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. 2017 Jun 1;6(6):CD011676.
doi: 10.1002/14651858.CD011676.pub2.

Nd:YAG laser vitreolysis versus pars plana vitrectomy for vitreous floaters

Jan Kokavec  1 , Zhichao Wu, Justin C Sherwin, Alan Js Ang, Ghee Soon Ang
Affiliations

Nd:YAG laser vitreolysis versus pars plana vitrectomy for vitreous floaters

Jan Kokavec et al. Cochrane Database Syst Rev. .

Abstract

Background: The vitreous is the clear jelly of the eye and contains fine strands of proteins. Throughout life the composition of this vitreous changes, which causes the protein strands in it to bundle together and scatter light before it reaches the retina. Individuals perceive the shadows cast by these protein bundles as 'floaters'. Some people are so bothered by floaters that treatment is required to control their symptoms. Two major interventions for floaters include Nd:YAG laser vitreolysis and vitrectomy. Nd:YAG laser vitreolysis involves using laser energy to fragment the vitreous opacities via a non-invasive approach. Vitrectomy involves the surgical replacement of the patient's vitreous (including the symptomatic vitreous floaters) with an inert and translucent balanced salt solution, through small openings in the pars plana.

Objectives: To compare the effectiveness and safety of Nd:YAG laser vitreolysis to pars plana vitrectomy for symptomatic vitreous floaters.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), MEDLINE Ovid (1946 to 17 January 2017), Embase Ovid (1947 to 17 January 2017), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 17 January 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 17 January 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 17 January 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 17 January 2017. We did not use any date or language restrictions in the electronic searches for trials. We also searched conference proceedings to identify additional studies.

Selection criteria: We included only randomised controlled trials (RCTs) that compared Nd:YAG laser vitreolysis to pars plana vitrectomy for treatment of symptomatic floaters.

Data collection and analysis: We planned to use methods recommended by Cochrane. The primary outcome we planned to measure was change in vision-related quality of life from baseline to 12 months, as determined by a vision-related quality of life questionnaire. The secondary outcomes we planned to measure were best corrected logMAR or Snellen visual acuity at 12 months for the treated eye(s) and costs. Adverse outcomes we planned to record were the occurrence of sight-threatening complications by 12 months (asymptomatic retinal tears, symptomatic retinal tears, retinal detachment, cataract formation, and endophthalmitis).

Main results: No studies met the inclusion criteria of this review.

Authors' conclusions: There are currently no RCTs that compare Nd:YAG laser vitreolysis with pars plana vitrectomy for the treatment of symptomatic floaters. Properly designed RCTs are needed to evaluate the treatment outcomes from the interventions described. We recommend future studies randomise participants to either a Nd:YAG laser vitreolysis group or a vitrectomy group, with participants in each group assigned to either receive treatment or a sham intervention. Future studies should follow participants at six months and 12 months after the intervention. Also they should use best corrected visual acuity (BCVA) using an Early Treatment of Diabetic Retinopathy Study (ETDRS) chart read at 4 metres, vision-related quality of life (VRQOL), and adverse outcomes as the outcome measures of the trial.

PubMed Disclaimer

Conflict of interest statement

JK: none known. ZW: none known. JCS: none known. AKSA: none known. GSA: none known.

Figures

1
1
Study flow diagram.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD011676

