VMR Institute for Vitreous Macula Retina, Huntington Beach, California.
Doheny Eye Institute, UCLA, Pasadena, California.
Retina. 2023 Jul 1;43(7):1114-1121. doi: 10.1097/IAE.0000000000003781.
Limited vitrectomy improves vision degrading myodesopsia, but the incidence of recurrent floaters postoperatively is not known. We studied patients with recurrent central floaters using ultrasonography and contrast sensitivity (CS) testing to characterize this subgroup and identify the clinical profile of patients at risk of recurrent floaters.
A total of 286 eyes (203 patients, 60.6 ± 12.9 years) undergoing limited vitrectomy for vision degrading myodesopsia were studied retrospectively. Sutureless 25G vitrectomy was performed without intentional surgical posterior vitreous detachment (PVD) induction. CS (Freiburg Acuity Contrast test: Weber index, %W) and vitreous echodensity (quantitative ultrasonography) were assessed prospectively.
No eyes (0/179) with preoperative PVD experienced new floaters. Recurrent central floaters occurred in 14/99 eyes (14.1%) without complete preoperative PVD (mean follow-up = 39 months vs. 31 months in 85 eyes without recurrent floaters). Ultrasonography identified new-onset PVD in all 14 (100%) recurrent cases. Young (younger than 52 years; 71.4%), myopic (≥-3D; 85.7%), phakic (100%) men (92.9%) predominated. Reoperation was elected by 11 patients, who had partial PVD preoperatively in 5/11 (45.5%). At study entry, CS was degraded (3.55 ± 1.79 %W) but improved postoperatively by 45.6% (1.93 ± 0.86 %W, P = 0.033), while vitreous echodensity reduced by 86.6% ( P = 0.016). New-onset PVD postoperatively degraded CS anew, by 49.4% (3.28 ± 0.96 %W; P = 0.009) in patients electing reoperation. Repeat vitrectomy normalized CS to 2.00 ± 0.74%W ( P = 0.018).
Recurrent floaters after limited vitrectomy for vision degrading myodesopsia are caused by new-onset PVD, with younger age, male sex, myopia, and phakic status as risk factors. Inducing surgical PVD at the primary operation should be considered in these select patients to mitigate recurrent floaters.
有限玻璃体切除术可改善视力下降性眼球震颤，但术后复发性飞蚊症的发生率尚不清楚。我们通过超声检查和对比敏感度（CS）测试研究了复发性中央飞蚊症患者，以描述这一亚组并确定有发生复发性飞蚊症风险的患者的临床特征。
回顾性分析了 286 只眼（203 例患者，60.6±12.9 岁）接受有限玻璃体切除术治疗视力下降性眼球震颤。采用无缝线 25G 玻璃体切除术，不进行有目的的手术性后玻璃体脱离（PVD）诱导。前瞻性评估 CS（弗里堡视力敏锐度对比试验：韦伯指数，%W）和玻璃体回声密度（定量超声）。
术前 PVD 的 179 只眼中无 1 只（0/179）出现新的飞蚊症。14/99 只（14.1%）术前无完全 PVD 的眼中出现复发性中央飞蚊症（平均随访时间为 39 个月，而 85 只无复发性飞蚊症眼中的随访时间为 31 个月）。在所有 14 例复发性病例中（100%），超声检查均发现新出现的 PVD。年轻（<52 岁；71.4%）、近视（≥-3D；85.7%）、远视（100%）、男性（92.9%）为主。11 例患者选择再次手术，其中 5 例（45.5%）术前有部分 PVD。研究开始时，CS 降低（3.55±1.79%W），但术后通过手术提高了 45.6%（1.93±0.86%W，P=0.033），而玻璃体回声密度降低了 86.6%（P=0.016）。在选择再次手术的患者中，术后新发生的 PVD 使 CS 再次下降 49.4%（3.28±0.96%W；P=0.009）。再次玻璃体切除术将 CS 恢复至 2.00±0.74%W（P=0.018）。
有限玻璃体切除术治疗视力下降性眼球震颤后复发性飞蚊症是由新发生的 PVD 引起的，年龄较小、男性、近视和有晶状体眼是危险因素。在这些选择的患者中，应在初次手术时考虑诱导手术性 PVD，以减轻复发性飞蚊症。
