for personalizing treatment and establishing best candidates for laser or surgery. .
Topics: Humans; Vitreous Body; Vision Disorders; Vitreous Detachment; Vitrectomy
PubMed: 37184989
DOI: 10.3928/23258160-20230412-02 -
Clinical Ophthalmology (Auckland, N.Z.) 2023To evaluate the use of dynamic infrared (IR) imaging as a tool for the objective evaluation of symptomatic vitreous floaters and to correlate it with the patient...
BACKGROUND AND OBJECTIVE
To evaluate the use of dynamic infrared (IR) imaging as a tool for the objective evaluation of symptomatic vitreous floaters and to correlate it with the patient symptomatology.
STUDY DESIGN/MATERIALS AND METHODS
Retrospective study that examined 66 eyes of 44 patients with symptomatic and asymptomatic vitreous opacities. Patients were imaged using the Heidelberg Spectralis dynamic infrared (IR) image in video mode to record the vitreous movements and shadow artifacts within 30 degrees of the center of the macula. Patients were also asked how symptomatic their vitreous floaters were from absent to severe. After reviewing IR videos and OCT, a grading system was created to evaluate the floaters and a masked reader was asked to evaluate the videos and OCT based on the grading system created.
RESULTS
A total of 66 eyes were identified and examined with the IR videos, 50 were symptomatic, and 16 were asymptomatic. After masked review and analysis of the IR videos, there were 4 characteristics that correlated with the patient's symptoms: size, location, movement, and density of obscuration of the OCT B Scan by the vitreous opacity. A table with grading of these characteristics was created to analyze how symptomatic patients were. A masked grader was asked to grade the videos and OCT using the grading system created. A positive correlation was found between the masked grader and the symptoms of patients. (0.70039; p < 0.00001).
CONCLUSION
Dynamic IR video capture of vitreous opacities is a new imaging technique that can qualitatively assess vitreous opacities in a way that correlates to a patient's symptoms. This imaging modality can provide a qualitative assessment of the patient's severity of symptoms based on the location, density, and movement of the visualized vitreous opacities in the imaged video.
PubMed: 37089579
DOI: 10.2147/OPTH.S399684 -
Current Eye Research Jul 2023Performing laser retinopexy through multifocal intraocular lenses may be challenging due to aberrations of the peripheral retinal view. This study investigated the...
PURPOSE
Performing laser retinopexy through multifocal intraocular lenses may be challenging due to aberrations of the peripheral retinal view. This study investigated the influence of multifocal versus monofocal intraocular lenses on outcomes of laser retinopexy for retinal tears.
METHODS
Pseudophakic eyes (multifocal and monofocal intraocular lenses) that underwent in-office laser retinopexy for retinal tears, with a minimum follow-up of 3 months, were retrospectively analyzed. Eyes with multifocal intraocular lenses were matched to controls with monofocal intraocular lenses in a 1:2 ratio for age, gender, number, and location of retinal tears. The main outcome measure was the rate of complications.
RESULTS
We included 168 eyes in the study. Fifty-six eyes (51 patients) with multifocal intraocular lenses were matched with 112 eyes (112 patients) with monofocal intraocular lenses. The mean follow-up was 26 months. Baseline characteristics were similar between two groups. No significant differences were noted in the rate of successful laser retinopexy without additional procedures (91% vs. 86% at 3 months and 79% vs. 74% during follow-up, in the multifocal intraocular lens and monofocal intraocular lens group, respectively). No significant differences were observed in the rate of subsequent rhegmatogenous retinal detachment (multifocal, 4% vs. monofocal, 6%, =.716) or need for additional laser retinopexy for new tears (14% vs. 15%; =.939). The surgery rates for vitreous hemorrhage (0% vs. 3%; =.537), epiretinal membrane (2% vs. 2%; =.553), and vitreous floaters (5% vs. 2%, =.422) were not significantly different. Visual outcomes were also similar.
CONCLUSION
Multifocal intraocular lenses did not appear to negatively impact the outcomes of in-office laser retinopexy for retinal tears.
