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Floaters are entopic phenomenon created by vitreous opacities. Some researchers term it as “symptomatic vitreous turbidity”, which usually refers to primary type in clinic. With the increasing prevalence and aging of myopia worldwide, vitreous floaters are becoming increasingly prevalent in clinics but receiving less attention. Floaters can impair patients' vision and quality of life due to their discomfort and disorientation. A few patients become intolerable and express a strong desire for treatment. YAG laser vitreolysis for floaters has garnered considerable attention in recent years. Although some doctors still have concerns about its efficacy and safety, a handful of studies have found some beneficial effects in recent years. The author has gained expertise in clinical practice in recent years. In this review, we talk about what causes floaters and how to classify them. We also talk about the clinical indications, how YAG laser ablation works, and whether or not it is safe.
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Purpose: To determine the effectiveness of laser vitreolysis in terms of contrast sensitivity function (CSF) and vision?related quality of life (VRQol) for symptomatic floaters due to posterior vitreous detachment (PVD). Materials: This is an interventional study that involved 57 eyes of 45 patients with symptomatic floaters for more than 3 months. Patients underwent one to three sessions of vitreolysis via Neodymiun?doped Yttrium Aluminum Garnet (Nd:YAG) laser. We examined the CSF using the computer programs Freiburg Acuity and Contrast Test (FrACT) and VRQoL survey using the National Eye Institute Visual Function Questionnaire?25 (NEI VFQ?25) before, and 1 month after, vitreolysis. Results: Twelve patients had both eyes lasered and 33 patients had one eye lasered. The mean CSF improved from 3.20 ± 0.85%W to 2.64 ± 0.63%W 1 month after vitreolysis. Each use of the laser showed a significant mean difference in CSF (%W) as analyzed by paired t?test before and after the first laser (0.29 ± 0.49%W [P ? 0.001]); after the first and second laser (0.35 ± 0.53%W [P = 0.01]); and after second and third laser (0.21 ± 0.31%W [P = 0.02]). There was improvement in the median of four subscales in NEI VFQ?25 scores post treatment: general vision (z = ?3.30, P = 0.001), near activity (z = 3.396, P = 0.001, distance activity (z = ?2.788, P = 0.005), and mental health (z = ?2.219, P = 0.026). The mean scores increased to 79.55 ± 9.45 from the baseline 75.06 ± 9.69 (P ? 0.001). No adverse events were recorded 1 month after the laser treatments. Conclusion: Vitreolysis by Nd:YAG laser improved the CFS and VRQoL in symptomatic PVD patients.
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@#AIM:To observe the long-term effect of Ultra Q:YAG vitreous ablation in the treatment of floaters, and to evaluate the advantages of Ultra Q:YAG over traditional Nd:YAG laser. <p>METHODS: Retrospective study. Totally 112 patients(130 eyes)were diagnosed with vitreous opacity were included and treated with laser vitreous ablation in our hospital from May 2018 to January 2020. All patients were performed the laser treatment for vitreous ablation and divided into groups A and B by different laser types. Group A(60 patients, 70 eyes)underwent Ultra Q:YAG vitreous ablation, and group B(52 patients, 60 eyes)underwent traditional Nd:YAG laser treatment. Then, we divided subgroups by the morphology of vitreous floaters. Subgroup A1(45 patients, 52 eyes)and subgroup B1(30 patients, 38 eyes)both with the morphology of Weiss ring, floccule and dense membrane; Subgroup A2(15 patients, 18 eyes)and subgroup B2(22 patients, 22 eyes)with the morphology of filiform and mesh. We observed the difference of frequency and visual improvement by patients compared to baseline.<p>RESULTS: BCVA: There was no significant difference between groups A1 and A2, groups B1 and B2, group A and group B at baseline(<i>P</i>>0.05). After treatment, there were statistically significant differences in BCVA between group A and group B at 2wk and 1mo. There were statistically significant differences between group A1 and group A2 at 1, 6 and 12mo(<i>P</i>=0.019, 0.042, <0.001). The effect of the laser treatment was significantly different between the two groups, group A was better than group B(<i>P</i>=0.006), group A1 was significantly better than that in group A2(<i>P</i><0.001). Compared to traditional Nd:YAG laser, Ultra Q:YAG laser requires less frequency of laser treatment(<i>P</i><0.001), and had no significant relationship with vitreous opacity(<i>P</i>>0.05). <p>CONCLUSION: Ultra Q:YAG is easier to operate, safer and has better subjective symptom improvement than traditional Nd:YAG laser treatment of vitreous floaters, especially for the patients with Weiss ring, floccule and dense membrane.
