Laser Vitreolysis Research Articles

The lack of floater perception in eyes with asteroid hyalosis and its direct implications on laser vitreolysis

PurposeTo present a novel optical model explaining why the vast majority of patients with Asteroid Hyalosis (AH) do not perceive any floaters. This changes our understanding of floater perception and undermines the operation mode of YAG laser vitreolysis.MethodsRelying on a previously published model of floater perception based on astronomical equations of a solar eclipse, and on ultrasound images of the vitreous in three eyes with AH, we explain why such patients do not perceive floaters in spite of opaque bodies filling their entire vitreous, to the point of, in severe cases of AH, obscuring the fundus view during ophthalmoscopy.Main outcome measuresDeveloping an optical model of light rays that can quantify the maximal distance upon which a vitreous floater or opacity will cast a shadow on the retina.ResultsCalculations using the proposed model demonstrated that with a 3 mm pupil, for a floater located between 1.5 mm and 2 mm from the retina, its shortest diameter must be > 215 microns and > 286 microns, respectively, to be perceived. Since AH floaters, based on ultrasound imaging, do not exist in the most peripheral 1.5 mm of the vitreous, it becomes understandable why these patients are asymptomatic.ConclusionsBased on the proposed model and our findings, we deduced that even large, degenerative floaters whose width is usually narrower than a large retinal vein (125 microns), must be located very close to the retina and hence are not the floaters that are aimed at when performing YAG laser vitreolysis. We speculate that in successful cases, YAG vitreolysis works by a different mechanism, most likely a shock wave that displaces floaters further away from the retina. Hence, vitreolysis might not necessarily require the laser be aimed at the floaters, as symptomatic floaters may be located in the outer 1.5–2.0 mm of the vitreous body, a very risky zone for YAG laser shots.

Nd: YAG laser of Weiss Ring for the Treatment of Symptomatic Vitreous Floaters in Patients with Posterior Vitreous Detachment

Purpose: To assess the effect of Nd: YAG laser vitreolysis of the Weiss ring in the management of symptomatic vitreous floaters in patients with posterior vitreous detachment in the outpatient department of a tertiary care hospital. Study Design: Quasi-experimental study. Place and Duration of Study: This quasi-experimental trial was conducted in the out-patient department (OPD) of The Layton Rahmatullah Benevolent Trust (LRBT) Tertiary Teaching Eye Hospital, Korangi, Karachi from February 2023 to July 2023. Methods: In this study, 75 eyes of 75 patients were selected using non-probability purposive sampling technique. Dilated fundus examination was performed and The National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) was used and compared pre and post Laser Floater Treatment (LFT). Results: Out of 75 eyes, 65 patients were included in final analysis. Mean age was 54.63±4.1 years. Out of these, 69.2% were 48–56 years old and 56.9% were females. Mean number of shots were 160±15.53. Mean Pre-LFT, VFQ was 56±5.89 and post-LFT was 74±13.2. The mean difference pre versus post treatment was -18 units with p<0.001. Twenty patients complained of blurring of vision and one patient suffered mild retinal hemorrhage which resolved spontaneously, two patients were lost to follow up. Conclusion: Nd: YAG laser vitreolysis of the Weiss ring can be a quick, and effective treatment option in patients suffering from symptoms of vitreous floaters after a posterior vitreous detachment. However, more trials with large number of patients and longer follow up durations are required for generalization of results.

Management of vitreous floaters: a review.

Vitreous floaters, characterized by the perception of spots or shadows in the visual field, commonly result from posterior vitreous detachment and can cause chronic symptoms in affected patients. The diagnosis of posterior vitreous detachment is typically determined clinically and can sometimes be confirmed with optical coherence topography (OCT) [1 ▪▪ ] . The objective of this review is to review management options for symptomatic vitreous floaters. Symptoms of vitreous floaters may be mild or may significantly affect patient quality of life. Observation is the most common management strategy. Procedural management options include pars plana vitrectomy (PPV) and neodymium-doped yttrium aluminium garnet (Nd:YAG) vitreolysis. PPV is considered the most definitive management option for vitreous floaters. PPV, however, carries inherent risks, notably infection, cataract formation, and retinal detachment [2] . Nd:YAG laser vitreolysis is a less invasive alternative with studies demonstrating varied success [1 ▪▪ ,3,4] . This review provides insights into the current state of knowledge regarding the management of vitreous floaters and can guide clinical decision-making.

