Shah CP, Heier JS. Long-Term Follow-Up of Efficacy and Safety of YAG Vitreolysis for Symptomatic Weiss Ring Floaters. Ophthalmic Surg Lasers Imaging Retina. 2020;51:85-88.
Vitreous floaters are a common complaint among patients who visit a vitreoretinal specialist. Management options for symptomatic vitreous floaters include observation, pars plana vitrectomy, and YAG vitreolysis. While vitrectomy is the most definitive treatment, it comes with side effects well-known to vitreoretinal surgeons such as accelerated cataract progression and potential complications such as endophthalmitis and retinal detachment. Thus, some patients may favor a less invasive approach to floater treatment such as YAG vitreolysis, but until recently, long-term safety and efficacy data regarding YAG vitreolysis were not available.
In a follow up to their randomized clinical trial comparing sham laser to YAG vitreolysis for patients with symptomatic Weiss ring floaters, Shah and Heier describe the subjective and objective improvement in vitreous floaters among 35 patients who received at least 1 and up to 3 YAG vitreolysis treatments. At 2.3 years of follow up, 50% of patients reported significant or complete resolution of vitreous floaters. Visual acuity and intraocular pressure were unchanged from baseline. Interestingly, 94% of patients exhibited objective improvement in floaters when pre-YAG fundus photos were compared to post-YAG fundus photos. Importantly, 3 patients developed asymptomatic retinal tears sometime between month 6 and 2.8 years after YAG vitreolysis. None of the patients progressed to a retinal detachment. Notably, one of the 35 patients exhibited worsening floaters during the study period and elected to have a vitrectomy, with 100% resolution of his vitreous floater symptoms 1.5 years after the vitrectomy and without any complications.
The main finding in this study is that 50% of patients with symptomatic Weiss ring floaters who underwent YAG vitreolysis reported a durable, significant reduction in floater symptoms evident at 2.3 years of follow up. It is somewhat concerning that ~10% of these patients developed delayed retinal tears. However, since all 35 of the patients in this extension study underwent YAG vitreolysis and there was no control group, it is unclear whether the 3 retinal tears represent a side effect of treatment or whether these eyes were inherently at increased risk of tear formation. The results of this study are worth mentioning as we counsel patients with symptomatic Weiss ring floaters for whom observation is not a viable option. Patients with an extremely low risk tolerance and for whom a 50% success rate is acceptable may wish to proceed with YAG vitreolysis. In contrast, patients who prefer a more definitive treatment of their floaters and who have a slightly higher risk tolerance may opt for vitrectomy.
Maxwell S. Stem, MD
Pennsylvania Retina Specialists, PC