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@#AIM:To observe the clinical effects of YAG laser ablation in patients with physiological vitreous floaters by A/B ultrasound combined with autofluorescence(AF)of angiography.<p>METHODS: Screening of 30 patients(30 eyes)with physiological vitreous floaters from August 2018 to January 2019 in Hankou Aier Eye Hospital, we used A/B ultrasound to measure the distance from the wall of the ball and the back surface of the lens before operations. Check the patient's best corrected visual acuity, non-contact intraocular pressure, scanning laser fundus photography, A/B ultrasound and autofluorescence(AF)of angiography before treatment, laser ablation was performed by the same skilled doctor using ELLEX YAG laser ablation machine. After treatment, the patients were followed up at the point of 1d, 1wk, and 1mo. The same examination was performed after operation. The Image-J software was used to measure the vitreous opacity in the autofluorescence of angiography pictures before and after treatment.<p>RESULTS:There was no significant difference in the best corrected visual acuity and non-contact intraocular pressure before and after treatment(<i>P</i>>0.05). Of the 30 eyes, 28 eyes underwent laser ablation treatment once, and 2 eyes underwent laser ablation treatment twice. The average number of treatments was 1.06. After treatment, the autofluorescence of angiography showed that the vitreous opacity was obviously reduced or disappeared, and the difference was statistically significant before and after treatment(<i>P</i><0.01). No complications occurred during or after surgery.<p>CONCLUSION: A/B ultrasound combined with autofluorescence confirmed that Nd:YAG laser is safe and effective in the treatment of physiological vitreous floaters.
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@#AIM:To observe the clinical effects of YAG laser ablation in patients with physiological vitreous floaters by A/B ultrasound combined with autofluorescence(AF)of angiography.<p>METHODS: Screening of 30 patients(30 eyes)with physiological vitreous floaters from August 2018 to January 2019 in Hankou Aier Eye Hospital, we used A/B ultrasound to measure the distance from the wall of the ball and the back surface of the lens before operations. Check the patient's best corrected visual acuity, non-contact intraocular pressure, scanning laser fundus photography, A/B ultrasound and autofluorescence(AF)of angiography before treatment, laser ablation was performed by the same skilled doctor using ELLEX YAG laser ablation machine. After treatment, the patients were followed up at the point of 1d, 1wk, and 1mo. The same examination was performed after operation. The Image-J software was used to measure the vitreous opacity in the autofluorescence of angiography pictures before and after treatment.<p>RESULTS:There was no significant difference in the best corrected visual acuity and non-contact intraocular pressure before and after treatment(<i>P</i>>0.05). Of the 30 eyes, 28 eyes underwent laser ablation treatment once, and 2 eyes underwent laser ablation treatment twice. The average number of treatments was 1.06. After treatment, the autofluorescence of angiography showed that the vitreous opacity was obviously reduced or disappeared, and the difference was statistically significant before and after treatment(<i>P</i><0.01). No complications occurred during or after surgery.<p>CONCLUSION: A/B ultrasound combined with autofluorescence confirmed that Nd:YAG laser is safe and effective in the treatment of physiological vitreous floaters.
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Ocular filariasis commonly presents as subconjunctival or eyelid nodules. We report a rare case of a live, motile worm causing floaters. The worm was isolated from the vitreous cavity and revealed to be Dirofilaria repens. Correct recognition of the worm is necessary as human dirofilariasis does not present as microfilaremia and does not require systemic therapy; in contrast to other causes of ocular filariasis, which require systemic therapy. As ophthalmologist may be the first physician to encounter such patients, a high index of suspicion is required for timely and adequate management.
