First Author: R.Fulga GERMANY
Co Author(s): A. Fricke C. Ullmann G. Auffarth D. Breyer K. Klabe H. Kaymak
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Vitreous opacities are usually harmless, but can be in some cases annoying, because they disturb the patient reading ability or patients have difficulty or can their profession no longer exercise. The vitrectomy was so far the only treatment option. As a novelty, the laser UltraQ from Ellex has the property that the illumination and laser beams are coaxial and has a precise focus in the middle and posteriour vitreous. This enables accurate YAG laser treatment of vitreous floaters.
Internationale Innovative Ophthalmochirurgie Düsseldorf, Germany; International Vision Correction Research Network, Germany
Retrospectively 300 eyes were evaluated after performing a YAG laser vitreolysis (UltraQ Laser; Ellex). We did the following investigation pre- and postoperative: subjective refraction, eye pressure, cell counting in anterior chamber (FM-600; Kowa), OCT (Cirrus HD-OCT; Zeiss / DRI OCT; Topcon), fundus photography (Daytona; Optos), direct ophthalmoscopy. We kept a safety distance of 3 mm to the retina and the lens. The treatments were carried out over a period of 2 years. We treated the patients that have to deal every day with problems due floaters and we excluded the patients with acute posterior vitreous detachment and uveitis.
The anatomical success rate was for a well-defined floaters about 95%, for multiple floaters 70% and for ill-defined 10%. Due to poor therapy adherence, a retina shot with local bleeding has occurred in 3 patients, and in 3 patients a lens hit with capsule perforation, which resulted in cataract surgery. In one case, an intracapsular lens implantation was possible, in two cases only one Rhexis fixation was done. 79% of the patients were pseudophakic. 15% of patients underwent retinal photocoagulation for retinal degenerations or retinal tears before YAG Vitreolysis treatment. On average from 2.1 sessions Vireolyse were needed. The rate of shots was between 250 and 600 with a mean energy of 6mJ/shot. It showed postoperatively in no case a retinal detachment or macular edema (follow-up 3 to 12 months).
Not all vitreous opacities are suitable for the treatment with the Laser Vitreolysis. Individual vitreous opacities such as white ring and other well-defined floaters can be treated without problems. A good selection of the patients ist the key to successful therapy. In case of poor compliance, surgery should be carried out in parabulbar anaesthesia and a biometrics should be used as a precaution. Retinal hits form back within one month without major damage. Lens hits are more complicated, so they can make cataract surgery more difficult. For this reason, comprehensive patient education is urgently recommended to increase compliance.