The Ellex Laser Floater Removal bibliography contains more than 200 laser floater removal (vitreolysis) references, including peer-review papers, articles, posters and book chapters. Continually updated, the bibliography can be customized based on date, topic, publication, language and/or author – simply enter your selected keywords into the search field. (Note: there is no need to add grammar or punctuation marks).
|Reported Complications Following Laser Vitreolysis||
IMPORTANCE: Use of laser vitreolysis for symptomatic floaters has increased in recent years, but prospective studies are not available and the complication profile is poorly understood.
OBJECTIVE: To analyze cases of complications following laser vitreolysis as voluntarily reported to the American Society of Retina Specialists Research and Safety in Therapeutics (ASRS ReST) Committee, an independent task force formed to monitor device-related and drug-related safety events.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective assessmentwas performed of all cases of complications following laser vitreolysis that were voluntarily reported by practitioners throughout the United States to the ASRS ReST Committee from the first report on September 19, 2016, through March 16, 2017, the date of data analysis and manuscript writing.
MAIN OUTCOMES AND MEASURES: Complications reported to the ASRS ReST Committee following laser vitreolysis were analyzed by type to gain an understanding of the spectrum of potential complications. RESULTS A total of 16 complications following laser vitreolysis were reported in 15 patients by 7 US vitreoretinal specialists during the study period. Complications included elevated intraocular pressure leading to glaucoma; cataracts, including posterior capsule defects requiring cataract surgery; retinal tear; retinal detachment; retinal hemorrhages; scotomas; and an increased number of floaters.
CONCLUSIONS AND RELEVANCE: This report presents a spectrum of complications reported to the ASRS ReST Committee across 6 months. The rate of complications cannot be determined because the denominator of total cases is unknown. Also, these findings cannot determine whether there is a causal association between these complications and laser vitreolysis. Prospective studies are warranted to better understand the efficacy of this procedure and the frequency of attendant complications. Until then, practitioners should be aware of the profile of potential complications to properly inform patients during the consent process. The ASRS ReST Committee will continue to monitor device-related and drug-related adverse events and encourages active surveillance and reporting by all physicians.
|English||JAMA ophthalmology||2017||Paul Hahn, EricW. Schneider, Homayoun Tabandeh, Robert W.Wong, Geoffrey G. Emerson||
ASRS ReST committee
|Cataracts induced by neodymium–yttrium-aluminium-garnet laser lysis of vitreous floaters||
Background: Neodymium–yttrium-aluminium-garnet Nd:YAG) laser vitreolysis has been proposed as a treatment modality for symptomatic vitreous floaters. The purpose of this paper is to report two cases of cataracts associated with posterior capsular compromise, induced by Nd:YAG laser vitreolysis for symptomatic vitreous floaters.
Method: Case series.
Results: Two patients who underwent ND:YAG laser vitreolysis for symptomatic floaters, presented with decline in visual acuity in the treated eye after the laser procedure. At the slit-lamp biomicroscope, each patient was found to have a posterior subcapsular cataract in the treated eye, with obvious loss of integrity of the posterior capsule. These two patients underwent cataract extraction by the same surgeon via phacoemulsification. Both eyes were found to have a defect in the posterior capsule intraoperatively. In both cases, a three-piece acrylic intraocular lens implant was placed in the sulcus, achieving optic capture. The best-corrected visual acuity (BCVA) was 20/20 in both patients, at 1 month following the surgery. At 2 months, one patient had a BCVA of 20/15. The second patient maintained a BCVA of 20/20 at 3 months.
