Vitrectomy for floaters can be safe, effective

Seattle-Symptomatic floaters can be safely and effectively treated with vitrectomy using 25-gauge instruments, and without inducing posterior vitreous detachment (PVD) or removing the anterior vitreous, said Christianne A. Wa, a third-year medical student at USC School of Medicine, Los Angeles.

This method can help eliminate iatrogenic retinal tears and/or detachments and also minimize the need for cataract surgery.

We basically found that we were able to reduce the risk because we did not induce PVD, Wa noted.

“We had 19% rate of cataracts which was in older patients, and none in younger patients,” Wa said. “This is considerably less than what has been seen in other studies.”

Vitrectomy has been associated with a 50% to 78% risk of developing cataracts, so this rate was considerably lower, Wa pointed out.

Floaters are more a nuisance than health concern, but patients often perceive floaters as being as serious as age-related macular degeneration or other diseases, such as glaucoma.

“Patients have a very negative perception of floaters and will to lengths to get rid of them,” Wa said. “Vitrectomy is really the only method of treating them, but there are concerns as it can lead to retinal tears and detachments, among other complications.”

They hypothesized that performing vitrectomy with 25-gauge instruments and not inducing a PVD intraoperatively would reduce the incidence of retinal tears, and that not inducing PVD and leaving the anterior vitreous intact will lower the incidence of post-vitrectomy cataract formation.

A retrospective chart review identified 66 patients who underwent 25-gauge vitrectomy for floaters, in this group, 65 had their floaters resolved. Over a period of 3 months to 4 years, none of the patients in their cohort developed retinal breaks, hemorrhage, infection, or glaucoma. And in particular, there were no retinal breaks/detachments in the 22 patients without PVD preoperatively. This is compared with 30% observed in another study, Wa said.

While none of the patients in their cohort experienced short-term complications, one patient did develop PVD and another macular pucker.

“Vitrectomy can be safe and effective,” Wa said. “If we can minimize the risk, and we should also look at the benefits.”

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