Stanga Paulo E, Reinstein Dan Z, Valentin Bravo Francisco J, Saladino Andrea, Stanga Sebastian F E, Reinstein Ursula I, O'Neill Yvonne, Archer Timothy J, Harmer Stuart W, Sebag J, Marshall John
The Retina Clinic London, London, United Kingdom.
UCL Institute of Ophthalmology, London, United Kingdom.
Retina. 2025 May 1;45(5):883-892. doi: 10.1097/IAE.0000000000004373.
Propose new terminology and evaluate the effectiveness of therapeutic refractive vitrectomy (TRV) for selective removal of vitreous floaters and opacities using Standardized Kinetic Anatomical Functional Testing of Vitreous Floaters and Opacities and new ultra widefield optical coherence tomography imaging techniques.
Retrospective analysis. Twenty eyes underwent therapeutic refractive vitrectomy for symptomatic vitreous floaters and opacities. Pre-TRV assessments/post-TRV assessments: Standardized and Kinetic Anatomical and Functional Testing of Vitreous Floaters and Opacities, including straylight measurements (HD Analyzer, Light Disturbance Analyzer, C-Quant) alongside noncontact imaging including a new ultra widefield optical coherence tomography to evaluate changes in vitreous anatomical and optical properties.
Post-TRV evaluations indicated objective changes in vitreous optical properties and subjective measures. Reduced straylight measurements: HD Analyzer 22%, light disturbance analyzer 54.4% ( P = 0.013), and C-Quant 7.8% ( P = 0.034). Patient-reported outcomes statistically significantly improved ( P = 0.022). Corrected distance visual acuity changes were marginal. New ultra widefield 26 mm by 12 mm imaging window optical coherence tomography facilitated detailed vitreous imaging, confirming the status of posterior vitreous detachment (100%). Post-TRV ultra widefield and optical coherence tomography imaging demonstrated restoration of vitreous clarity, confirmed the presence of residual cortical vitreous and absence of new posterior vitreous detachments.
Therapeutic refractive vitrectomy is a significant contribution for therapeutic refractive surgery as a safe and effective approach to enhancing visual quality, correcting refractive and opaque vitreous anomalies. Improvement in corrected distance visual acuity was minimal, representing limited effectiveness as a measure of comprehensive visual function. Improvements in objective straylight measures and imaging are in alignment with subjective symptom improvements post-TRV. This underscores the utility and value of new holistic evaluation methods beyond traditional metrics to assess the impact of therapeutic refractive vitrectomy on visual function and quality of life.
提出新术语，并使用玻璃体漂浮物和混浊的标准化动态解剖功能测试以及新的超广角光学相干断层扫描成像技术，评估治疗性屈光性玻璃体切除术（TRV）选择性去除玻璃体漂浮物和混浊的有效性。
回顾性分析。20只眼睛因有症状的玻璃体漂浮物和混浊接受了治疗性屈光性玻璃体切除术。TRV术前评估/术后评估：玻璃体漂浮物和混浊的标准化和动态解剖及功能测试，包括杂散光测量（高清分析仪、光干扰分析仪、C-Quant）以及非接触成像，其中包括一种新的超广角光学相干断层扫描，以评估玻璃体解剖和光学特性的变化。
TRV术后评估显示玻璃体光学特性和主观测量有客观变化。杂散光测量值降低：高清分析仪降低22%，光干扰分析仪降低54.4%（P = 0.013），C-Quant降低7.8%（P = 0.034）。患者报告的结果在统计学上有显著改善（P = 0.022）。矫正远视力变化很小。新的26毫米×12毫米成像窗口超广角光学相干断层扫描有助于详细的玻璃体成像，证实了玻璃体后脱离的状态（100%）。TRV术后超广角和光学相干断层扫描成像显示玻璃体清晰度恢复，证实存在残留的皮质玻璃体且无新的玻璃体后脱离。
治疗性屈光性玻璃体切除术作为一种安全有效的方法，可提高视觉质量、矫正屈光和不透明玻璃体异常，对治疗性屈光手术有重大贡献。矫正远视力的改善很小，作为综合视觉功能的衡量指标有效性有限。客观杂散光测量和成像的改善与TRV术后主观症状的改善一致。这强调了除传统指标外新的整体评估方法在评估治疗性屈光性玻璃体切除术对视觉功能和生活质量影响方面的实用性和价值。