Conclusions: Secondary cataract formation accompanied by loss of integrity of the posterior capsule is a potential complication of Nd:YAG laser vitreolysis for symptomatic floaters.
|English||Br J Ophthalmol||2017||Ellen H Koo, Luis J Haddock, Namita Bhardwaj, Jorge A Fortun||
Bascom Palmer, Miami
|Management of Symptomatic Floaters: Current Attitudes, Beliefs, and Practices among Vitreoretinal Surgeons||
Background and Objective: To assess the current attitudes, beliefs, and practice patterns among vitreoretinal surgeons when dealing with symptomatic floaters in patients with otherwise healthy eyes.
|Journal Article||English||Ophthalmic Surgery, Lasers and Imaging Retina||2015||Michael N. Cohen, MD; Ehsan Rahimy, MD; Allen C. Ho, MD; Sunir J. Garg, MD||
Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
|Short-Term Clinical Results and Safety of Ultra Q Laser Treatment for Vitreous Floaters||
Purpose: To evaluate the short-term clinical results and safety of Ultra Q neodymium-doped yttrium aluminium garnet (Nd:YAG) laser treatment for vitreous floaters.
|Journal Article||English/South Korean||J Korean Ophthalmol Soc.||2015||Na Yeon Jung, MD, Ji Sun Moon, MD, Gi Hyun Bae, MD and Seong Joo Shin, MD||
Department of Ophthalmology, Sahmyook Medical Center, Seoul, Korea
|Vitrectomy for Vitreous Floaters: Analysis of the Benefits and Risks||
Purpose of review: To review the pros and cons of small-gauge vitrectomy for symptomatic floaters.
|Peer-Review||English||Current Opinion in Ophthalmology||2015||Sommerville, Drew N.||
Talley Eye Care
|Surgical Management of Symptomatic Vitreous Floaters||
We all recognize that we cannot dismiss a patient who presents to us with symptomatic vitreous opacities: however, patient education regarding observation versus surgical intervention is of paramount importance when managing this condition. Undoubtedly, the use of PPV to manage floaters remains a controversial subject and the community needs to reach a consensus regarding standard of care for this condition.
|Journal Article||English||OSLI Retina||2014||Carl Danzig||
Rand Eye Institute, Florida
|Vitreous Floaters and Vision: Current Concepts and Management Paradigms||
Abstract: Floaters most commonly occur in the middle age due to age-related changes in vitreous structure and light scattering by the posterior vitreous cortex after collapse of the vitreous body during posterior vitreous detachment (PVD). In youth, floaters are most often due to myopic vitreopathy. Vitreous floaters can have a negative impact on visual function and in turn the quality of life. Techniques to characterize floaters clinically include ultrasound imaging, optical coherence tomography, and dynamic light scattering for structural characterization. Functional impact can be assessed by straylight measurements, as well as contrast sensitivity testing. When the severity of floater symptomatology is significant, commonly used therapies include neodymium:yttrium-aluminum-garnet (YAG) laser and limited 25-gauge vitrectomy. While the former is of unproven efficacy, the latter has been shown to be a safe, effective, and definitive cure that improves patients’ quality of life and eradicates symptomatology produced by light scattering and diffraction. It is thus reasonable to offer limited vitrectomy to individuals who have attempted to cope unsuccessfully and in whom functional deficit can be objectively demonstrated by testing contrast sensitivity, an important aspect of vision.
|Journal Article||English||Vitreous (Book)||2014||Laura C. Huang, Kenneth M. P. Yee, Christianne A. Wa, Justin N. Nguyen, Alfredo A. Sadun and J. Sebag|
|Refractory Open Angle Glaucoma after Nd:YAG Laser Lysis of Vitreous Floaters||
Purpose: To illustrate three cases of chronic open angle glaucoma secondary to the Nd:YAG laser vitreolysis procedure for symptomatic vitreous floaters.
|Peer-Review||English||AJOPHT||2014||Lisa A. Cowan, Kay T. Khine, Vikas Chopra, Doreen T. Fazio, Brian A. Francis||
Doheny Eye Institute, Los Angeles
|How YAG Laser Vitreolysis can be used in Practice for Treatment of Floaters||
Inder Paul Singh, MD, shares his surgical pearls for how advances in YAG laser vitreolysis can make the procedure a safe, effective option for the treatment of floaters.
|Oph Times||English||2014||Paul Singh||
|A 10-Year Follow-up to Determine the Effect of YAG Laser Iridotomy on the Natural History of Pigment Dispersion Syndrome: A Randomized Clinical Trial||
Importance: Prospective long-term analyses of the role of drug-inducedmydriasis and laser peripheral iridotomy (LPI) are needed to identify and manage the eyes of patients with pigment dispersion syndrome (PDS) at risk for progressing to ocular hypertension.
