Treatment for symptomatic floaters range from floater reduction using laser strategies to full vitrectomy necessitating a surgical PVD. Furthermore, patient’s individual perceptions of vitreous opacities differ significantly, and therefore treatment strategies must respect their expectations. A subgroup of patients suffers heavily and is almost not able to continue normal daily life or work, although floaters are hardly detectable by ophthalmoscopy and ultrasound imaging. Sometimes patients have undergone psychological treatment as ophthalmologists deny surgical treatment. The present analysis of a retrospective consecutive case series of 99 eyes treated for symptomatic floaters between 2009-2015 should give information about the risk benefit ratio of surgery.

Material & Methods:

99 eyes (71 patients, age: 28-85 years) received complete vitrectomy for symptomatic floaters and had no other vision-affecting disease.

Results:

Surgical details: In 44 eyes (45,5%) the vitreous was completely attached and surgical PVD was performed. From those eyes, 61% received intraoperative laser or cryo therapy for either preexisting peripheral degeneration or intraoperative traction or tears. On the other hand 55 eyes (55,5%) had a preexisting PVD and only in 18% additional retinopexy was done.

Postoperative course: Three patients developed peripheral rhegmatogenous retinal detachment (RRD) that was fixed with coagulation therapy and gas. This complication did not affect visual outcomes. Another 2 patients complained of persistent vitreous opacities and asked for repeat vitrectomy. Intraoperatively, only peripheral vitreous remnants were detected and removed. No further complications were encountered. Subjective evaluation: 49% were highly satisfied, 37% felt happy and 7,5% noticed no improvement. Only 6,5% felt the situation had got worse, although VA had not changed.

Conclusions:

Complete vitrectomy for symptomatic floaters is highly appreciated by the patients and the vast majority is satisfied with the procedure. Especially for patients with minor floaters vitreous surgery is the only option that cures their symptoms. Those few being not happy after surgery had no complications nor had significant vitreous remnants, but possibly a supernormal visual perception. Intraoperatively, a careful inspection of the vitreous base is mandatory. The high rate of retinopexy-maneuvers of suspicious degenerative areas or retinal defects, particularly in cases that needed surgical PVD, certainly contributed to the low rate of postoperative RRDs. Compared to other treatment options for floaters, complete vitrectomy is a permanent solution of a problem and carries a low risk in the hands of experienced surgeons.

Contact Details:

Email: s.bopp@retina.to
Cell Phone: +491724102301

Silvia Bopp