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Christianne Wa, Kenneth Yee, Laura Huang, Alfredo Sadun, J Sebag; Long-term Safety of Vitrectomy for Patients with Floaters. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2142.
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Floaters are curable by vitrectomy, but retinal tears/ detachments and cataract formation are concerns. It is hypothesized that performing vitrectomy with 25G instruments and not inducing a PVD intra-operatively will lower the incidence of retinal tears (previously reported 30%; Tan et al, AJO 2011). It is further hypothesized that not inducing PVD and also leaving the anterior vitreous intact will lower the incidence of post-vitrectomy cataract formation.
A retrospective chart review was performed for consecutive cases of therapeutic 25G vitrectomy for floaters. Eyes that had injections or previous vitrectomy or scleral buckle were excluded. PVD was not induced during surgery and the anterior vitreous was left intact in phakic eyes. 66 eyes in 52 patients (age = 63 ± 12 years) were included; 36/66 (54.5%) eyes were phakic. The average duration of coping was 30 months. The etiology of floaters was PVD in 44/66 (67%), myopia in 19/66 (28%), asteroid hyalosis in 8/66 (12%) and old blood in 2/66 (3%) eyes. Retinopexy for retinal breaks occurring at the time of PVD was performed in 16 eyes (36% of all eyes with PVD; 24% of all eyes), a minimum of 3 months prior to vitrectomy. The mean follow-up was 12.3 months (range: 3-50 months). Main outcome measures were the incidence of retinal tears/ detachments and cataract formation requiring surgery.
Floater symptoms resolved in 65 of 66 eyes (98.5%). Over a period of 3 months to 4 years, no patients (0/66; 0%) developed retinal breaks, hemorrhage, infection, or glaucoma. More specifically, retinal breaks/ detachments did not develop in the 22 patients without PVD pre-operatively (0/22 vs 9/30 (30%); Tan et al, AJO 2011; Fisher’s exact t-test P < 0.007). Only 7/36 (19%) phakic eyes developed cataracts requiring surgery, an average of 16.5 months post-vitrectomy (7/36 vs 18/36 (50%); Tan et al, AJO 2011; Fisher’s exact t-test P < 0.02).
Vitrectomy using small-gauge instruments without PVD induction reduced retinal tear incidence from 30% to 0% (P < 0.007). Not inducing PVD and leaving the anterior vitreous intact lowered the incidence of post-vitrectomy cataract surgery from 50% to 19% (P < 0.02). Treating symptomatic floaters by 25G vitrectomy without inducing PVD or removing the anterior vitreous can be safe and still effective, eliminating iatrogenic retinal tears/ detachments and minimizing the need for cataract surgery.
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