Laser Vitreolysis Research Articles

YAG laser vitreolysis for treatment of symptomatic vitreous opacities

YAG laser vitreolysis is an innovative procedure to treat symptomatic vitreous floaters. The treatment decision is based on taking acomprehensive 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. Aclassification 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.

Posterior capsule disruption with cataract formation caused by neodymium:YAG laser vitreolysis: May consultation #1

Journal of Cataract & Refractive Surgery: May 2018 - Volume 44 - Issue 5 - p 666 doi: 10.1016/j.jcrs.2018.04.015

Evaluation of YAG-laser vitreolysis effectiveness based on quantitative characterization of vitreous floaters

To develop methods for evaluating effectiveness of YAG-laser vitreolysis of vitreous floaters. 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). 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. 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.

Catarata como complicación tras vitreolisis láser

Catarata como complicación tras vitreolisis láser

YAG Laser Vitreolysis vs Sham YAG Vitreolysis for Symptomatic Vitreous Floaters

Vitreous floaters are common and can worsen visual quality. YAG vitreolysis is an untested treatment for floaters. To evaluate YAG laser vitreolysis vs sham vitreolysis for symptomatic Weiss ring floaters from posterior vitreous detachment. 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. Patients were randomly assigned to YAG laser vitreolysis or sham YAG (control). Primary 6-month outcomes were 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. Fifty-two patients (52 eyes; 17 men and 35 women; 51 white and 1 Asian) with symptomatic Weiss 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. YAG laser vitreolysis subjectively improved Weiss ring-related symptoms and objectively improved Weiss ring appearance. Greater confidence in these outcomes may result from larger confirmatory studies of longer duration. clinicaltrials.gov NCT02897583.

YAG Laser Vitreolysis—Is It as Clear as It Seems?

YAG Laser Vitreolysis—Is It as Clear as It Seems?

Nd:YAG laser vitreolysis versus pars plana vitrectomy for vitreous floaters.

The vitreous is the clear jelly of the eye and contains fine strands of proteins. Throughout life the composition of this vitreous changes, which causes the protein strands in it to bundle together and scatter light before it reaches the retina. Individuals perceive the shadows cast by these protein bundles as 'floaters'. Some people are so bothered by floaters that treatment is required to control their symptoms. Two major interventions for floaters include Nd:YAG laser vitreolysis and vitrectomy. Nd:YAG laser vitreolysis involves using laser energy to fragment the vitreous opacities via a non-invasive approach. Vitrectomy involves the surgical replacement of the patient's vitreous (including the symptomatic vitreous floaters) with an inert and translucent balanced salt solution, through small openings in the pars plana. To compare the effectiveness and safety of Nd:YAG laser vitreolysis to pars plana vitrectomy for symptomatic vitreous floaters. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), MEDLINE Ovid (1946 to 17 January 2017), Embase Ovid (1947 to 17 January 2017), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 17 January 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 17 January 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 17 January 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 17 January 2017. We did not use any date or language restrictions in the electronic searches for trials. We also searched conference proceedings to identify additional studies. We included only randomised controlled trials (RCTs) that compared Nd:YAG laser vitreolysis to pars plana vitrectomy for treatment of symptomatic floaters. We planned to use methods recommended by Cochrane. The primary outcome we planned to measure was change in vision-related quality of life from baseline to 12 months, as determined by a vision-related quality of life questionnaire. The secondary outcomes we planned to measure were best corrected logMAR or Snellen visual acuity at 12 months for the treated eye(s) and costs. Adverse outcomes we planned to record were the occurrence of sight-threatening complications by 12 months (asymptomatic retinal tears, symptomatic retinal tears, retinal detachment, cataract formation, and endophthalmitis). No studies met the inclusion criteria of this review. There are currently no RCTs that compare Nd:YAG laser vitreolysis with pars plana vitrectomy for the treatment of symptomatic floaters. Properly designed RCTs are needed to evaluate the treatment outcomes from the interventions described. We recommend future studies randomise participants to either a Nd:YAG laser vitreolysis group or a vitrectomy group, with participants in each group assigned to either receive treatment or a sham intervention. Future studies should follow participants at six months and 12 months after the intervention. Also they should use best corrected visual acuity (BCVA) using an Early Treatment of Diabetic Retinopathy Study (ETDRS) chart read at 4 metres, vision-related quality of life (VRQOL), and adverse outcomes as the outcome measures of the trial.

Cataracts induced by neodymium–yttrium-aluminium-garnet laser lysis of vitreous floaters

BackgroundNeodymium–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...