No side effects on rabbit retina or vitreous microenvironment by nd:YAG laser vitreolysis.

To explore the safety of Neodymium:Yttrium-aluminum-garnet (Nd:YAG) laser vitreolysis based on the histological examination of the retina and the alteration of vitreous cytokines in the rabbits. Nine male New Zealand rabbits underwent Nd:YAG laser vitreolysis of 10mJ x 500 pulses in the left eyes, while the right eyes were used as controls. Intraocular pressure, color fundus photography, and ultrasound B scan were measured before, as well as 1day, 4 weeks, and 12 weeks after Nd:YAG laser vitreolysis. Three rabbits were euthanized 1day, 4 weeks, and 12 weeks after treatment, respectively. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining and hematoxylin-eosin (H&E) staining were used to look for pathological changes in the retina. An enzyme-linked immunosorbent assay (ELISA) was utilized to detect the expression of vascular endothelial growth factor (VEGF) and some inflammatory cytokines, including interferon inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1) and interlenkin 6 (IL-6) in the vitreous humor. The ascorbic acid (AsA) and total reactive antioxidant potential (TRAP) in the vitreous humor were also measured. Following Nd:YAG laser vitreolysis, the levels of VEGF, IP-10, MCP-1, IL6, AsA, and TRAP in the vitreous humor did not change substantially (P > 0.05). There were no detectable pathological changes in the retinal tissues, and no apoptotic signal was found. Rabbits tolerate Nd:YAG laser vitreolysis without observable impact on retinal tissue or the microenvironment of the vitreous.

Neodymium yttrium aluminum garnet (Nd: YAG) laser vitreolysis versus oral iodized lecithin tablets for the management of symptomatic vitreous opacities

Neodymium yttrium aluminum garnet (Nd: YAG) laser vitreolysis versus oral iodized lecithin tablets for the management of symptomatic vitreous opacities

ND:YAG Laser Vitreolysis as The Management of Occluded Tube After Glaucoma Drainage Device Implantation (GDD)

Introduction : Glaucoma Drainage Devices (GDD) implantation surgery can be an alternative therapy for patients with uncontrolled IOP after trabeculectomy. However, tube occlusion is a common complication of GDD implantation. Management of tube occlusion can be done using laser or with surgery. This case presents the management of vitreous occlusion of tube implant using ND:YAG laser-vitreolysis.
 Case Illustration : A 63 year-old male patient came with chief complaint of pain in his right eye. The patient had a history of cataract surgery on the right eye and was diagnosed with glaucoma. An examination showed IOP in the right eye was increased, vitreous in COA and lens was aphakic with posterior capsule rupture. The patient had undergone trabeculectomy, but IOP remained high, so an Aurolab Aqueous Drainage Implant (AADI) GDD implantation was performed. However, six weeks after the procedure, the IOP still increased, and an examination revealed vitreous occlusion of the GDD tube (Figure 1) . The patient underwent Zeiss ND-YAG laser-vitreolysis on his right eye (Figure 2) with laser spot size of 50?m and power of 2.1 MJ. Post laser IOP was decreased.
 Discussion : GDD implantation is a surgical option for primary or secondary therapy, but tube occlusion can cause implantation failure. Laser-vitreolysis is a non- invasive modality to treat tube occlusion caused by vitreous.
 Conclusion : GDD occlusion can occur due to various etiologies, but laser-vitreolysis is a non-invasive treatment option aimed at restoring tube patency and aqueous outflow.