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AIM:To observe the effect of Nd ∶ YAG laser ablation on vitreous floaters.METHODS:From October 2016 to January 2017,78 cases (84 eyes) with vitreous floaters treated with Nd ∶YAG laser ablation were involved.Chi-square test,Mann-Whitney Test,Kruskal-Wallis test and Spearman test were used to compare the therapeutic effect with different etiologies and grades.RESULTS:After two-week treatment,there were 66 eyes (79％) with a significant resolution,16 eyes (19％)with an improvement and 2 eyes (2％) invalid.The total effective rate was 98％.There was no significant difference between the therapeutic effect and times in different etiologies (H=3.842,P=0.146;x2 =0.070,P=0.966);the effective rate were 100％ in grade Ⅰ and Ⅱ,92％ in grade Ⅲ,83％ in grade Ⅳ,and the grade had a negative correlation with the therapeutic effect (rs =-0.027,P=0.013).There were 38 eyes (90％) in grade Ⅰ,21 eyes (88％) in grade Ⅱ,9 eyes (75％) in grade Ⅲ,and 2 eyes (33％) in grade Ⅳ needed once treatment.There was significant difference between different grades and treatment times (U=2.580,P=0.010).CONCLUSION:Nd ∶YAG laser ablation is a simple and convenient operation for vitreous floaters,and could improve the symptom of vitreous floater rapidly.
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AIM: To observe the structure changes of vitreous and retina after YAG laser ablation in patients with physiological vitreous floaters.METHODS: The selected 40 patients of physiological vitreous floaters,before YAG laser ablation,were checked for best corrected visual acuity,non-contact intraocular pressure,took their anterior segment photos,measured their foveola thickness(FT) and retinal nerve fiber layer(RNFL) by OCT.The YAG laser ablation was completed by one experienced surgeon.After the YAG laser ablation,all patients were checked for non-contact intraocular pressure and gave pranoprofen eye drops tid for 3d.At 2d,1wk,1 and 3mo after the surgery,they were reviewed for best corrected visual acuity,non-contact intraocular pressure.At 3mo later anterior segment photos were taken.At 1wk,1 and 3mo after the surgery,FT and RNFL were measured again.RESULTS: The postoperative 2d,1wk,1 and 3mo,best corrected visual acuity,non-contact intraocular pressure of the patients had no significant difference with preoperative(P>0.05).The preoperative anterior segment photos showed obvious single or sheet opacity of vitreous,the postoperative 3mo photos showed that vitreous opacities decreased or disappeared,no other abnormal changes were found.The preoperative OCT data showed that FT was 214.60±9.35μm,the postoperative 1wk,1 and 3mo FT were 213.75±9.07μm,213.40±8.83μm,213.85±9.22μm.The preoperative RNFL were upper 130.26±14.23μm,lower 133.15±14.46μm,nasal 82.48±13.50μm,temporal 75.40±11.89μm;The postoperative 1wk RNFL were upper 130.02±14.02μm,lower 132.99±14.05μm,nasal 82.35±13.07μm,temporal 75.42±11.66μm.The postoperative 1mo RNFL were upper 130.28±14.43μm,lower 133.08±13.99μm,nasal 82.31±13.72μm,temporal 75.45±12.03μm.The postoperative 3mo RNFL were upper 130.43±14.30μm,lower 133.22±14.20μm,nasal 82.27±13.11μm,temporal 75.46±11.91μm.The differences of preoperative and postoperative 1wk,1 and 3mo FT and RNFL had no statistical significance (P>0.05).CONCLUSION: YAG laser ablation has no adverse effects to vitreous and retinal structure in patients with physiological vitreous floaters,it is effective and safe.
