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    Small-gauge PPV for vitreous floaters

    Although rare, complications that do occur can be serious



    James M. Osher, MD, identifies the patient characteristics and reviews some of the complications with small-gauge vitrectomy for vitreous floaters.



    Cincinnati—Small-gauge pars plana vitrectomy (PPV) for symptomatic floaters is associated with few but potentially serious complications, said James M. Osher, MD, on behalf of the Vitrectomy for Floaters Study Group (VFSG).

    “Floaters most commonly result from posterior vitreous detachment (PVD) or vitreous syneresis,” explained Dr. Osher, who began this study with Michael Lai, MD, PhD, during his surgical retina fellowship at Retina Group of Washington/Georgetown University. Dr. Osher is now assistant professor of ophthalmology at the Cincinnati Eye Institute/University of Cincinnati.

    “Vitrectomy for symptomatic vitreous floaters has become more widespread with the use of small-gauge instrumentation, which affords a higher safety profile,” he added.

    To that end, the VFSG initiated a study to identify risk factors for symptomatic vitreous floaters and to analyze the intraoperative and postoperative complications of small-gauge PPV. The retrospective interventional case series included 204 eyes of 153 patients who underwent 23- or 25-gauge PPV for vitreous floaters over a 45-month period at a single private retina practice.

    Preoperative data recorded included length of symptoms, visual acuity, IOP, lens status, and IOL type. Premium IOL patients were considered those with multifocal or accommodating lenses (toric lenses were not considered premium for the purposes of this study).

    Intraoperatively, the group evaluated vitrectomy gauge, PVD induction, and presence of retinal tears. Finally, postoperative data included visual acuity, IOP, cataract development, and complications.

    In short, Dr. Osher said “premium IOL patients may be more symptomatic from vitreous floaters and, therefore, elect surgical intervention sooner than patients with monofocal, toric, or crystalline lenses.”

    What the study found

    The mean age of the patients was 62.8 years (40 to 88) and mean follow-up was 8.7 months (1 to 41). Sixty-four percent (n = 131) of eyes were pseudophakic, with 15% (n = 19) of IOLs being either multifocal or accommodating. Most eyes (94.1%) underwent 25-gauge PPV.

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