|Peer-Review||English||JAMA Ophthalmol||2014||Stefano A. Gandolfi, Nicola Ungaro, Maria Grazia Tardini, Stella Ghirardini, Arturo Carta, Paolo Mora||
University of Parma
|How YAG laser vitreolysis can be used to treat floaters||
Surgeon’s clinical experience shows therapy yields robust safety profile, quality-of-life benefits
|Trade Journal||English||Ophthalmology Times||2014||Inder Paul Singh||
Eye Center of Racine
|Endophthalmitis following Pars Plana Vitrectomy for Vitreous Floaters||
Abstract: A case of Staphylococcus caprae endophthalmitis in a young patient following pars plana vitrectomy for symptomatic vitreous floaters is reported here. Recent literature suggests that there is an increasing trend of performing pars plana vitrectomy for symptomatic floaters. Although rare, the potential risk of endophthalmitis should be explicitly discussed with patients considering surgical intervention for vitreous floaters.
|Journal Article||English||Clinical Ophthalmology||2014||Christopher R Henry, Stephen G Schwartz, and Harry W Flynn, Jr||
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
|Vitrectomy for Floaters: Prospective Efficacy Analyses and Retrospective Safety Profile||
Purpose: Floaters impact vision but the mechanism is unknown. We hypothesize that floaters reduce contrast sensitivity function, which can be normalized by vitrectomy, and that minimally invasive vitrectomy will have lower incidences of retinal tears (reported at 30%) and cataracts (50–76%).
|Peer-Review||English||RETINA 34:1062–1068, 2014||2014||JERRY SEBAG, KENNETH M. P. YEE, CHRISTIANNE A. WA, LAURA C. HUANG, ALFREDO A. SADUN||
VMR Institute, Huntingdon Beach
|Neodymium: Yttrium-Aluminum-Garnet Laser Anterior Hyaloidotomy to Treat Trapped Triamcinolone Acetonide Behind the Crystalline Lens After Intravitreal Injection||
A 65-year-old male underwent intravitreal triamcinolone acetonide (IVTA) injection for treating a clinically significant macular edema (CSME) due to background diabetic retinopathy in his left eye. On the first postoperative day, visual acuity dropped from 20/80 to hand movements. Slit-lamp examination showed the drug between the posterior capsule of the lens and the anterior hyaloid face. Two weeks later, visual acuity and the milky fluid seemed unchanged. Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser anterior hyaloidotomy was performed. One week later, slit-lamp examination of the retrolental space revealed the complete disappearance of triamcinolone and intraocular pressure remained stable. After a follow-up period of 2 months, visual acuity increased to 20/50 with the lens remaining clear. Nd:YAG laser anterior hyaloidotomy is an effective, simple, useful and minimally invasive outpatient procedure in patients with persistent entrapment of triamcinolone behind the crystalline lens, allowing the drug to clear without trauma to the lens.
|Peer-Review||English||Middle East Afr J Ophthalmol. 2012 Jan-Mar; 19(1): 163–165. doi: 10.4103/0974-9233.92135||2012||Francisco J. Ascaso, Erika Ruiz de Gopegui, and José M. Cascante|
|Floaters and the Quality of Life||
In this issue of the Journal, Wagle and associates present fascinating new information concerning the utility value of floaters, as expressed by patients. Utility values allow an objective quantification of the functional quality of life associated with a specific “disease” state. A utility value of 1.0 implies a perfect “health” state, while death has a utility value of 0.0. The findings of this study indicate that the utility values of floaters are equal to AMD and lower than diabetic retinopathy and glaucoma. According to this study, floaters have lower utility values than mild angina, mild stroke, colon cancer, and asymptomatic HIV infection. This indicates that floaters have a significant negative impact on the quality of life as compared to ocular as well as systemic diseases.
|Article||English||Am J Ophthalmol. 2011 Jul;152(1):3-4.e1. doi: 10.1016/j.ajo.2011.02.015||2011||Sebag J|
|Utility Values associated with Vitreous Floaters||
Purpose: To ascertain the health-related quality of life associated with symptomatic degenerative vitreous floaters.
