YAG vitreolysis resolves floaters in select cases
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YAG laser vitreolysis alleviated symptomatic floaters in select patients whose treatable opacities were identified and followed by swept-source OCT of the vitreous.
At the virtual American Society of Retina Specialists meeting, Netan Choudhry, MD, FRCS(C), reported on the VOYAGE study, which evaluated the impact of YAG laser vitreolysis on visual outcomes and the use of vitreous OCT imaging to inform treatment.
“What was unique about our study was, we used OCT imaging, particularly swept-source of the vitreous, which is a little bit of a leap forward, to actually identify the opacity that the patients were complaining about, and then titrate the treatment to the endpoint of the disappearance of those opacities,” Choudhry said in discussion of the presentation.
In the cross-sectional study of 40 eyes of 35 patients treated with YAG laser vitreolysis for vitreous opacities or posterior vitreous detachment, all eyes underwent ultra-widefield imaging with Optos California (Optos) and swept-source OCT imaging with the Plex Elite 9000 (Carl Zeiss Meditec) before and after treatments. Treatment was performed with the Ultra Q Reflex laser (Ellex) by a single surgeon.
Fourteen eyes (35%) required only one YAG laser procedure to resolve symptoms, 12 eyes (30%) required two YAG procedures, and 14 eyes (35%) required a third YAG procedure.
“These procedures can take some time, probably 10 to 15 minutes,” Choudhry said. “The reason it was broken up into sessions, two on average, was because after a certain amount of power is administered to the eye, there’s a risk for an increase in IOP. So, the idea [is] that you want to limit all complications or side effects.”
Mean best corrected visual acuity was significantly improved from 0.14 logMAR at baseline to 0.11 logMAR after the first YAG laser vitreolysis (P = .02).
After the final treatment session, 90% of patients reported resolution of their visual disturbance. No retinal detachments or tears occurred, but four patients went on to further treatment with pars plana vitrectomy to resolve residual vitreous opacities.
Not every patient who has floaters needs YAG vitreolysis, Choudhry said. Ideal candidates were identified as those with a single, focal visible opacity residing in the central field of view.
“In the world of optics, the definitive result will always be the clearing of the vitreous, but if we can avoid vitrectomy and the small risk of complications of vitrectomy in those patients that are good for this procedure, then why not?” Choudhry said.
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Choudhry N. Real-world visual outcomes after YAG vitreolysis for vitreous opacities (VOYAGE). Presented at: American Society of Retina Specialists annual meeting; July 24-26, 2020 (virtual meeting).
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