Topics: Humans; Lens Implantation, Intraocular; Retinal Perforations; Cohort Studies; Retrospective Studies; Visual Acuity; Lenses, Intraocular; Lasers
PubMed: 36976845
DOI: 10.1080/02713683.2023.2197185 -
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 -
Graefe's Archive For Clinical and... Jun 2023The study aims to observe the spontaneous remission of posterior vitreous detachment (PVD)-type vision degrading myodesopsia (VDM) during long-term follow-up.
PURPOSE
The study aims to observe the spontaneous remission of posterior vitreous detachment (PVD)-type vision degrading myodesopsia (VDM) during long-term follow-up.
METHODS
We retrospectively reviewed VDM patients with PVD type that refused any treatment. The ratio and time of significant spontaneous remission of floater symptoms occurring were described. The associated factors with significant remission of floater symptoms were analyzed in the univariate and multivariate logistic regression analyses.
RESULTS
In total, 179 patients with VDM were assessed. The mean age of all patients was 60.56 ± 0.47 years old, and the mean duration of follow-up was 23.89 ± 6.63 months. Of the patients, 40.78% have significant improvement in their floater symptoms after mean 16.55 ± 10.63-month follow-up. Myopia (OR = 0.280, 95% CI = 0.084-0.932, P = 0.038), the number of floaters > 3 (OR = 0.343, 95% CI = 0.172-0.683, P = 0.002), and floaters with string-like pattern (OR = 0.370, 95% CI = 0.166-0.824, P = 0.015) and blocky pattern (OR = 0.299, 95% CI = 0.090-0.993, P = 0.049) were negatively correlated with the significant spontaneous remission of VDM symptoms in the multiple binary logistic regression analysis.
CONCLUSIONS
Approximately 40% of VDM patients with PVD may experience significant spontaneous remission during long-term follow-up. Patients that are non-myopic and with fewer floaters are more likely to feel relief from VDM symptoms. Floaters with string-like or blocky patterns are less likely to undergo spontaneous remission.
Topics: Humans; Middle Aged; Vitreous Detachment; Remission, Spontaneous; Retrospective Studies; Myopia
PubMed: 36565330
DOI: 10.1007/s00417-022-05948-4 -
Ceska a Slovenska Oftalmologie :... 2022To examine the effectiveness and safety of Nd:YAG laser vitreolysis in patients with symptomatic vitreous floaters.
AIMS
To examine the effectiveness and safety of Nd:YAG laser vitreolysis in patients with symptomatic vitreous floaters.
MATERIAL AND METHODS
This was a single-centre study of adult patients with symptomatic vitreous floaters who underwent laser vitreolysis. Patients treated between 1/2020 and 10/2021 were included. Intraocular pressure was measured by non-contact tonometry before and one month after treatment. Colour fundus photography, slit lamp examination in mydriasis, best corrected visual acuity, optical coherence tomography, and ultrasound examinations were performed before treatment. The patients completed a questionnaire to subjectively rank the degree of impairment associated with the floaters before and between 1 and 2 months after treatment.
RESULTS
89 eyes from 84 patients were included in the study, with a slight predominance of women (53%). A Weiss ring was present in 46%, and other types of vitreous opacity were found in 54%. Before treatment, 69% evaluated floaters as very troublesome (i.e., a value of 4 or 5 on a 1-5 scale). After treatment, 42% indicated subjective improvement (9% viewed the treatment as a complete success and 33% as a significant success). In 33% of eyes there was a partial improvement, i.e., some floaters could still be seen, and in 17% there was no improvement; 8% of patients were dissatisfied with the treatment results. There was no statistically significant difference in improvement between the group with Weiss rings and the group with other types of floaters. The procedure itself and the subsequent observation period were without complications, i.e., no cases of intraocular pressure elevation, cataract formation or retinal complications. Intraocular pressure did not significantly change from the pre-procedure value (p = 0.29). Average best corrected visual acuity after treatment was 0.97, thus it did not differ significantly from the pre-treatment values (p = 0.82).
CONCLUSION
Nd:YAG laser vitreolysis subjectively improved floater-related symptoms in treated eyes. The lack of an objective measurement of treatment success is a limiting factor. Laser vitreolysis is more suitable for solitary than diffuse vitreous opacities.
Topics: Adult; Humans; Female; Male; Vitrectomy; Laser Therapy; Eye Diseases; Vitreous Body; Vision Disorders; Lasers, Solid-State
PubMed: 36543595
DOI: 10.31348/2022/28