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Pneumatic retinopexy is known as one of the treatment options for a specific type of retinal detachment. It is done in an office setting and may be the most cost-effective means of retinal reattachment surgery. Location and size of the retinal break remain as the major criteria for a successful outcome. We describe a case that fulfilled all except one major criteria for pneumatic retinopexy and underwent multiple procedures but failed. Fluctuation in the resolution of the retinal detachment such as in this particular case suggested possibility of early treatment failure.
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VitrectomyABSTRACT
AIM: To study the efficacy and safety of Ultra Q- YAG vitreolysis for vitreous floaters. METHODS: Retrospective case series study. From September 2014 to May 2015 in Beijing Aier - Intech Eye Hospital, 263 cases (340 eyes) with vitreous floaters were involved. All patients underwent visual acuity, intraocular pressure, slit lamp, mydriatic fundus, B ultrasonic examination, and recorded the form of a vitreous opacity excluded pathological fundus lesions. All the patients were divided into two groups: Group A ( 45 years old), 185 cases (258 eyes), the morphology of vitreous opacity was Weiss ring, translucent flocculent clouds or dense fibrous membrane. Patients in 30 - 45 years old were eliminated because of the untypical opacity factor. The treatment was done by the same physician. Vision changes was analyzed before and after the treatment. RESULTS: Questionnaire survey was done. According to the scores of the questionnaires, patients were divided into 3 groups: no improvement ( 1 - 2 points), partial improvement (3-5 points), significant improvement (6-10 points ). At 1mo after treatment, Group A: no improvement in 9 eyes (11. 0%), partial improvement in 57 eyes (69. 5%) and significant improvement in 16 eyes (19. 5%); Group B: no improvement in 0 eyes, partial improvement in 23 eyes ( 8. 9%) and significant improvement in 235 eyes (91. 1%); all the patients had no complications. CONCLUSION: The treatment with YAG vitreolysis for vitreous floaters is safe and effective, especially for the patients more than 45 years old whose vitreous floaters caused by posterior vitreous detachment.
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PURPOSE: To evaluate the long-term follow-up of adverse effects after neodymium: yttrium-aluminum-garne (Nd:YAG) laser treatment for posterior capsular opacification (PCO). METHODS: In this study, 152 patients (184 eyes) diagnosed with PCO and who received Nd:YAG laser posterior capsulotomy with at least 5 years of follow-up were retrospectively analyzed to evaluate the clinical adverse consequences after Nd:YAG laser posterior capsulotomy. RESULTS: The mean age in the study group was 63.2 +/- 4.2 years and the mean follow-up period was 6.2 +/- 0.6 years. Vitreous floaters (8.1%) were the most common complication followed by reactive anterior uveitis (5.9%) and transient increase in intraocular pressure of more than 30 mm Hg (5.4%). Other complications included primary Nd:YAG laser failure (2.7%), recurrent lens epithelial remnant proliferation (1.6%), cystoid macular edema (1.1%), corneal edema (0.5%), retinal tear (0.5%), and rhegmatogenous retinal detachment (0.5%). CONCLUSIONS: Although Nd:YAG laser treatment is the most effective and safe method, surgeons should be aware of the occasional complications such as recurrent lens epithelial remnant proliferation, retinal tear, and rhegmatogenous retinal detachment through long-term follow-up.
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Humans , Corneal Edema , Follow-Up Studies , Intraocular Pressure , Macular Edema , Neodymium , Posterior Capsulotomy , Retinal Detachment , Retinal Perforations , Retrospective Studies , Uveitis, AnteriorABSTRACT
Vitreous floaters is a common complaint in the ophthalmic care setting,and it is commonly caused by vitreous liquefaction and posterior vitreous detachment (PVD).Because vitreous floaters is considered to be a benign procedure,ophthalmologists have little to offer regarding treatment options.Although almost all patients accept the conservative management option,there are some patients with a significant visual disturbance who may desire a more aggressive treatment intervention for resolution of their visual symptoms.Vitrectomy has been used as a treatment option for patients with symptomatic vitreous floaters abroad.The risks and benefits for these treatment options are not fully covered.Therefore,safety of vitrectomy for floaters is being concerned.This article reviews the researching progression in the treatment options for symptomatic patients with vitreous floaters.