Jiang Shangjun, Golding John, Choudhry Netan
Section of Ophthalmology, Department of Surgery, Cumming School of Medicine, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada.
Vitreous Retina Macula Specialists of Toronto, 3280 Bloor Street West, Suite 310, Etobicoke, ON, M8X 2X3, Canada.
Int Ophthalmol. 2023 Oct;43(10):3587-3594. doi: 10.1007/s10792-023-02765-4. Epub 2023 Jul 4.
To demonstrate the methodology and efficacy of using scanning laser ophthalmoscopy (SLO) and dynamic optical coherence tomography (OCT) to identify and treat symptomatic vitreous floaters using yttrium-aluminum garnet laser vitreolysis (YLV).
This is a case series highlighted from a cross sectional retrospective study conducted at the Vitreous Retina Macula Specialists of Toronto. Forty eyes from thirty-five patients were treated with YLV between November 2018 and December 2020 for symptomatic floaters and imaged with SLO and dynamic OCT. Patients were re-treated with YLV if they reported ongoing significant vision symptoms during follow-up which correlated to visible opacities on exam and or imaging. Three cases will be highlighted to present the practical applications of SLO and dynamic OCT imaging for YLV treatment.
Forty treated eyes were enrolled in this study, with twenty-six eyes (65%) requiring at least one repeat YLV treatment following the first treatment due to ongoing symptomatic floaters. Following the first YLV, there was a significant improvement in overall mean best corrected visual acuity compared to before treatment (0.11 ± 0.20 LogMAR units vs. 0.14 ± 0.20 LogMAR units, p = 0.02 (paired t test)). Case 1 demonstrates a dense, solitary vitreous opacity that has been localized with dynamic OCT imaging to track its movements and retinal shadowing with the patient's eye movements. Case 2 shows the utility of adjusting the fixation target to monitor the movement of vitreous opacities in real-time. Case 3 exhibits an association between decreased symptom burden and vitreous opacity density after YLV.
Image-guided YLV facilitates the localization and confirmation of vitreous opacities. SLO and dynamic OCT of the vitreous can provide a real-time evaluation of floater size, movement, and morphology, to help clinicians target treatment and monitoring of symptomatic floaters.
展示使用扫描激光检眼镜（SLO）和动态光学相干断层扫描（OCT），通过钇铝石榴石激光玻璃体溶解术（YLV）识别和治疗有症状的玻璃体混浊的方法及疗效。
这是一个病例系列，来自于在多伦多玻璃体视网膜黄斑专科医生处进行的横断面回顾性研究。2018年11月至2020年12月期间，对35例患者的40只眼睛进行了YLV治疗以消除有症状的飞蚊症，并使用SLO和动态OCT进行成像。如果患者在随访期间报告持续存在严重的视觉症状，且与检查和/或成像中可见的混浊相关，则再次接受YLV治疗。将重点介绍3个病例，以展示SLO和动态OCT成像在YLV治疗中的实际应用。
本研究纳入了40只接受治疗的眼睛，其中26只眼睛（65%）由于持续存在有症状的飞蚊症，在首次治疗后至少需要进行一次重复YLV治疗。与治疗前相比，首次YLV治疗后，总体平均最佳矫正视力有显著改善（0.11±0.20 LogMAR单位对0.14±0.20 LogMAR单位，p = 0.02（配对t检验））。病例1展示了一个致密的孤立性玻璃体混浊，通过动态OCT成像对其进行定位，以跟踪其运动以及随着患者眼球运动产生的视网膜阴影。病例2显示了调整注视目标以实时监测玻璃体混浊运动的效用。病例3展示了YLV治疗后症状负担减轻与玻璃体混浊密度之间的关联。
图像引导的YLV有助于玻璃体混浊的定位和确认。玻璃体的SLO和动态OCT可以实时评估飞蚊症的大小、运动和形态，以帮助临床医生针对有症状的飞蚊症进行治疗和监测。
