Vitreous floaters: Etiology, diagnostics, and management.
Milston Rebecca,Madigan Michele C,Sebag J
Survey of ophthalmology
Vitreous is a hydrated extracellular matrix comprised primarily of water, collagens, and hyaluronan organized into a homogeneously transparent gel. Gel liquefaction results from molecular alterations with dissociation of collagen from hyaluronan and aggregation of collagen fibrils forming fibers that cause light scattering and hence symptomatic floaters, especially in myopia. With aging, gel liquefaction and weakened vitreoretinal adhesion result in posterior vitreous detachment, the most common cause of primary symptomatic floaters arising from the dense collagen matrix of the posterior vitreous cortex. Recent studies indicate that symptomatic floaters are not only more prevalent, but also have a negative impact on the quality of life that is greater than previously appreciated. We review the literature concerning management of symptomatic vitreous floaters, currently either with observation, vitrectomy, or Nd:YAG laser. Published evidence is consistent with a low-risk profile and excellent success rate for floater vitrectomy, particularly with sutureless small gauge instruments and a limited core vitrectomy without PVD induction. Nd:YAG laser treatment of floaters, reported less commonly, claims resolution of floaters ranging between 0% and 100%; however, both peer-reviewed literature and assertions on web-based nonpeer-reviewed laser vitreolysis sites remain to be substantiated, and at present only vitrectomy has proven value. Prospective studies using objective, quantitative outcome measures are required to assess the relative efficacy and safety of these two procedures as well as new therapies such as pharmacologic vitreolysis.
The Incidence and Risk Factors of Lens-iris Diaphragm Retropulsion Syndrome during Phacoemulsification.
Lim Dong Hui,Shin Dong Hoon,Han Gyule,Chung Eui Sang,Chung Tae Young
Korean journal of ophthalmology : KJO
PURPOSE:In the present study, the incidence and risk factors of lens-iris diaphragm retropulsion syndrome (LIDRS) were evaluated. METHODS:Patients who underwent cataract surgery using phacoemulsification between June 2014 and December 2014 were included in the study. The preoperative ocular biometric and intraoperative surgical parameters were examined. The incidence of LIDRS and various risk factors were analyzed using an independent t-test, Pearson's chi-square test, and univariable and multivariable logistic regression analyses. RESULTS:Among 124 eyes of 124 patients, 100 (80.6%) had no LIDRS and 24 (19.4%) had LIDRS. LIDRS occurred in 13 of 31 vitrectomized eyes (41.9%) and 11 of 93 non-vitrectomized eyes (11.8%). Based on univariable analysis, age (odds ratio [OR], 0.920; p = 0.001), vitrectomized eye (OR, 5.038; p = 0.001), spherical equivalent (OR, 0.778; p < 0.001), axial length (OR, 1.716; p < 0.001), anterior chamber depth (OR, 3.328; p = 0.037), and 3.0 mm vs. 2.2 mm incision size (OR, 4.964; p = 0.001) were statistically significant risk factors associated with the development of LIDRS. Conditional multivariable logistic regression showed that vitrectomized eye (OR, 3.865; 95% confidence interval [CI], 1.201 to 12.436; p = 0.023), long axial length (OR, 1.709; 95% CI, 1.264 to 2.310; p = 0.001), and 3.0 vs. 2.2 mm incision size (OR, 3.571; 95% CI, 1.120 to 11.393; p = 0.031) were significant independent risk factors associated with LIDRS. CONCLUSIONS:LIDRS is a relatively common occurrence and was found to be associated with vitrectomized eye, long axial length, and larger incision size. Evaluating risk factors prior to cataract surgery can help reduce associated morbidity.
Anterior vitreous detachment: risk factor for intraoperative complications during phacoemulsification.
Anisimova Natalia S,Arbisser Lisa B,Shilova Natalya F,Melnik Maria A,Belodedova Alexandra V,Knyazer Boris,Malyugin Boris E
Journal of cataract and refractive surgery
PURPOSE:To confirm the presence of incomplete vitreolenticular adhesion via microscope-integrated intraoperative optical coherence tomography (iOCT) during cataract surgery and via diagnostic spectral-domain OCT (SD-OCT) postoperatively. SETTING:S. Fyodorov Eye Microsurgery Complex State Institution, Moscow, Russia. DESIGN:Prospective noninterventional single-center study. METHODS:Clinical characteristics and surgical videos of 27 patients (28 eyes) who had cataract surgery were documented. Real-time iOCT integrated into the surgical microscope was directed to view the retrolenticular anatomy at the end of the surgery. Postoperatively, SD-OCT was also performed. RESULTS:This study comprised 28 eyes of 27 patients. Berger space was identified in 21 cases (75%) intraoperatively via iOCT and in 23 cases (82%) postoperatively via stationary OCT. Depth dimensions varied from 33.5 ± 87.0 μm to 383.1 ± 226.3 μm. Hyperreflective dots and particles of different shapes and sizes were documented within Berger space in 16 cases (57%) intraoperatively and in 9 cases (32%) postoperatively. Capsular rupture occurred in 1 case due to excessive posterior capsular movement anteriorly. The posterior capsular rupture was converted into a posterior capsulorhexis, leaving the anterior hyaloid membrane intact. CONCLUSIONS:iOCT confirmed the penetration of crystalline lens microfragments, cellular material, or medical suspension (triamcinolone) into the space between the posterior lens capsule and the anterior hyaloid membrane. This occurs due to discontinuity of both lenticular zonules and Wieger ligament attachment. A Wieger ligament rupture can also allow excessive Berger space hydration during phacoemulsification leading to anterior displacement of the posterior lens capsule increasing the risk of instrument touch and posterior capsule rupture.