Efficacy and safety of early YAG laser vitreolysis for symptomatic vitreous floaters: the study protocol for a randomized clinical trial

BackgroundVitreous floaters are a common ocular condition that affects individuals of all ages. Although vitreous floaters are typically benign, they can significantly impair visual acuity and quality of life. Laser vitreolysis, which uses an Nd: YAG laser to vaporize collagenous vitreous opacities, is increasingly being used as a treatment option. However, there is currently a lack of evidence regarding its efficacy and the appropriate timing of its application. This study aims to evaluate the efficacy and safety of early intervention with YAG laser vitreolysis in treating symptomatic vitreous floaters.MethodsThe present study is a randomized, controlled, double-blind clinical trial. A total of 70 participants with symptomatic floaters for 1 month were prospectively recruited. These participants will be randomly assigned to two groups, with 35 individuals in each group: the early treatment group and the delayed treatment group. Participants assigned to the early treatment group will undergo YAG laser vitreolysis immediately, followed by a sham laser treatment 3 months later. On the other hand, participants assigned to the delayed treatment group will receive a sham laser treatment and then undergo YAG laser vitreolysis 3 months later. The follow-up time points will be 1, 3, 6, and 12 months from randomization. Primary outcomes will be participants’ self-reported improvement in visual disturbance on a scale of 1 to 10 and their scores on the National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25). Secondary outcomes will be an objective evaluation of the effectiveness of the treatment in reducing vitreous floaters through OCT and fundus photography and tracking any adverse events related to the eyes or overall health.DiscussionThis clinical trial aims to evaluate the effectiveness of YAG laser vitreolysis in treating symptomatic vitreous floaters and assess the safety of performing early intervention with YAG laser vitreolysis.Trial registrationClinicalTrials.gov NCT05800353. Registered on 10 March 2023.

Long-term efficacy and safety of YAG laser vitreolysis for vision degrading myodesopsia.

To assess the long-term efficacy and safety of yttrium-aluminum garnet (YAG) laser vitreolysis for vision degrading myodesopsia (VDM) caused by posterior vitreous detachment (PVD). This retrospective study reviewed VDM patients of PVD type undergoing YAG laser vitreolysis. The baseline demographic information, the patterns of floaters, the number of floaters, and the subjective improvement of floater sympotoms (ranging from 0 to 100%) from medical records were collected. Significant improvement was defined as a relief of floater symptoms of ≥50% at the final visit. The long-term efficacy and safety of YAG laser vitreolysis were analyzed. The risk factors linked to significant improvement of floater symptoms were defined using univariate and multivariate logistic regression analyses. The final analysis included 221 patients with VDM. The mean age of patients was 61.08±7.74y, and the mean length of follow-up was 21.38±5.61mo. Totally 57.01% of patients experienced a significant improvement in their floater symptoms after YAG laser therapy, and none of them developed delayed retinal abnormalities such as retinal tears or detachments. Age (OR=1.049, 95%CI=1.007-1.092, P=0.021) was identified as a significant risk factor for significant improvement in VDM. YAG laser vitreolysis is an effective and secure treatment for PVD-type VDM, and patients of advanced age are more likely to get favorable outcomes.

Safety of YAG laser vitreolysis for intraocular tissues: analysis of postoperative complications

PurposeTo evaluate the safety of yttrium–aluminum-garnet (YAG) laser vitreolysis for intraocular tissues.MethodsThirty-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.ResultsThere 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.ConclusionYAG 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.

Practical applications of vitreous imaging for the treatment of vitreous opacities with YAG vitreolysis.

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). 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. 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. 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.

Visual outcomes and safety profile of intraocular lens implantation versus aphakia in children with microspherophakia with no subluxation

ObjectiveTo study the visual, refractive and surgical outcomes of intraocular lens (IOL) implantation versus aphakia in children with microspherophakia.DesignRetrospective, comparative, non-randomised interventional study.MethodsAll consecutive children with microspherophakia who satisfied the...