|Peer-Review||English||Am J Ophthalmol. 2011 Jul;152(1):60-65.e1. doi: 10.1016/j.ajo.2011.01.026. Epub 2011 May 12||2011||Wagle AM, Lim WY, Yap TP, Neelam K, Au Eong KG. Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore.|
The vitreoretinal interface is involved in a wide range of vitreoretinal disorders and separation of the posterior vitreous face from the retinal surface is an essential part of vitrectomy surgeries. A diverse range of enzymatic and non-enzymatic agents are being studied as an adjunct before or during vitrectomy to facilitate the induction of posterior vitreous detachment. There is a significant body of knowledge in the literature about different vitreolytic agents under investigation for a variety of pathologies involving the vitreoretinal interface which will be summarized in this review.
|Peer-Review||English||J Ophthalmic Vis Res 2010; 5 (1): 44-52||2010||Hossein Nazari, MD; Mehdi Modarres-Zadeh, MD; Arash Maleki, MD. Eye Research Center, Iran University of Medical Sciences, Tehran, Iran|
|Nd:YAG Vitreolysis and Pars Plana Vitrectomy: Surgical Treatment for Vitreous Floaters||
Purpose of Study: To determine the efficacy of Nd:YAG vitreolysis and pars plana vitrectomy in the treatment of vitreous floaters.
|Peer-Review||English||Eye (Lond). 2002 Jan;16(1):21-6||2002||Delaney YM, Oyinloye A, Benjamin L|
|Eligibility Criteria for Nd-YAG Laser Treatment of Highly Symptomatic Vitreous Floaters||
Ten eyes of nine patients were treated for very disturbing vitreous floaters with the technique of Nd-YAG laser vitreolysis. The Scanning Laser Ophthalmoscope (SLO) was used to objectivate the position, the size and the motility of the vitreous floaters with respect to the patient’s visual axis, which can be precisely located with the SLO. With this technique it was possible to define more precisely some eligibility criteria for Nd-YAG laser treatment of vitreous floaters and to classify the vitreous floaters in ill-suspended and well-suspended floaters in the vitreous body, the well-suspended floaters responding better to treatment compared to the ill-suspended vitreous floaters. The treatment was performed using the Q-Switched Nd-YAG Laser type Nanolas 15S of Alcon.
|Peer-Review||English||Bull Soc Belge Ophtalmol. 2001;(280):15-9||2001||Vandorselaer T, Van De Velde F, Tassignon MJ. University Hospital Antwerp, Department of Ophthalmology, Wilrijkstraat 10, B-2650 Edegem|
|Nd:YAG Laser Treatment for Macular Preretinal Hemorrhage||
An 18-YEAR-OLD woman who was 36 weeks’ pregnant had a 1-week history of a large red scotoma in the superior half of her vision in the left eye. She denied trauma or pain. Her ophthalmic and medical histories were negative for diabetes mellitus and systemic hypertension. Visual acuity was 20/20 OD and counting fingers OS. There was no afferent pupillary defect. Intraocular pressure was normal in both eyes. Extraocular motility was normal and visual fields were full to confrontation in both eyes. Anterior segment examination results were normal. Results of a dilated fundus examination were normal in the right eye; the left eye showed a large area of preretinal hemorrhage over the macula.
|Peer-Review||English||Arch Ophthalmol. 1999;117(5):694. doi:10.1001/archopht.117.5.694||1999||Fiaz Zaman, MD; Richard Irwin; Bernard F. Godley, MD, PhD|
|Use of Nd:YAG Laser in Treatment of Vitreous Floaters||
Aim: The aim of the paper is to present results obtained after photodisruption of non-resorptive vitreous floaters by means of the Nd:YAG laser.
|Article||English||Klinika Oczna [1998, 100(3):155-157]||1998||Toczołowski J, Katski W|
|Nd:YAG Laser Posterior Hyaloidotomy for the Treatment of a Premacular Vitreous Floater||
A 63-year old man, with a large central vitreous floater, underwent a Nd:YAG laser posterior hyaloidotomy. Although the vitreous floater disappeared from the central optical axis, visual acuity did not improve. Microperimetry performed with the SLO revealed an absolute scotoma, which corresponded well in shape and dimension with the original vitreous floater. This finding suggests that a fragment of the neurosensory retina became detached together with the internal limiting membrane in the process of the vitreous collapse.
