THERAPEUTIC REFRACTIVE VITRECTOMY FOR THE MANAGEMENT OF VITREOUS FLOATERS AND OPACITIES ASSESSED BY THE STANDARDIZED AND KINETIC ANATOMICAL AND FUNCTIONAL TESTING OF VITREOUS FLOATERS AND OPACITIES

Abstract

Purpose: Propose new terminology and evaluate the effectiveness of therapeutic refractive vitrectomy (TRV) for selective removal of vitreous floaters and opacities using Standardized Kinetic Anatomical Functional Testing of Vitreous Floaters and Opacities and new ultra widefield optical coherence tomography imaging techniques.

Methods: Retrospective analysis. Twenty eyes underwent therapeutic refractive vitrectomy for symptomatic vitreous floaters and opacities. Pre-TRV assessments/post-TRV assessments: Standardized and Kinetic Anatomical and Functional Testing of Vitreous Floaters and Opacities, including straylight measurements (HD Analyzer, Light Disturbance Analyzer, C-Quant) alongside noncontact imaging including a new ultra widefield optical coherence tomography to evaluate changes in vitreous anatomical and optical properties.

Results: Post-TRV evaluations indicated objective changes in vitreous optical properties and subjective measures. Reduced straylight measurements: HD Analyzer 22%, light disturbance analyzer 54.4% ( P = 0.013), and C-Quant 7.8% ( P = 0.034). Patient-reported outcomes statistically significantly improved ( P = 0.022). Corrected distance visual acuity changes were marginal. New ultra widefield 26 mm by 12 mm imaging window optical coherence tomography facilitated detailed vitreous imaging, confirming the status of posterior vitreous detachment (100%). Post-TRV ultra widefield and optical coherence tomography imaging demonstrated restoration of vitreous clarity, confirmed the presence of residual cortical vitreous and absence of new posterior vitreous detachments.

Conclusion: Therapeutic refractive vitrectomy is a significant contribution for therapeutic refractive surgery as a safe and effective approach to enhancing visual quality, correcting refractive and opaque vitreous anomalies. Improvement in corrected distance visual acuity was minimal, representing limited effectiveness as a measure of comprehensive visual function. Improvements in objective straylight measures and imaging are in alignment with subjective symptom improvements post-TRV. This underscores the utility and value of new holistic evaluation methods beyond traditional metrics to assess the impact of therapeutic refractive vitrectomy on visual function and quality of life.

Keywords: C-Quant; Dream OCT; HD analyzer; Heidelberg Engineering Ltd; Intalight; Nd:YAG vitreolysis; SK VFO test; VFO; core; diagnostic methodology; imaging; infrared confocal SLO; kinetic; laser; light disturbance analyzer; light scattering; limited; myopic vitreopathy; opacities; optical coherence tomography; optomap; optos; posterior vitreous detachment; quality of vision; refractive; refractive surgery; selective; spectralis; standardized; straylight; therapeutic refractive surgery; therapeutic refractive vitrectomy; vitrectomy; vitreous; vitreous floaters.