Introduction
Vitreolysis is a pain-free and non-invasive laser technique used to treat visual anomalies caused by floaters. They are cobwebs, threads, cloud-like images, or specks that at times drift across a patient's field of vision. Floaters are the most common visual complaint, especially in people over the age of 60 years.
In most cases, floaters are collagen clumps drifting in the vitreous, the gel-like fluid that fills the eyeball. Collagen is a vitreous ingredient, and as people age, the gel gradually liquefies and shrinks. It causes the sac housing the vitreous gel to separate from the inner back wall of the eyeball. Some collagen breaks or clumps into pieces and floats in the fluid, casting a shadow on the retina, which affects vision.
The procedure aims at improving vision by eliminating the hindrance or disturbance of floaters. It involves the application laser beam to cut the vitreous strands and evaporate the vitreous opacities. The collagen and hyaluronan molecules are converted into a gas, which removes or reduces the floaters' size and improves vision.
Also Known As
- Laser vitreolysis
- Floater laser removal
Before the Procedure
The eye surgeon will take the complete patient's medical and surgical history. The patient should explain how floaters affect their vision and daily activities. S/he will also conduct a thorough eye examination, including a slit-lamp evaluation, fundoscopy and imaging tests, such as ocular computerized tomography (OCT) and ultrasound scans. It helps him/her to determine whether vitreolysis is a suitable treatment option.
Vitreolysis is recommended for patients over 45, especially in cases where the symptoms have persisted for over four months, the floaters are large with a soft border and located away from the retina. The patient should not have severe eye disorders, such as retinal detachments or tears, cataracts, corneal clouding that impairs vitreous visualization, etc.
The patient should come with someone or arrange to be driven home after the surgery.
Procedure
Vitreolysis is an outpatient procedure performed in an eye surgeon's office or an outpatient surgery center under topical or local anesthesia. The surgeon will conduct pre-surgery tests and apply anesthetic eye drops or administer an injection to numb the patient's eye. S/he will then place a device on the patient's eye to keep it open and use a treatment lens to direct the laser beam on the floating material.
During the treatment, the patient may notice small, dark shadows/specks as the floaters are vaporized, and the small gas bubbles dissolve and are reabsorbed into the vitreous. Typically, each treatment session takes 20 to 60 minutes. After the procedure, the surgeon measures the eye pressure and examines the internal eye structures before releasing the patient to go home. S/he may apply eye drop medication to prevent inflammation and an increase in eye pressure.
In most cases, the patient needs to undergo two to three treatment sessions for a satisfactory outcome.
Risks & Complications
Risks associated with vitreolysis are rare and include:
- Retinal tear
- Retinal hemorrhage
- Retinal detachment
- Increased quantity of floaters
The patient may experience mild discomfort, increased sensitivity to light, redness, or blurred temporary following treatment. They may also see tiny, dark specks in the lower field of vision soon after the operation caused by gas bubbles, which rapidly dissolve.
Vitreolysis complications may arise sporadically, with the most common being cataract formation and glaucoma.
After Care & Recovery
The patient has to see the doctor the day after the procedure for a follow-up eye exam and pressure check. S/he will provide a follow-up schedule depending on the condition of the patient. Usually, the patient returns after a week for eye pressure checks and monitoring eye examination.
Outcome
Studies indicate that vitreolysis is a safe and effective floater treatment in most cases. However, if the condition persists, the doctor may recommend other treatments, such as surgical vitrectomy.