|Peer-Review||English||Bull Soc Belge Ophtalmol. 1997;265:39-43||1997||Van der Veken A, Van de velde F, Smeets B, Tassignon MJ|
|Neodymium:YLF Picosecond Laser Segmentation for Retinal Traction associated with Proliferative Diabetic Retinopathy||
Purpose To determine the applicability of laser segmentation for severing fibrovascular tissue and hyaloid interfaces in the treatment of tractional complications of proliferative diabetic retinopathy.
|Peer-Review||English||Am J Ophthalmol. 1997 Apr;123(4):515-23||1997||Cohen BZ, Wald KJ, Toyama K. Retina Associates of New York, NY 10021, USA|
|Relationship between Floaters, Light Flashes, or both, and Complications of Posterior Vitreous Detachment||
We examined biomicroscopically the vitreous and retinal conditions of 902 consecutive symptomatic eyes (785 patients) to ascertain the relationship between floaters, light flashes, or both, and complications of posterior vitreous detachment. Of 785 patients, 785 symptomatic eyes were divided as follows: group 1, 342 eyes with floaters alone; group 2, 240 eyes with floaters and light flashes; and group 3, 203 eyes with light flashes alone. We also studied 636 asymptomatic fellow eyes. The prevalence of posterior vitreous detachment was significantly higher in groups 1 (138 of 342, 40%), 2 (214 of 240, 89%), and 3 (137 of 203, 67%) than in the asymptomatic eyes (127 of 636, 20%), in group 2 than in groups 1 and 3, and in group 3 than in group 1 (P = .01). The prevalence of retinal breaks in eyes with posterior vitreous detachment was 5% (seven of 138), 13% (27 of 214), 12% (16 of 137), and 4% (five of 127) in groups 1, 2, 3, and the asymptomatic eyes, respectively; the prevalence was significantly higher in groups 2 and 3 than in asymptomatic eyes (P = .02 and P = .04) and group 1 (P = .04 and P = .05). The prevalence of vitreous hemorrhage in eyes with retinal breaks was 71% (five of seven), 70% (19 of 27), and 6% (one of 16) in groups 1, 2, and 3, respectively. Of 117 patients with bilateral symptoms, 105 (90%) had the same symptoms and 104 (89%) had the same vitreoretinal relationship bilaterally.
|Peer-Review||English||Am J Ophthalmol. 1994 May 15;117(5):593-8||1994||Hikichi T, Trempe CL. Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts|
|Treatment of Vitreous Floaters with Neodymium YAG laser||
Fifteen cases of vitreous floaters with serious psychological reactions have been collected. By using a direct ophthalmoscope, causal vitreous opacities were detected. The opacities were photodisrupted with neodymium YAG laser, using energy levels of 5 to 7.1 mJ and total energy 71 to 742.0 mJ. Symptoms completely disappeared immediately after treatment in all 15 cases. There were no intraoperative or postoperative complications noted during a follow up period of at least 1 year. To our knowledge, the use of neodymium YAG laser to treat vitreous floaters has not been previously described. Our initial experience indicates that the treatment is simple, safe, and effective.
|Peer-Review||English||Br J Ophthalmol. 1993 August; 77(8): 485–488||1993||W F Tsai, Y C Chen, and C Y Su|
|Indications for Q-Switched and Mode-Locked Nd: YAG Lasers in Vitreoretinal Pathology.||
The indications for two types of pulsed Nd: YAG lasers in the treatment of vitreous pathology are reviewed. A series of 94 eyes from 93 patients were treated with the mode-locked system and 72 eyes from 71 patients were treated with the Q-switched system. A classification of vitreous pathology with prognostic value for the efficacy of treatment of both lasers is established. For the Q-switched laser the range of indications in the posterior pole is larger and fewer sessions are needed; however, complications are more frequent than with the mode-locked laser. This difference is due to the higher energy needed with the Q-switched laser to treat more severe vitreous pathology.