References

References to studies excluded from this review

de Nie 2013 {published data only}
    1. Nie KF, Crama N, Tilanus MA, Klevering BJ, Boon CJ. Pars plana vitrectomy for disturbing primary vitreous floaters: clinical outcome and patient satisfaction. Graefe's Archive for Clinical and Experimental Ophthalmology 2013;251(5):1373‐82. - PubMed
Martínez‐Sanz 2009 {published data only}
    1. Martínez‐Sanz F, Velarde JI, Casuso P, Fernández‐Cotero JN. Surgical solution to vitreous floaters visual problem [Solucion quirurgica al problema visual de los cuerpos vitreos flotantes]. Archivos de la Sociedad Espanola de Oftalmologia 2009;84(5):259‐62. - PubMed
NCT01970267 {published data only}
    1. NCT01970267. Randomized trial of laser ablation for highly symptomatic floaters. clinicaltrials.gov/ct2/show/NCT01970267 (first received 22 October 2013).
NCT02812004 {published data only}
    1. NCT02812004. New horizons in the treatment of vitreous floaters (Ellex) [New horizons in the treatment of vitreous floaters: efficacy and safety of vitreolysis with the Ultra Q Reflex YAG laser (Ellex)]. clinicaltrials.gov/ct2/show/NCT02812004 (first received 17 June 2016).
NCT02897583 {published data only}
    1. NCT02897583. YAG vitreolysis for floaters [A prospective randomized controlled trial evaluating the safety and efficacy of YAG vitreolysis versus sham for symptomatic Weiss ring due to posterior vitreous detachment]. clinicaltrials.gov/ct2/show/NCT02897583 (first received 16 June 2016).
Ruiz‐Moreno 1998 {published data only}
    1. Ruiz‐Moreno J. Retinal detachment after vitreolysis with the Nd: YAG laser. Lasers and Light in Ophthalomology 1998;8:231‐4.
Schulz‐Key 2011 {published data only}
    1. Schulz‐Key S, Carlsson JO, Crafoord S. Longterm follow‐up of pars plana vitrectomy for vitreous floaters: complications, outcomes and patient satisfaction. Acta Ophthalmologica 2011;89(2):159‐65. - PubMed
Sebag 2014 {published data only}
    1. Sebag J, Yee KM, Wa CA, Huang LC, Sadun AA. Vitrectomy for floaters: prospective efficacy analyses and retrospective safety profile. Retina 2014;34(6):1062‐8. - PubMed
Toczołowski 1998 {published data only}
    1. Toczołowski J, Katski W. Use of Nd:YAG laser in treatment of vitreous floaters. Klinika Oczna 1998;100(3):155‐7. - PubMed