Clinical outcome of YAG laser vitreolysis (Ultra Q Reflex®) for the treatment of floaters

PurposeFloaters are localized vitreous opacities that are products of vitreous degeneration or posterior vitreous detachment (PVD). Usually, observation was the only solution, however some patients are suffered from floaters. This study reports the clinical results of YAG laser vitreolysis for the treatment of floaters.MethodsThe patients with floaters were involved who visited Pureun eye hospital between January and March 2015. The patients were involved who met the following criteria; the floaters caused by localized vitreous opacities or PVD; patients suffered from floaters and strong desire for cure. The patients with diabetic retinopathy, retinal detachment, severe media opacity and young age were excluded. Patients had pre and postoperative examinations including visual acuity, tonometry, wide fundus photography, slit lamp and fundus examination. Patients were examined 1, 4 and 8 weeks after treatment. The floater scores were measured with survey paper for the evaluation of subjective change. The wide fundus photography was used for the objective change.ResultsThe 47 eyes were involved (27 cases:male and 20 cases:female). The mean age was 69.5 ± 14.3. Informed consent was obtained in all cases. The floater scores were significantly improved after treatment (preoperative: 73.6 ± 10.5, postoperative: 8.2 ± 4.6, P &lt; 0.001). The visible floaters disappeared in 43/47 cases (91.5%) in wide fundus photography. There were no significant changes in VA and IOP. Other side effects such as retinal detachment or hemorrhage and cataract were not developed during follow up period.ConclusionsThe clinical outcome of YAG laser vitreolysis using Ultra Q Reflex showed favorable results in subjective and objective measurement. There were no significant complications after procedure. We think YAG laser vitreolysis could be the excellent treatment option for the floaters.

Efficacy of YAG laser vitreolysis on vitreous Weiss ring

Efficacy of YAG laser vitreolysis on vitreous Weiss ring

Refractory Open-Angle Glaucoma After Neodymium–Yttrium-Aluminum-Garnet Laser Lysis of Vitreous Floaters

To illustrate 3 cases of chronic open-angle glaucoma secondary to the neodymium-yttrium-aluminum-garnet (Nd:YAG) laser vitreolysis procedure for symptomatic vitreous floaters. Observational case series. Location of the study was the Doheny Eye Institute. Three eyes of 2 patients who developed chronic open-angle glaucoma after Nd:YAG vitreolysis for symptomatic floaters presenting with very high intraocular pressure (IOP >40 mm Hg) were selected. The time from the laser treatment to the onset of elevated pressure ranges from 1 week to 8 months. There was no associated inflammation, steroid use, or other identifiable cause of chronic IOP elevation. All eyes were treated initially with glaucoma medication, followed by selective laser trabeculoplasty (SLT) and eventually glaucoma surgery (Trabectome) in 2 eyes for disease management. In all eyes, intraocular pressures were eventually stabilized within a normal pressure range from 18 to 38 months following Nd:YAG vitreolysis. At the latest follow-up post surgery, all eyes had intraocular pressures of 22 mm Hg or less with or without medications. Secondary open-angle glaucoma is a complication of Nd:YAG vitreolysis for symptomatic floaters that may present with an increase in intraocular pressure immediately, or many months after the surgery. Furthermore this complication may be permanent and require chronic medical therapy or glaucoma surgery.

Postsurgical cystoid macular edema

AbstractPurpose Cystoid macular edema (CME) is a major cause of reduced vision following cataract and vitreoretinal surgery, with a reported incidence of 0.1‐ 2.35%. Intraretinal accumulation of fluid determines the formation of perifoveal cysts, which may combine and give rise to lamellar holes. The etiology of CME is not completely clarified. Risk factors, among which preexisting ocular (uveitis, retinal vein occlusion, epiretinal membrane) and systemic conditions (diabetes mellitus, systemic hypertension) as well as intraoperative complications can raise the risk of developing CME postoperatively. Modern surgical techniques have reduced the incidence of CME.Methods Pseudophakic CME is characterized by poor postoperative visual acuity. Onset of clinically significant CME is generally 4‐12 weeks after surgery (peak at 4‐6 weeks). Fluorescein angiography (FA) is indispensable in the workup of CME, showing the classical perifoveal petaloid staining pattern and late leakage of the optic disk. Optical coherence tomography (OCT) reveals cystic spaces in the outer nuclear layer. Differential diagnosis with FA and biomicroscopy is crucial for postsurgical CME management.Results Most cases of pseudophakic CME resolve spontaneously. Available therapeutic interventions, for both prophylaxis and treatment of CME, are based on pathogenesis theories. The value of prophylactic treatment is doubtful, especially long‐term postoperatively. First‐line treatment should include topical nonsteroidal anti‐inflammatory drugs (NSAIDs ) and corticosteroids, with best results for acute postsurgical CME. In cases of resistant CME, periocular or intraocular corticosteroids represent an option. Antiangiogenic agents, though experimental, should be considered for nonresponsive persistent CME. Surgical options such as laser vitreolysis or vitrectomy should be reserved for special cases.

