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    How YAG laser vitreolysis can be used in practice for treatment of floaters

    Surgeon’s clinical experience shows procedure yields robust safety profile, quality-of-life benefits in patients

    Take-home: 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.

    By Inder Paul Singh, MD, Special to Ophthalmology Times

     

    Until recently, patients suffering from bothersome floaters had only one of two options: learn to tolerate them, or undergo vitrectomy.

    Given that the latter option can be a highly invasive procedure often associated with complications—including infection, macular edema, and retinal detachment—many ophthalmologists, understandably, reserve vitrectomy for only the most severe and distressing cases.1

    More in this issue: Novel IOL provides promising results in small series

    In contrast, vitreolysis—which involves the use of a specially designed YAG laser to vaporize the vitreous strands and opacities—has shown to be highly effective in providing functional improvement with a low complication rate.2

    In a study by Cees van der Windt, MD, and colleagues, 100 eyes with posterior vitreous detachment-related floaters persisting for more than 9 months were treated with vitreolysis (n = 65) or pars plana vitrectomy (n = 35). Findings showed that both the YAG and vitrectomy groups reported an improvement in vision at 80% and 90%, respectively.

    Additionally, over the 8-year follow-up period, no complications occurred among patients in the vitreolysis treatment arm. Moreover, data from two studies carried out in 1990, demonstrated a near-100% rate of floater removal with vitreolysis. No intra- or postoperative complications occurred in any patient.3, 4

    Although vitreolysis is a much safer procedure than vitrectomy, medical schools generally do not teach it. Also, because of some problems associated with traditional YAG lasers, some ophthalmologists may be a little reluctant to offer the procedure to their patients. Though initially a little skeptical about vitreolysis, after incorporating multimodality YAG laser technology (Ultra Q Reflex, Ellex Medical Lasers) into daily practice, I have revised my opinion.

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    Surgical pearls for adding vitreolysis into daily practice

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