Recurrent Floaters Following Limited Vitrectomy for Vision Degrading Myodesopsia.
Academic Article
Overview
abstract
PURPOSE: Limited vitrectomy improves vision degrading myodesopsia (VDM), but the incidence of recurrent floaters post-operatively is not known. We studied patients with recurrent central floaters using ultrasonography and contrast sensitivity (CS) testing to characterize this subgroup and identify the clinical profile of patients at risk of recurrent floaters. METHODS: 286 eyes (203 patients, 60.6±12.9 years old) undergoing limited vitrectomy for VDM were studied retrospectively. Sutureless 25G vitrectomy was performed without intentional surgical PVD induction. CS (Freiburg Acuity Contrast Test: Weber Index, %W) and vitreous echodensity (quantitative ultrasonography) were assessed prospectively. RESULTS: No eyes (0/179) with pre-operative PVD experienced new floaters. Recurrent central floaters occurred in 14/99 (14.1%) without complete pre-operative PVD (mean follow-up = 39 months vs. 31 months in the 85 without recurrent floaters). Ultrasonography identified new-onset PVD in all 14 (100%) recurrent cases. Young (<52 years; 71.4%), myopic (≥-3D; 85.7%), phakic (100%) males (92.9%) predominated. Re-operation was elected by 11 patients, who had partial PVD pre-operatively in 5/11 (45.5%). At study entry, CS was degraded (3.55±1.79%W) but improved post-operatively by 45.6% (1.93±0.86 %W, p = 0.033), while vitreous echodensity reduced by 86.6% (p = 0.016). New-onset PVD post-operatively degraded CS anew, by 49.4% (3.28±0.96%W; p=0.009) in patients electing re-operation. Repeat vitrectomy normalized CS to 2.00±0.74%W (p=0.018). CONCLUSION: Recurrent floaters following limited vitrectomy for VDM are caused by new-onset PVD, with younger age, male gender, myopia, and phakic status as risk factors. Inducing surgical PVD at the primary operation should be considered in these select patients to mitigate recurrent floaters.