Efficacy and Safety of YAG Laser Vitreolysis for Symptomatic Vitreous Floaters

Efficacy and Safety of YAG Laser Vitreolysis for Symptomatic Vitreous Floaters

Исследование эффективности и безопасности yag-лазерного витреолизиса в раннем периоде полной задней отслойки стекловидного тела

Aim. To research the subjective satisfaction and morphometric parameters of the central retinal thickness and subfoveal choroidal thickness in patients before and after YAG-laser vitreolysis in the early period of complete posterior vitreous detachment (PVD). Methods. The research included 38 patients operated in the early period of complete PVD. All the patients underwent the research of subjective satisfaction, central retinal thickness (CCT) and subfoveal choroidal thickness (SFCT) over a period of 6 months. Results. Subjective satisfaction with treatment in patients was 93.5 %, where the complete satisfaction with the result was 47.2 %. Comparative evaluation of morphometric parameters before and after early laser vitreolysis: central retinal thickness (p = 0.176) and subfoveal choroidal thickness (p = 0.475) showed no statistically significant changes. Conclusions. The results of the research indicate the safety of laser vitreolysis in the early period after the completion of PVD (up to three months) with careful patients selection. Key words: YAG-laser vitreolysis; optical coherence tomography; vaporization.

Nd:YAG laser vitreolysis in the treatment of premacular subhyaloid hemorrhage

Nd:YAG laser vitreolysis in the treatment of premacular subhyaloid hemorrhage

Эффективность ИАГ-лазерного витреолизиса помутнений стекловидного тела у пациентов с артифакией на лазерной установке «Ultra Q Reflex» (Ellex, Австралия)

The vitreous body is a special, complexly arranged tissue, the structure and functions of which remain not fully studied. Purpose: to study the efficiency of YAG-laser vitreolysis of vitreous opacities in patients with pseudophakia using the “Ultra Q Reflex” laser device. Material and methods. There were 19 people (21 eyes) under observation. Diagnosis: pseudophakia, high myopia, destruction of the vitreous body of both eyes. A standard pre- and postoperative examination was performed. YAG-laser vitreolysis was performed using “Ultra Q Reflex” laser system. All patients were divided into two groups. The first group (control) consisted of 7 people, who received drug treatment for 6 months. The main group included 12 patients who underwent laser vitreolysis. Results. 88 % of patients noted the complete disappearance of floating opacities in the field of view, including one year after laser treatment. During the next 3, 6, 12 months after the operation, no complications were identified. Patients in the control group did not notice a significant improvement in their condition during drug treatment. Conclusion. YAG-laser action on floating opacities of the vitreous body made it possible to achieve their evaporation, fragmentation and displacement from the visual axis, to increase visual acuity in the absence of complications. The obtained results make it possible to consider this method of treating for vitreous opacities to be effective and safe. Keywords: vitreolysis, destruction of the vitreous body, laser unit, opacity, pseudophakia.

The effectiveness of laser vitreolysis for vitreous floaters in posterior vitreous detachment.

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). 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. 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. Vitreolysis by Nd:YAG laser improved the CFS and VRQoL in symptomatic PVD patients.

Application of Nd:YAG laser to the anterior vitreous in malignant glaucoma - a systemic review and meta-analysis.

The study aims to review the efficacy, safety, and technique of Nd:YAG laser vitreolysis for the management of malignant glaucoma (MG). We performed a search of electronic databases for all published studies which included technical specifications of Nd:YAG laser application for MG. Individual patient data was extracted and evaluated in a weighted pooled analysis. Thirty eyes were reported on from seven studies worldwide. Age of affected patients ranged between 37 and 82years. Nd:YAG vitreolysis was performed either through an iritodomy (66.7%, 18/27 eyes), transpupillary (18.5%, 5/27 eyes), or through both simultaneously (14.8%, 4/27 eyes). Treatment intensity ranged between 1.0 and 11.00mJ with 75.9% (22/29 eyes) of treatments being 3.0mJ or lower. Between 1 and 41 pulses per session were applied. Rates of both anatomical and intraocular pressure resolution were examined. Overall, in a pooled analysis, 77% of eyes demonstrated MG resolution with no further treatment required after Nd:YAG vitreolysis (95% CI: 58.1 to 91.4%). A trend for lower need of additional interventions was seen with transpupillary application (11.1% versus 42.1%). No complications were reported. Nd:YAG laser vitreolysis is a safe procedure, associated with MG resolution in the majority of reported cases, regardless of treatment intensity. Transpupillary treatment may be associated with lower risk of re-intervention.

