Purpose:

To review the outcome of small gauge vitrectomy for symptomatic floaters and compare risks versus benefits.

Background:

Floaters can be a symptomatic condition due to partial liquefaction of vitreous gel or accumulation of opacities in vitreous. Patients may complain of a variety of visual symptoms, which can be potentially disabling. This phenomenon may or may not be associated with posterior vitreous detachment (PVD) which is either a spontaneous event or may be secondary to conditions such as cataract surgery, particularly when complicated with posterior capsular rupture, YAG laser posterior capsulotomy, posterior uveitis or endophthalmitis. Floaters may also be due to asteroid hyalosis. The majority of patients with asymptomatic floaters tend to diminish their complain with time due to adaptation by the brain to ignore the unwanted images. Some vitreous opacities can cause variable degree of obscuration of vision. These symptoms can be debilitating and interfere with visually demanding tasks involving higher degrees of concentration such as reading, driving, precision work etc.

Material and methods:

25 eyes of 22 patients with vitreous floaters were treated at Queen Elizabeth Hospital King Lynn UK and Optegra Eye Hospital London UK between August 2010 to October 2015. They underwent 23 gauge Pars Plana Vitrectomy (Oertli OS3, Alcon Constellation) using iBos or Biom viewing system, under sub-tenon anaesthesia. All patients had symptomatic floaters. Symptoms reported were shadows, black dots, floaters, cloud or cobweb like shadow. All subjects had significant debilitating symptoms and gave informed consent accepting the risks and benefits of vitrectomy. OCT was done on all cases to exclude macular pathology. There was no case with underlying serious co-pathology such as retinal vascular occlusion, severe diabetic retinopathy or macular degeneration. Some cases were pseudophakic. They were followed up 1 day, 1, 4, 12 and 24 weeks post-operatively.

Results:

All patients had symptomatic relief. Surgical complications were limited to post operative hypotony (1 patient) and cystoid macular edema (1 patient). There was no case of visual loss, retinal detachment, endophthalmitis or serious post op complication.

Conclusions:

Increasing awareness and high lifestyle expectation is encouraging more and more patients to seek treatment for visual floaters. It is therefore important for healthcare professionals to be equipped with necessary knowledge, required to guide patients on pros and cons of vitrectomy. Modern small gauge minimally invasive vitrectomy for floaters is a well-tolerated, safe and effective procedure to remove symptoms. Symptomatic patients are willing to take some risks to have their troublesome vitreous floaters removed, often resulting in an improvement in their vision and quality of life.

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