|Peer-Review||English||Eur J Ophthalmol. 1991 Jul-Sep;1(3):123-30||1991||Tassignon MJ, Kreissig I, Stempels N, Brihaye M. Department of Ophthalmology, Free University Hospital of Brussels VUB, Belgium.|
|Q-Switched Neodymium: YAG Laser Surgery of the Vitreous||
Fifty-nine eyes underwent vitreous surgery (vitreolysis) with the Q-switched Nd: YAG laser. This was used to cut vitreoretinal bands and membranes in 16 eyes and to clear persistent vitreous opacities in 25 eyes. The use of appropriate specialized contact lenses and modification of the standard slit-lamp delivery system were essential for vitreous YAG laser surgery. Successful results occurred in eyes where the target tissues were located at distances greater than 2 mm from the crystalline lens and the retina. Vision was improved in 18 eyes, unchanged in 40 eyes, and worse in 1. Complications included focal opacities of the crystalline lens in 5 eyes, retinal holes with detachment in 1 eye, and minor retinal hemorrhages in 4. Methods of preventing complications are discussed.
|Peer-Review||English||Graefes Arch Clin Exp Ophthalmol. 1986;224(3):240-6||1986||Little HL, Jack RL|
|Neodymium: YAG Laser Vitreolysis||Peer-Review||English||Int Ophthalmol Clin. 1985 Fall;25(3):125-34||1985||Aron-Rosa D, Greenspan DA|
|Vitreolysis with the Q-Switched Laser||
We present an overview concerning the current status of photodisruptive methods used in the treatment of pathologic changes in the vitreous space. In one series of 320 cases studied, 65% of the planned dissections of pathologic structures were successful. In a second series of 34 more complicated cases, the success rate was even lower. Complications included 15 retinochoroidal hemorrhages and one damaged posterior lens capsule. When one compares optical-surgical methods with conventional methods, it is obvious that the former aim at achieving goals that are less ambitious than those of classic vitrectomy and, in many cases, serve only to prepare for – and facilitate – a classic vitrectomy. By definition, laser vitreolysis dissects, but cannot remove, the fragments of disrupted structures from the eyeball. However, despite the obvious risks, photodisruptive laser surgery is considered less dangerous than is classic vitrectomy because photodisruption is a “noninvasive” procedure. Since laser vitreolysis is able to solve a number of clinical problems, obviating the need for vitrectomy, the former procedure should receive increasing attention for the treatment of pathologic problems in the vitreous cavity.
|Peer-Review||English||Arch Ophthalmology 103:116-1171, 1985||1985||Fankhauser F, Kwasniewska S, van der Zypen E|
|Contact Lenses for Nd:YAG Application in the Vitreous||
A set of convex-surfaced contact lenses with radii of 12.5mm, 18mm, and 25mm has been developed for Nd:YAG laser work in the vitreous cavity. The lenses reduce the energy threshold for plasma formation and increase the safety of intraocular YAG laser use.
|Peer-Review||English||Retina. 1984 Spring-Summer;4(2):129-31||1984||Peyman GA|
|Risk of Retinal Tears in Patients with Vitreous Floaters||
A total of 589 patients (369 women and 220 men, 123 of whom were less than 40 years old and 52 of whom were more than 70 years old) with photopsia, vitreous floaters, or both participated in a prospective study designed to identify patients at particularly high risk for retinal tears. The patients were graded on a number of factors before undergoing peripheral retinal examinations. Computer analysis showed that the following factors had the strongest associations (P less than .001) with retinal tears: visual symptoms of diffuse dots (62 of 120 patients, or 51.7%), many vitreous cells (graded 2+ or worse) (61 of 94 patients, or 64.9%), and grossly visible vitreous or preretinal blood (51 of 56 patients, or 91.1%). Of the 176 eyes that had at least one of these three conditions, 93 (52.8%) had retinal tears compared to 16 of the remaining 413 eyes (3.9%). Although other factors correlated with retinal tears to some degree, the associations were not strong enough to help select the high-risk group.