Влияние различных типов плавающих помутнений стекловидного тела на субъективное качество зрения

Purpose. To compare subjective visual quality on patients with different types of vitreous floaters. Material and methods. The study included 68 patients (68 eyes). Three groups were formed: I – Weiss Ring – 24 eyes, II – Сloud opacities – 22 eyes, III – Solid conglomerates – 22 eyes. To evaluate the visual quality all subjects completed non-standartised questionnaire. Laser treatment was performed with the “Ultra Q Reflex” using pulse energy 3–7 mJ. Follow-up: at the baseline and, 1 months after treatment. Results. There was a statistically significant difference observed in I group in questions of floaters intensity and occurrence frequency compared to the II and III groups. In the II group there was a statistically significant difference in questions of spots size and number compare to the other floaters. In the III group there was a statistically significant difference of overall quality of life questions compare to the other patients. Comparative analysis of survey outcomes in groups I and II revealed a significant increase of subjective perceptions (p < 0,05) and a positive trend in groups III at 1 month follow-up after laser surgery. Conclusions. Patients with Weiss rings and cloud-like floaters have great psychological discomfort, with the little impact on the visual functions of patients. On the contrary, solid conglomerates, due to their structure, have a significant impact on the subjective quality of vision and impede daily activities. The initial type of floaters determines the tactics of management, as well as the results of laser treatment. Keywords: YAG laser vitreolysis, vitreous floaters, questionnaire.

The Efficacy and Safety of YAG Laser Vitreolysis for Symptomatic Vitreous Floaters of Complete PVD or Non-PVD.

IntroductionTo evaluate and compare the efficacy and safety of YAG laser vitreolysis in treating symptomatic vitreous floaters of complete posterior vitreous detachment (PVD) and non-PVD.MethodsIn this prospective cohort study, 51 eyes with symptomatic floaters were treated with YAG laser vitreolysis. Participants were divided into complete PVD and non-PVD groups. Objective visual quality measures including the Strehl ratio (SR), internal spherical aberration (SA), internal comatic aberration (CA), internal high-order aberration (HOA), area ratio of modulation transfer function (MTFa) and Vitreous Floaters Symptom Questionnaire (VFSQ-13) scores were used to compare the efficacy of YAG laser vitreolysis treatment between two groups.ResultsThe mean age of all patients was 56.80 ± 10.82 years old. In total, 36 of 51 (70.59%; 95% CI 58.10–83.10) patients reported their symptoms as significant or complete improvement after YAG laser vitreolysis treatment. Post-treatment MTFa, internal SA and internal HOA were significantly better compared to baseline (26.19 ± 14.73 vs. 29.19 ± 17.98, p = 0.013; 0.05 ± 0.05 vs. 0.04 ± 0.04, p = 0.031 and 0.23 ± 0.22 vs. 0.16 ± 0.07, p = 0.044; respectively) in all eyes. Twenty-nine of 51 (56.86%) eyes had floaters of non-PVD type. Significant or complete subjective improvements in the PVD group and non-PVD group were 72.73% and 68.97% (p = 0.344), respectively.ConclusionsImproved subjective and objective visual quality in participants with symptomatic floaters following YAG laser vitreolysis was found in both groups. The efficacy of YAG laser vitreolysis was comparable in floaters of complete PVD and non-PVD types.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-021-00422-6.

Retinal Complications after Yttrium-Aluminum-Garnet Laser Vitreolysis for Vitreous Floaters.

This is an observational case series of two patients who developed direct retinal damage following neodymium-doped yttrium-aluminum-garnet (YAG) laser treatment for symptomatic vitreous floaters. The first patient developed a vitreous hemorrhage and subsequent branch retinal vein occlusion from laser damage to a major retinal venule. The second patient developed a temporal scotoma from a full-thickness retinal break in the posterior pole requiring laser retinopexy. Direct YAG laser damage to the posterior pole can cause permanent visual deficits. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:610-613.].