VMR Institute for Vitreous Macula Retina, Huntington Beach, California.
Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
Ophthalmology. 2019 Nov;126(11):1517-1526. doi: 10.1016/j.ophtha.2019.06.021. Epub 2019 Jun 22.
Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser treatment is performed on vitreous floaters, but studies of structural and functional effects with objective outcome measures are lacking. This study evaluated Nd:YAG laser effects by comparing participants with vitreous floaters who previously underwent laser treatment with untreated control participants and healthy persons without vitreous floaters using quantitative ultrasonography to evaluate vitreous structure and by measuring visual acuity and contrast sensitivity function to assess vision.
Retrospective, comparative study.
One eye was enrolled for each of 132 participants: 35 control participants without vitreous floaters, 59 participants with untreated vitreous floaters, and 38 participants with vitreous floaters previously Nd:YAG-treated. Of these, 25 were dissatisfied and sought vitrectomy; 13 were satisfied with observation.
The 39-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-39) to assess participant visual well-being, quantitative ultrasonography (QUS) to measure vitreous echodensity, and best-corrected visual acuity (BCVA) and contrast sensitivity function (CSF) to evaluate vision.
Results of NEI-VFQ-39, QUS, BCVA, and CSF.
Compared with control participants without vitreous floaters, participants with untreated vitreous floaters showed worse NEI-VFQ-39 results, 57% greater vitreous echodensity, and significant (130%) CSF degradation (P < 0.001 for each). Compared with untreated eyes with vitreous floaters, Nd:YAG-treated eyes had 23% less vitreous echodensity (P < 0.001), but no differences in NEI-VFQ-39 (P = 0.51), BCVA (P = 0.42), and CSF (P = 0.17) results. Of 38 participants with vitreous floaters who previously were treated with Nd:YAG, 25 were dissatisfied and seeking vitrectomy, whereas 13 were satisfied with observation. Participants seeking vitrectomy showed 24% greater vitreous echodensity (P = 0.018) and 52% worse CSF (P = 0.006). Multivariate linear regression models confirmed these findings.
As a group, participants previously treated with Nd:YAG laser for bothersome vitreous floaters showed less dense vitreous, but similar visual function as untreated control participants with vitreous floaters. Because some treated eyes showed less dense vitreous and better visual function than those of untreated control participants, a prospective randomized study of Nd:YAG laser treatment of vitreous is warranted, using uniform laser treatment parameters and objective quantitative outcome measures.
钕：钇铝石榴石（Nd：YAG）激光用于治疗玻璃体浮游物，但缺乏使用客观结果测量来评估结构和功能效果的研究。本研究通过比较先前接受 Nd：YAG 激光治疗的玻璃体浮游物患者与未治疗的对照组参与者和无玻璃体浮游物的健康人，使用定量超声评估玻璃体结构，并测量视力和对比敏感度功能，以评估视力，评估 Nd：YAG 激光的效果。
回顾性、比较性研究。
共有 132 名参与者的一只眼被纳入研究：35 名无玻璃体浮游物的对照组参与者、59 名未治疗的玻璃体浮游物参与者和 38 名先前接受 Nd：YAG 激光治疗的玻璃体浮游物参与者。其中，25 名不满意并寻求玻璃体切除术；13 名满意观察。
使用美国国立眼科研究所视觉功能问卷（NEI-VFQ-39）评估参与者的视觉幸福感，使用定量超声（QUS）测量玻璃体回声密度，并使用最佳矫正视力（BCVA）和对比敏感度功能（CSF）评估视力。
NEI-VFQ-39、QUS、BCVA 和 CSF 的结果。
与无玻璃体浮游物的对照组参与者相比，未治疗的玻璃体浮游物患者的 NEI-VFQ-39 结果更差，玻璃体回声密度增加 57%，CSF 显著下降（每项均为 P <0.001）。与未治疗的玻璃体浮游物眼相比，Nd：YAG 治疗眼的玻璃体回声密度降低 23%（P <0.001），但 NEI-VFQ-39（P=0.51）、BCVA（P=0.42）和 CSF（P=0.17）结果无差异。在 38 名先前接受 Nd：YAG 激光治疗的玻璃体浮游物患者中，25 名不满意并寻求玻璃体切除术，而 13 名满意观察。寻求玻璃体切除术的患者玻璃体回声密度增加 24%（P=0.018），CSF 下降 52%（P=0.006）。多变量线性回归模型证实了这些发现。
作为一个整体，先前因恼人的玻璃体浮游物而接受 Nd：YAG 激光治疗的患者玻璃体密度较低，但与有玻璃体浮游物的未治疗对照组参与者的视觉功能相似。由于一些治疗眼的玻璃体密度低于未治疗的对照组参与者，并且视觉功能更好，因此需要使用统一的激光治疗参数和客观的定量结果测量方法，对 Nd：YAG 激光治疗玻璃体进行前瞻性随机研究。
