YAG laser vitreolysis for floaters / 国际眼科杂志(Guoji Yanke Zazhi)

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.

Clinical effect of Fuming tablets combined with lecithin complexed iodine tablets in the treatment of vitreous opacities / 药学实践杂志

Objective To analyze the clinical efficacy of Fuming tablets and lecithin-complexed iodine tablets in the treatment of vitreous opacities. Methods 80 patients with vitreous opacities admitted to the department of ophthalmology in the central region general hospital from May 2019 to May 2020 were selected for this research. According to the random grouping method, the patients were divided into a control group and an observation group. The control group patients received lecithin-complexed iodine tablets orally for the treatment. The observation group was treated with Fuming tablets combined with lecithin-complexed iodine tablets. The therapeutic effects in the two groups were evaluated by comparing the visual acuity and vitreous opacity of the two groups before and after treatment. Results The visual acuity level was improved in both groups after the treatments. The visual acuity level in the observation group was significantly higher than that in the control group with statistical significance (P<0.05). There was no difference in the degree of vitreous opacity score between the two groups before treatment. The vitreous opacity score improvement in the observation group was greater than that in control group after the treatment with statistical significance (P<0.05). The treatment effective rate in the observation group was 95.0% (38/40), which was significantly higher than the control group, 80.0% (32/40). The difference was statistically significant (P<0.05). There was no statistically significant difference in adverse reactions between the two groups (P>0.05). Conclusion Fuming tablets combined with lecithin-complexed iodine tablets have outstanding therapeutic effects in improving the vision and degree of vitreous opacities. This combination therapy deserves the extensive clinical applications.

Complicated Ophthalmopathy in Herpes Zoster Ophthalmicus Including Vitreous Opacity, Retinal Hemorrhage and Optic Neuropathy

PURPOSE: To introduce a case of complicated ophthalmopathy in herpes zoster ophthalmicus including vitreous opacity, retinal hemorrhage and optic neuropathy having components of anterior ischemic optic neuropathy and optic neuritis. CASE SUMMARY: A 59-year-old man visited our clinic because of visual disturbance in the right eye which occurred after right facial pain and vesicles. There were inflammatory cells in the anterior chamber, retinal hemorrhage in the retina and vitreous opacity was found. Track-like high signal intensity along the right optic nerve was found on T1 MRI. Partial filling defect of optic disc was observed on fluorescein angiography (FAG). The patient was diagnosed with herpes zoster ophthalmicus complicated by anterior uveitis and optic neuropathy having components of anterior ischemic optic neuropathy and optic neuritis. The patient was started on intravenous acyclovir at a dose of 10 mg/kg every 8 hours for 5 days and Herpesid eye ointment 5 times daily. After the initial treatment, oral acyclovir 400 mg was given 3 times daily for 14 days. Skin symptoms and fundus findings improved but the visual acuity did not improve because of optic atrophy. CONCLUSIONS: Ophthalmopathy including anterior uveitis, vitreous opacity, retinal hemorrhage and optic neuropathy having components of anterior ischemic optic neuropathy and optic neuritis should be considered in herpes zoster ophthalmicus patients.

Ultrasonographic Findings in Infectious Endophthalmitis

PURPOSE: To investigate the correlation between ultrasonographic findings and clinical features of infectious endophthalmitis. METHODS: We analyzed ultrasonographic findings of 38 eyes of 36 patients who had been diagnosed as having infectious endophthalmitis with various etiologies. The correlation between ultrasonographic findings and clinical features such as initial and final visual acuities were studied. RESULTS: Fourteen eyes were diagnosed with endogenous endophthalmitis and 11 eyes with postoperative endophthalmitis. Posterior vitreous opacity in the endophthalmitis secondary to keratitis was more severe and subhyaloid opacity in the traumatic endophthalmitis was less severe. Coagulase negative staphylococcus was the most common causative agents. Subhyaloid opacity in the eyes where cultures were not performed, was more severe than in those where coagulase negative staphylococcus was identified. Among the various ultrasonographic findings only the degree of the posterior vitreous opacity was correlated with the initial visual acuity, and none of the findings was significantly related with the final visual acuity. Treatment modalities included intravitreal antibiotics injections in 13 eyes, immediate vitrectomies and antibiotics injection in 6 eyes, conversion to vitrectomy after antibiotics injection in 17 eyes, and eviscerations in 2 eyes. The grades of posterior vitreous opacity of the patients with conversion to vitrectomy after antibiotics injection were lower than those of the other groups. CONCLUSIONS: Ultrasonographic findings might be a useful factors in the diagnosis and the determination of treatment modality and may therefore be helpful in the prognosis of patients with suspected infectious endophthalmitis.

Effects of Vitrectomy on the Clinical Course of Chronic Uveitis

This study was undertaken to evaluate the efficacy of vitrectomy in the patients with chronic uveitis complicated with vitreous opacity and/or epiretinal membrane formation. We reviewed the records of 23 eyes of 23 patients with recurrent chronic uveitis.Final visual acuity improved in 18 (78.3%)of 23 eyes, unchanged in 3 eyes (13.0%), but decreased in 2 eyes (8.7%).Five eyes showed a reactivation of inflammation after surgery.In 2 eyes of them, the recurrence was so severe to decrease visual acuity.Intraoperative factors which may be associated with the postoperative recurrence were incomplete vitrectomy, no cryotherapy in the peripheral uveitis with neovascularization, and type of uveitis.However the preoperative severity and recurrence rate of the disease were not significant factors in postoperative recurrence. Our results indicate that the chronic recurrent uveitis with poor vision would be a good indication for vitrectomy, and in these cases, complete vitrectomy and combined cryotherapy may result in better prognosis.