Upside-down vitreolysis

We describe a technique for performing laser vitreolysis in patients lying upside down on a gurney.

Valsalva-like Retinopathy Following Hyperopic Laser In Situ Keratomileusis

&lt;P&gt; A 50-year-old woman presented with unilateral acute loss of vision 15 hours after undergoing bilateral hyperopic laser in situ keratomileusis (LASIK). She denied “straining.” Fluorescein angiography showed no retinal vascular abnormalities but demonstrated blocked fluorescence corresponding with subhyaloid, intraretinal, and subretinal hemorrhages seen clinically in the left eye. YAG laser vitreolysis was performed after noting posterior cortical vitreous thickening with a loculated subhyaloid hemorrhage. Best spectacle-corrected visual acuity was restored to 20/20 by the 2-month follow-up examination. Valsalva-like retinopathy, possibly the result of the rapid rise and fall of intraocular pressure during the microkeratome and suction ring operation, may occur following hyperopic LASIK surgery. [&lt;CITE&gt;Ophthalmic Surg Lasers Imaging&lt;/CITE&gt; 2006;37:486-488.] &lt;/P&gt; &lt;H4&gt;AUTHORS&lt;/H4&gt; &lt;P&gt;From the Department of Ophthalmology (AAM, PJF), North Shore University Hospital, Great Neck, New York; Kaiser Permanente (SAH), Oakland, California; the Department of Ophthalmology (DZR), Weill Medical College, Cornell University, New York, New York; Reinstein Institute (DZR), London, United Kingdom; and Long Island Vitreoretinal Consultants (PJF), Great Neck, New York. Dr. Moshfeghi is currently affiliated with the Bascom Palmer Eye Institute, Miami, Florida. &lt;/P&gt; &lt;P&gt;Accepted for publication November 20, 2005. &lt;/P&gt; &lt;P&gt;Presented in part at the annual meeting of the American Academy of Ophthalmology, New Orleans, Louisiana, November 11-14, 2001. &lt;/P&gt; &lt;P&gt;Address reprint requests to Philip J. Ferrone, MD, 600 Northern Boulevard, Suite 216, Great Neck, NY 11021. &lt;/P&gt;

Infections rubéoliques confirmées au laboratoire chez la femme enceinte et le nouveau-né en France (1990)

To illustrate 3 cases of chronic open-angle glaucoma secondary to the neodymium–yttrium-aluminum-garnet (Nd:YAG) laser vitreolysis procedure for symptomatic vitreous floaters.Observational case series.Location of the study was the Doheny Eye Institute. Three eyes of 2 patients who developed chronic open-angle glaucoma after Nd:YAG vitreolysis for symptomatic floaters presenting with very high intraocular pressure (IOP >40 mm Hg) were selected. The time from the laser treatment to the onset of elevated pressure ranges from 1 week to 8 months. There was no associated inflammation, steroid use, or other identifiable cause of chronic IOP elevation.All eyes were treated initially with glaucoma medication, followed by selective laser trabeculoplasty (SLT) and eventually glaucoma surgery (Trabectome) in 2 eyes for disease management. In all eyes, intraocular pressures were eventually stabilized within a normal pressure range from 18 to 38 months following Nd:YAG vitreolysis. At the latest follow-up post surgery, all eyes had intraocular pressures of 22 mm Hg or less with or without medications.Secondary open-angle glaucoma is a complication of Nd:YAG vitreolysis for symptomatic floaters that may present with an increase in intraocular pressure immediately, or many months after the surgery. Furthermore this complication may be permanent and require chronic medical therapy or glaucoma surgery.

Clinical experience with Nd:YAG laser vitreolysis in the anterior segment

The clinical experience of two surgeons performing Nd:NAG laser anterior vitreolysis to disrupt vitreous strands adherent to surgical wounds with and without pupillary distortions and/or cystoid macular edema is presented. We describe our technique. The results indicate that vision improved in 50% of the cases, with visual acuity improving from 20/40 or better in three of 20 eyes preoperatively to 11 of 20 eyes postoperatively. No adverse effects or complications occurred in any of our 20 patients. Neodymium:NAG laser vitreolysis should be considered presently as the method of choice for initial treatment of vitreous strands incarcerated in the wound.