Save Sight Institute, The University of Sydney, Sydney, Australia.
Sydney Institute of Vision Science, Sydney, Australia.
Asia Pac J Ophthalmol (Phila). 2020 Mar-Apr;9(2):96-103. doi: 10.1097/APO.0000000000000276.
Vitreous floaters are a common cause for presentation to ophthalmologists, and may significantly affect visual function. In the absence of some more serious underlying pathology such as uveitis, many patients may not experience significant persistent visual impairment from floaters. For some patients, the symptomatic effects of floaters may persist. For these patients, treatment options are available, of which the most commonly reported is vitrectomy. Other treatment modalities have also become more common, notably YAG vitreolysis. Selection of appropriate patients for surgery is often difficult, in part due to the relative lack of objective outcomes with which to measure both visual impairment and improvement post-procedure. Although well-tolerated, vitrectomy does carry with it risks, including iatrogenic retinal breaks, retinal detachment, and in phakic patients, subsequent cataract formation. Techniques such as small gauge vitrectomy, intraoperative examination and treatment of breaks or other worrying lesions, and careful consideration of the need for posterior vitreous detachment induction may help limit the incidence of these adverse events. For other treatment options such as YAG vitreolysis, research and clinical experience remain more limited, and as such the long-term efficacy and risks of these therapies are still unclear. Here, we review the evidence surrounding the role of vitrectomy and YAG vitreolysis in the treatment of vitreous floaters and potential means to minimize therapeutic complications.
玻璃体浮游物是眼科就诊的常见原因，可能会显著影响视觉功能。在没有一些更严重的潜在疾病（如葡萄膜炎）的情况下，许多患者可能不会因浮游物而出现明显的持续性视力损害。对于一些患者，浮游物的症状影响可能会持续存在。对于这些患者，有治疗选择，其中最常报告的是玻璃体切除术。其他治疗方式也变得更加常见，尤其是 YAG 玻璃体切割术。选择合适的手术患者通常很困难，部分原因是缺乏客观的结果来衡量视觉损伤和术后改善。尽管玻璃体切除术耐受性良好，但它确实存在风险，包括医源性视网膜裂孔、视网膜脱离，以及在有晶状体患者中，随后发生白内障。一些技术，如小口径玻璃体切除术、术中检查和治疗裂孔或其他令人担忧的病变，以及仔细考虑是否需要后玻璃体脱离诱导，可能有助于降低这些不良事件的发生率。对于 YAG 玻璃体切割术等其他治疗选择，研究和临床经验仍然更为有限，因此这些治疗的长期疗效和风险仍不清楚。在这里，我们回顾了玻璃体切除术和 YAG 玻璃体切割术在治疗玻璃体浮游物中的作用的证据，并探讨了最小化治疗并发症的潜在方法。
