Clinical Management of Vision Degrading Myodesopsia from Vitreous Floaters - Observation vs. Limited Refractive Vitrectomy.
Academic Article
Overview
abstract
PURPOSE: To manage clinically significant vitreous floaters, called vision degrading myodesopsia, using objective quantification of vitreous structure and visual function, in order to distinguish cases that can be observed (OBS) from those that merit surgery, and define the profile of OBS patients. DESIGN: Retrospective non-randomized interventional clinical study. SUBJECTS: There were 651 eyes in 393 patients (220 men, 173 women; aged 57.3±14.7 years) with the chief complaint of floaters. Etiologies were posterior vitreous detachment (PVD; 252/651, 38.7%), myopic vitreopathy (MV; 133/651, 20.4%), and combined PVD+MV (210/651, 32.3%). Follow-up = 23.9 ± 29.0 months. METHODS: Observation alone was performed in 362 cases. Sutureless 25-gauge limited refractive vitrectomy (LRV) without surgical PVD was performed in 289 eyes. MAIN OUTCOME MEASURES: Vitreous echodensity was measured by quantitative ultrasonography, contrast sensitivity (CS) with Freiburg Acuity Contrast Testing (%W); patient reported outcomes with NEI Visual Function Questionnaire (VFQ-25). RESULTS: OBS was chosen in 362/651 (55.6%; mean age 55.0 years), and LRV was elected in 289/651 (44.4%; mean age 60.1 years). OBS cases had 43.7% less vitreous echodensity (688 ± 170 AU vs. 1222 ± 356 AU; p<0.0001), 35.7% better CS (2.90±1.33 %W vs. 4.51±1.56 %W; p<0.0001), and better VFQ-25 (79.2±6.0 vs. 77.2±5.2; p<0.01). Subjects initially choosing OBS who converted to surgery >1 year later had comparable CS to the OBS group at study entry, which worsened prior to electing LRV. Post-operatively, echodensity decreased by 59.6% (to 494±64 AU, p<0.0001), CS improved by 45.7% (to 2.45±1.12%W, p<0.0001), and VFQ-25 improved by 6.3% (to 82.0±9.0, p<0.0001). Sequelae of LRV included vitreous hemorrhage (0.7%), retinal tears (2.8%), retinal detachment (2.4%), macular pucker surgery (1.4%), recurrent floaters (5.2%), and cataract surgery [35.8%; average age = 62.7±6.7years, 23.7±25.7 months post-vitrectomy; below age 50 only 3/37 (8.1%) underwent cataract surgery (follow-up = 28.9±35 months)]. CONCLUSIONS: Patients with vision degrading myodesopsia from vitreous floaters can be managed by observation or vitrectomy. Objective quantitative measures of vitreous echodensity and contrast sensitivity aid patient selection for observation. These patients were younger and phakic, had floaters from myopic vitreopathy without PVD, and had less vitreous echodensity, as well as better contrast sensitivity.