|Peer-Review||English||American Journal of Ophthalmology 96:783-787, 1983||1983||Boldrey E|
|Vitreous Floaters||Peer-Review||English||Ophthalmology 90:1271-1276, 1983||1983||Murakami K et al|
|Threshold for Retinal Damage associated with the use of High-Powered Neodymium-YAG Lasers in the Vitreous||
Ultrashort, Q-switched or mode-locked, neodymium-YAG laser pulses focused within 2 mm of the retina caused reproducible retinal damage in four eyes of two monkeys and in four eyes of three rabbits. The distance of the laser focus from the retina for clinically observed threshold retinal damage was characterized for pulse energies up to 9 mJ. For the 2-mJ to 6-mJ pulse energies necessary to rupture vitreal membranes in clear media in rabbits, the high-power laser pulses could not be focused within 2mm of the retina without substantial risk of damaging the underlying retina. These laser pulses did not rupture vitreal membranes in hazy ocular media that prevented precise focusing. The retinal damage was somewhat greater than expected for retinal absorption of 1.06-micron laser energy, suggesting that secondary effects such as self-focusing and shock waves emanating from the focus may be important.
|Peer-Review||English||American Journal of Ophthalmology 96:153-159, 1983||1983||Bonner FB, Sanford MM, Gaasterland DE|
|YAG Laser Vitreolysis vs Sham YAG Vitreolysis for Symptomatic Vitreous Floaters A Randomized Clinical Trial||
IMPORTANCE: Vitreous floaters are common and can worsen visual quality. YAG vitreolysis is an untested treatment for floaters.
OBJECTIVE: To evaluate YAG laser vitreolysis vs sham vitreolysis for symptomaticWeiss ring floaters from posterior vitreous detachment.
DESIGN, SETTING, AND PARTICIPANTS: This single-center, masked, sham-controlled randomized clinical trial was performed from March 25, 2015, to August 3, 2016, in 52 eyes of 52 patients (36 cases and 16 controls) treated at a private ophthalmology practice.
INTERVENTIONS: Patients were randomly assigned to YAG laser vitreolysis or sham YAG (control).
MAIN OUTCOMES AND MEASURES: Primary 6-month outcomeswere subjective change measured from 0% to 100% using a 10-point visual disturbance score, a 5-level qualitative scale, and National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25). Secondary outcomes included objective change assessed by masked grading of color fundus photography and Early Treatment Diabetic Retinopathy Study best-corrected visual acuity.
RESULTS: Fifty-two patients (52 eyes; 17 men and 35 women; 51 white and 1 Asian) with symptomaticWeiss rings were enrolled in the study (mean [SD] age, 61.4 [8.0] years for the YAG laser group and 61.1 [6.6] years for the sham group). The YAG laser group reported greater symptomatic improvement (54%) than controls (9%) (difference, 45%; 95%CI, 25%-64%; P < .001). In the YAG laser group, the 10-point visual disturbance score improved by 3.2 vs 0.1 in the sham group (difference, −3.0; 95%CI, −4.3 to −1.7; P < .001). A total of 19 patients (53%) in the YAG laser group reported significantly or completely improved symptoms vs 0 individuals in the sham group (difference, 53%; 95%CI, 36%-69%, P < .001). Compared with sham, NEI VFQ-25 revealed improved general vision (difference, 16.3; 95%CI, 0.9-31.7; P = .04), peripheral vision (difference, 11.6; 95%CI, 0.8-22.4; P = .04), role difficulties (difference, 17.3; 95%CI, 8.0-26.6; P < .001), and dependency (difference, 5.6; 95%CI, 0.5-10.8; P = .03) among the YAG laser group. Best-corrected visual acuity changed by −0.2 letters in the YAG laser group and by −0.6 letters in sham group (difference, 0.4; 95%CI, −6.5 to 5.3; P = .94). No differences in adverse events between groups were identified.
CONCLUSIONS AND RELEVANCE YAG: laser vitreolysis subjectively improvedWeiss ring–related symptoms and objectively improvedWeiss ring appearance. Greater confidence in these outcomesmay result from larger confirmatory studies of longer duration.
|English||JAMA Ophthalmol||Chirag P. Shah, Jeffrey S. Heier||
Ophthalmic Consultants of Boston