Sebag Jerry, Yee Kenneth M P, Wa Christianne A, Huang Laura C, Sadun Alfredo A
*VMR Institute, Huntington Beach, California; †Doheny Eye Institute, Los Angeles, California; and ‡University of Miami School of Medicine, Miami, Florida.
Retina. 2014 Jun;34(6):1062-8. doi: 10.1097/IAE.0000000000000065.
Floaters impact vision but the mechanism is unknown. We hypothesize that floaters reduce contrast sensitivity function, which can be normalized by vitrectomy, and that minimally invasive vitrectomy will have lower incidences of retinal tears (reported at 30%) and cataracts (50-76%).
Seventy-six eyes (34 phakic) with floaters were evaluated in 2 separate studies. Floater etiologies were primarily posterior vitreous detachment in 61 of 76 eyes (80%) and myopic vitreopathy in 24 of 76 eyes (32%). Minimally invasive 25G vitrectomy was performed without posterior vitreous detachment induction, leaving anterior vitreous, and using nonhollow probes for cannula extraction. Efficacy was studied prospectively (up to 9 months) in 16 floater cases with Freiburg Acuity Contrast Testing (Weber index [%W] reproducibility = 92.1%) and the National Eye Institute Visual Function Questionnaire. Safety was separately evaluated in 60 other cases followed up on an average of 17.5 months (range, 3-51 months).
Floater eyes had 67% contrast sensitivity function attenuation (4.0 ± 2.3 %W; control subjects = 2.4 ± 0.9 %W, P < 0.013). After vitrectomy, contrast sensitivity function normalized in each case at 1 week (2.0 ± 1.4 %W, P < 0.01) and remained normal at 1 month (2.0 ± 1.0 %W, P < 0.003) and 3 months to 9 months (2.2 ± 1.5 %W, P < 0.018). Visual Function Questionnaire was 28.3% lower in floater patients (73.2 ± 15.6, N = 16) than in age-matched control subjects (93.9 ± 8.0, N = 12, P < 0.001), and postoperatively improved by 29.2% (P < 0.001). In the safety study of 60 floater cases treated with vitrectomy, none developed retinal breaks, infection, or glaucoma after a mean follow-up of 17.5 months. Only 8 of 34 cases (23.5%) required cataract surgery (none younger than 53 years) at an average of 15 months postvitrectomy.
Floaters lower contrast sensitivity function, which normalizes after vitrectomy. Visual Function Questionnaire quantified improvement in satisfaction. Not inducing posterior vitreous detachment reduced retinal tear incidence from 30% to 0% (P < 0.007). Postvitrectomy cataract incidence was reduced from 50% to 23.5% (P < 0.02). This approach thus seems effective and safe in alleviating the visual dysfunction induced by floaters.
飞蚊症影响视力，但其机制尚不清楚。我们假设飞蚊症会降低对比敏感度功能，而玻璃体切割术可使其恢复正常，并且微创玻璃体切割术导致视网膜裂孔（报道发生率为30%）和白内障（50 - 76%）的发生率会更低。
在两项独立研究中对76只患有飞蚊症的眼睛（34只眼有晶状体）进行了评估。76只眼中，61只眼（80%）的飞蚊症病因主要为玻璃体后脱离，24只眼（32%）为近视性玻璃体病变。采用微创25G玻璃体切割术，不进行玻璃体后脱离诱导，保留前部玻璃体，并使用非空心探头进行套管拔出。对16例飞蚊症患者进行前瞻性研究（长达9个月），采用弗莱堡视力对比测试（韦伯指数[W%]重复性 = 92.1%）和美国国立眼科研究所视觉功能问卷。在另外60例患者中分别评估安全性，平均随访17.5个月（范围3 - 51个月）。
有飞蚊症的眼睛对比敏感度功能衰减67%（4.0 ± 2.3%W；对照组 = 2.4 ± 0.9%W，P < 0.013）。玻璃体切割术后，对比敏感度功能在1周时恢复正常（2.0 ± 1.4%W，P < 0.01），1个月时（2.0 ± 1.0%W，P < 0.003）及3个月至9个月时（2.2 ± 1.5%W，P < 0.018）均保持正常。飞蚊症患者的视觉功能问卷得分比年龄匹配的对照组低28.3%（73.2 ± 15.6，N = 16），而术后提高了29.2%（P < 0.001）。在对60例接受玻璃体切割术治疗的飞蚊症患者的安全性研究中，平均随访17.5个月后，无一例发生视网膜裂孔、感染或青光眼。34例患者中只有8例（23.5%）在玻璃体切割术后平均15个月需要进行白内障手术（均不小于53岁）。
飞蚊症会降低对比敏感度功能，玻璃体切割术后可恢复正常。视觉功能问卷量化了满意度的改善情况。不诱导玻璃体后脱离使视网膜裂孔发生率从30%降至0%（P < 0.007）。玻璃体切割术后白内障发生率从50%降至23.5%（P < 0.02）。因此，这种方法在缓解飞蚊症引起的视觉功能障碍方面似乎有效且安全。