Additional references

Begg 1994
    1. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50(4):1088‐101. - PubMed
Bishop 2000
    1. Bishop PN. Structural macromolecules and supramolecular organisation of the vitreous gel. Progress in Retinal and Eye Research 2000;19(3):323‐44. - PubMed
de Boer 2004
    1. Boer MR, Moll AC, Vet HC, Terwee CB, Völker‐Dieben HJ, Rens GH. Psychometric properties of vision‐related quality of life questionnaires: a systematic review. Ophthalmic and Physiological Optics 2004;24(4):257‐73. - PubMed
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315(7109):629‐34. - PMC - PubMed
Glanville 2006
    1. Glanville JM, Lefebvre C, Miles JN, Camosso‐Stefinovic J. How to identify randomized controlled trials in MEDLINE: ten years on. Journal of the Medical Library Association 2006;94(2):130‐6. - PMC - PubMed
Guyatt 2002
    1. Guyatt GH, Osoba D, Wu AW, Wyrwich KW, Norman GR. Methods to explain the clinical significance of health status measures. Mayo Clinic Proceedings 2002;77(4):371‐83. - PubMed
Higgins 2002
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in Medicine 2002;21(11):1539‐58. - PubMed
Hikichi 1994
    1. Hikichi T, Trempe CL. Relationship between floaters, light flashes, or both, and complications of posterior vitreous detachment. American Journal of Ophthalmology 1994;117(5):593‐8. - PubMed
Hilford 2009
    1. Hilford D, Hilford M, Mathew A, Polkinghorne PJ. Posterior vitreous detachment following cataract surgery. Eye 2009;23(6):1388‐92. - PubMed
Jackson 2017
    1. Jackson TL, Verstraeten T, Duchateau L, Lescrauwaet B. Visual function response to ocriplasmin for the treatment of vitreomacular traction and macular hole. Acta Ophthalmologica 2017 Jan 30 [Epub ahead of print]. [DOI: 10.1111/aos.13369] - DOI - PMC - PubMed
Kwasniewska 2003
    1. Kwasniewska S. Some applications of the neodymium:YAG laser operating in the thermal and photodisruptive modes. Vitreolysis. In: Fankhauser F, Kwasniewska S editor(s). Lasers in Ophthalmology: Basic, Diagnostic, and Surgical Aspects: a Review. Amsterdam: Kugler Publications, 2003:403‐13.
Levin 2007
    1. Levin KA. Study design VII. Randomised controlled trials. Evidence‐Based Dentistry 2007;8(1):22–3. - PubMed
Mamou 2015
    1. Mamou J, Wa CA, Yee KM, Silverman RH, Ketterling JA, Sadun AA, et al. Ultrasound‐based quantification of vitreous floaters correlates with contrast sensitivity and quality of life. Investigative Ophthalmology & Visual Science 2015;56(3):1611‐7. - PMC - PubMed
Marella 2010
    1. Marella M, Pesudovs K, Keeffe JE, O'Connor PM, Rees G, Lamoureux EL. The psychometric validity of the NEI VFQ‐25 for use in a low‐vision population. Investigative Ophthalmology & Visual Science 2010;51(6):2878‐84. - PubMed
Mossa 2002
    1. Mossa F, Delaney YM, Rosen PH, Rahman R. Floaterectomy: combined phacoemulsification and deep anterior vitrectomy. Journal of Cataract and Refractive Surgery 2002;28(4):589‐92. - PubMed
Naik 2013
    1. Naik RK, Gries KS, Rentz AM, Kowalski JW, Revicki DA. Psychometric evaluation of the National Eye Institute Visual Function Questionnaire and Visual Function Questionnaire Utility Index in patients with non‐infectious intermediate and posterior uveitis. Quality of Life Research 2013;22(10):2801‐8. - PubMed
Oshima 2010
    1. Oshima Y, Wakabayashi T, Sato T, Ohji M, Tano Y. A 27‐gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology 2010;117(1):93‐102.e2. - PubMed
RevMan 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Roufail 2006
    1. Roufail ED, Polkinghorne P. Vitreous floaters. Comprehensive Ophthalmology Update 2006;7(4):171‐7. - PubMed
Sebag 2009
    1. Sebag J. Vitreous: the resplendent enigma. British Journal of Ophthalmology 2009;93(8):989‐91. - PubMed
Sebag 2011
    1. Sebag J. Floaters and the quality of life. American Journal of Ophthalmology 2011;152(1):3‐4.e1. - PubMed
Sendrowski 2010
    1. Sendrowski DP, Bronstein MA. Current treatment for vitreous floaters. Optometry 2010;81(3):157‐61. - PubMed
Spandau 2012
    1. Spandau U, Heimann H. Practical Handbook for Small‐Gauge Vitrectomy: A Step‐By‐Step Introduction to Surgical Techniques. Berlin‐Heidelberg: Springer‐Verlag, 2012.
Vandorselaer 2001
    1. Vandorselaer T, Velde F, Tassignon MJ. Eligibility criteria for Nd‐YAG laser treatment of highly symptomatic vitreous floaters. Bulletin de la Societe Belge d'Ophtalmologie 2001;280:15‐9. - PubMed
Wagle 2011
    1. Wagle AM, Lim WY, Yap TP, Neelam K, Au Eong KG. Utility values associated with vitreous floaters. American Journal of Ophthalmology 2011;152(1):60‐5.e1. - PubMed
Wyrwich 1999
    1. Wyrwich KW, Tierney WM, Wolinsky FD. Further evidence supporting an SEM‐based criterion for identifying meaningful intra‐individual changes in health‐related quality of life. Journal of Clinical Epidemiology 1999;52(9):861‐73. - PubMed
Yanoff 2008
    1. Yanoff M, Duker JS. Ophthalmology. 3rd Edition. St Louis: Mosby Elsevier, 2008.

References to other published versions of this review

Kokavec 2015
    1. Kokavec J, Wu Z, Sherwin JC, Ang AJS, Ang G. Laser or vitrectomy for vitreous floaters. Cochrane Database of Systematic Reviews 2015, Issue 4. [DOI: 10.1002/14651858.CD011676] - DOI - PMC - PubMed

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