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Ophthalmic Surgery, Lasers & Imaging... Nov 2018Nd:YAG laser vitreolysis has been used as a noninvasive approach to treat visually significant vitreous strands and floaters. However, severe vision-threatening...
Nd:YAG laser vitreolysis has been used as a noninvasive approach to treat visually significant vitreous strands and floaters. However, severe vision-threatening complications may occur. The authors describe a rare case of a 60-year-old woman who had suffered rupture of the posterior lens capsule with subsequent cataract formation 1 week post-Nd:YAG laser vitreolysis in the right eye. The authors performed phacoemulsification, pars plana vitrectomy, and intraocular lens implantation at the ciliary sulcus. At 1 month post-surgery, the patient's visual acuity had not recovered well and optical coherence tomography showed epiretinal membrane (ERM) formation. Thus, she underwent secondary pars plana vitrectomy for ERM removal. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e214-e217.].
Topics: Female; Humans; Iatrogenic Disease; Lasers, Solid-State; Middle Aged; Phacoemulsification; Posterior Capsule of the Lens; Postoperative Complications; Reoperation; Rupture; Visual Acuity; Vitrectomy
PubMed: 30457659
DOI: 10.3928/23258160-20181101-21 -
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 -
Der Ophthalmologe : Zeitschrift Der... Jan 2019YAG laser vitreolysis is an innovative procedure to treat symptomatic vitreous floaters. The treatment decision is based on taking a comprehensive patient history,... (Review)
Review
YAG laser vitreolysis is an innovative procedure to treat symptomatic vitreous floaters. The treatment decision is based on taking a comprehensive patient history, thorough clinical examination, realistic expectations, and detailed patient information including risk of the procedure. Manifestation of vitreous opacities and possible subjective impairments are considerably variable. Dynamic changes over time are possible. Therefore, not all vitreous opacities are suitable for laser treatment. A classification according to histoanatomical origin can aid the treatment decision. In comparison to other ophthalmic YAG laser applications, YAG laser vitreolysis differs predominantly by its specific technical equipment requirements. In addition, treatment is more complex and time consuming, requires appropriate experience and knowledge of the surgeon, and should be carried out with utmost care and accuracy.
Topics: Humans; Laser Therapy; Lasers, Solid-State; Vision Disorders; Vitrectomy; Vitreous Body
PubMed: 30203171
DOI: 10.1007/s00347-018-0782-1 -
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 -
Ophthalmology Mar 2018To report longer-term outcomes of 27-gauge pars plana vitrectomy (PPV) in eyes with posterior segment disease.
PURPOSE
To report longer-term outcomes of 27-gauge pars plana vitrectomy (PPV) in eyes with posterior segment disease.
DESIGN
Multicenter, retrospective, interventional case series.
PARTICIPANTS
A total of 390 eyes of 360 patients undergoing 27-gauge PPV for a vitreoretinal surgery indication.
INTERVENTION
Three-port, transconjunctival, 27-gauge PPV.
MAIN OUTCOME MEASURES
Change in visual acuity (VA) and occurrence of intraoperative and postoperative complications with a minimum follow-up of 365 days.
RESULTS
Mean follow-up was 715±332 days (median, 514; range, 365-1440 days). Surgical indications included epiretinal membrane (ERM) (n = 121), vitreous floaters (n = 69), diabetic tractional retinal detachment (n = 49), vitreous hemorrhage (n = 40), full-thickness macular hole (n = 33), recurrent proliferative vitreoretinopathy (PVR)-related retinal detachment (n = 18), primary rhegmatogenous retinal detachment (RRD) (n = 17), silicone oil removal (n = 16), dislocated intraocular lens (n = 10), submacular hemorrhage (n = 7), endophthalmitis (n = 6), and retained lens material (n = 4). Mean logarithm of the minimum angle of resolution (logMAR) VA improved from 0.72±0.62 (20/105 Snellen equivalent) preoperatively to 0.40±0.55 (20/50 Snellen equivalent) postoperatively (P < 0.001). No case required conversion to 23- or 25-gauge instrumentation. Postoperative complications included transient ocular hypertension in 44 eyes (11.3%), vitreous hemorrhage in 31 eyes (7.9%), and transient hypotony in 22 eyes (5.6%). Acute postoperative endophthalmitis occurred in 1 case (0.26%). Overall, 82 of 390 eyes (21.0%) underwent at least 1 additional intraocular surgery in the follow-up period, most commonly for cataract extraction (n = 40/82 eyes, 48.8%). Of the 18 eyes undergoing surgery for primary RRD, recurrent detachment due to PVR occurred in 2 eyes (11.1%).
CONCLUSIONS
At a minimum follow-up of 1 year, 27-gauge PPV was well tolerated with low rates of postoperative complications across varied surgical indications, including primary and complex retinal detachment.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Equipment Design; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Posterior Eye Segment; Postoperative Complications; Retinal Diseases; Retrospective Studies; Time Factors; Treatment Outcome; United States; Visual Acuity; Vitrectomy; Young Adult
PubMed: 29146307
DOI: 10.1016/j.ophtha.2017.09.013