Results of Surgical Treatment of Complicated Pars Planitis

We performed pars plana vitrectomy on 19 patients with pars planitis with its complications like vitreous opacity and retinal detachment.There were 16 males and 3 females with a mean age of 42.8 years.The follow-up ranged from 6 to 122 months with a mean of 25 months.Following surgery, final visual acuity was improved or unchanged in the 78.9 percent of patients.Eight cases (42.1%)showed improved vision, seven patients (36.8%) showed no change and four cases (21.1%)worse vision.Retinal detachment was successfully repaired in 17 patients and two eyes failed anatomically due to the proliferative vitreoretinopathy.The main factor favoring functional success was the short duration from the onset to the time of vitrectomy.It might be concluded that vitrectomy should be performed in the vision threatening stages on the patients with complicated pars planitis.

Postoperative outcome of trans pars pklana vitrectomy in the treatment of posterior and intermediate uveitis

We performed standard pars plana vitrectomies in 17 eyes with uveitis which were complicated with vitreous opacities. Postoperatively, visual acuity was improved in 11 eyes(64.7%),maintained in4 eyes(23.5%) and decreased in 2 eyes (11.8%). Four weeks after vitrectomy, inflammatory cells were rarely noticed in the anterior vitreous of all eyes. We suggest that early surgical approach is of value for visual improvement in the management of uvitis eyes with vitreous opacity.

Results of vitreous surgery for posterior complications of chronic uveitis

To determine surgical results and predictive factors of final visual acuity, a total of 30 eyes in 30 uveitis patients who underwent vitreous surgery including pars plana vitrectomy were followed for at least 6 months and various preoperative factors and postoperative results were analyzed. Our surgical indications were vitreous opacity, traction retinal detachment, combined rhegmatogenous-traction detachment. Preoperatively detached retina was finally reattached in 15 (83.3%) of 18 eyes. Final visual acuity improved in 19 (63.3%) of 30 eyes, but decreased in 3 eyes compared with the initial acuity. Cystoid macular edema was the main cause of poor visual acuity after surgery. Eyes with good final visual acuity showed relatively normal electroretinograms before surgery, but the relationship between them was not statistically significant. Duration of postoperative inflammation affected final visual acuity significantly. These results suggest that chronic uveitis patients with vitreoretinal complications can be managed by vitreous surgery with good anatomic and functional results.

Results of vitreous surgery for posterior complications of chronic uveitis

To determine surgical results and predictive factors of final visual acuity, a total of 30 eyes in 30 uveitis patients who underwent vitreous surgery including pars plana vitrectomy were followed for at least 6 months and various preoperative factors and postoperative results were analyzed. Our surgical indications were vitreous opacity, traction retinal detachment, combined rhegmatogenous-traction detachment. Preoperatively detached retina was finally reattached in 15 (83.3%) of 18 eyes. Final visual acuity improved in 19 (63.3%) of 30 eyes, but decreased in 3 eyes compared with the initial acuity. Cystoid macular edema was the main cause of poor visual acuity after surgery. Eyes with good final visual acuity showed relatively normal electroretinograms before surgery, but the relationship between them was not statistically significant. Duration of postoperative inflammation affected final visual acuity significantly. These results suggest that chronic uveitis patients with vitreoretinal complications can be managed by vitreous surgery with good anatomic and functional results.

Clinical Analysis of Fringe Acuity by Lotmar Visometer

In cases of opacity of ocular optical media, we can predict postoperative visual outcome vaguely with electroretiongram, Visual evoked potential, Two point discrimination, Blue field entoptoscope, Laser interferometer, Lotmar visometer, Potential acuity meter, Visual display terminal. The Lotmar visometer which is attached to the slit lamp provides simple and inexpensive method to check for fringe acuity. It distinguishes the interval of changeable moire fringes for the measurement of postoperative visual acuity in spite of opacity in ocular media. We compared the preoperative Lotmar visometer fringe acuity with the postoperative final corrected visual acuity in 82 cases of cataract and 15 cases of vitreous opacity at the department of Ophthalmology, Pusan Paik Hospital, Inje University Medical college from January to August 1989. We tested the clinical use of the Lotmar visometer and the results were as follows: 1. The visual acuity when checked by preoperative Lotmar visometer acuity and postoperatIve visual acuity differed in mature cataract and dense vitreous opacity cases. 2. The preoperative Lotmar visometer acuity was within one line of postoperative visual acuity in 47.4% with ECCE only, 34.1% with ECCE and PCL, 53.3% with vitrectomy. 3. The preoperative Lotmar visometer acuity which is included +/-25% of postoperative visual acuity in cases with ECCE only is 58.62%, in cases with ECCE and PCL is 46.15%, in cases with vitrectomy is 66.6% except in mature cataract and dense vitreous opacity. 4. There is a high correlation(r=0.8407)in the cases of vitreous opacity between preoperative Lotmar visometer acuity and postoperative visual acuity except in mature cataract and dense vitreous opacity.