Interventional procedure overview of YAG laser vitreolysis for symptomatic vitreous floaters
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Appendix
The following table outlines the studies that are considered potentially relevant to the IP overview but were not included in the summary of the key evidence. It is by no means an exhaustive list of potentially relevant studies.
Article | Number of patients/ follow up | Direction of conclusions | Reasons for non-inclusion in summary of key evidence section |
|---|---|---|---|
Broadhead GK, Hong T and Chang AA (2020) To treat or not to treat: management options for symptomatic vitreous floaters. Asia-Pacific journal of ophthalmology (Philadelphia, Pa.) 9(2): 96-103 | Review | Treatment seems to be more effective with the use of vitrectomy to remove floaters as compared with YAG vitreolysis, although currently there are no prospective trials comparing and assessing these treatments. When indicated, vitrectomy for floaters is an effective means of treating what may be a visually distressing phenomenon, although patients should be fully counselled regarding possible surgical complications. | Review article |
Cowan LA, Khine KT, Chopra V et al. (2015) Refractory open-angle glaucoma after neodymium-yttrium-aluminum-garnet laser lysis of vitreous floaters. American journal of ophthalmology 159(1): 138-43 | Case series n=3 | Secondary open-angle glaucoma is a complication of Nd:YAG vitreolysis for symptomatic floaters that may present with an increase in intraocular pressure immediately, or many months after the surgery. Furthermore, this complication may be permanent and require chronic medical therapy or glaucoma surgery. | Small sample |
Delaney YM, Oyinloye A and Benjamin L (2002) Nd:YAG vitreolysis and pars plana vitrectomy: surgical treatment for vitreous floaters. Eye (London, England) 16(1): 21-6 | Non-randomised comparative study n=31 | The results showed Nd:YAG vitreolysis to be a safe but only moderately effective primary treatment conferring clinical benefit in one third of patients. Pars plana vitrectomy, while offering superior results, should be reserved for patients who remain markedly symptomatic following vitreolysis, until future studies further clarify its role in the treatment of patients with floaters and posterior vitreous detachment. | Limited efficacy data were reported. Studies with larger samples or better design are included. |
Frankhauser F, Kwasniewska S and van der Zypen E (1985) Vitreolysis with the Q-Switched laser. Archives of ophthalmology, 103(8): 1166-71 | Case series 10 eyes treated for floaters for thickened posterior hyaloid membranes | Since laser vitreolysis is able to solve a number of clinical problems, obviating the need for vitrectomy, the former procedure should receive increasing attention for the treatment of pathologic problem in the vitreous cavity. | Small sample |
Huang KH, Weng TH, Chen YJ et al. (2018) Iatrogenic posterior lens capsule rupture and subsequent complications due to Nd:YAG laser vitreolysis for vitreous floaters: a case report. Ophthalmic surgery, lasers & imaging retina 49(11): e214-e7 | Case report n=1 | Nd:YAG laser vitreolysis has the potential to cause disastrous complications, even though it could be an option for treating visually significant vitreous strands and floaters. Nevertheless, these side effects should be kept in mind, and the procedure should be performed with great caution, particularly in young and phakic patient groups. | Single case report |
Hosseini H, Mehryar M and Farvardin M (2008) Triamcinolone-assisted neodymium: YAG laser vitreolysis. Ophthalmic surgery, lasers & imaging: the official journal of the International Society for Imaging in the Eye 39(3): 234-6 | Case report n=1 | This study described the application of triamcinolone-assisted neodymium: YAG laser vitreolysis. This approach could be a useful addition to the application of laser use in similar cases. Adding this step could facilitate the procedure and increase the success rate. However, significant complications can occur within this procedure and caution must be exercised not to generalise too widely on the base of this case. | Small sample |
Katsanos A, Tsaldari N, Gorgoli K et al. (2020) Safety and efficacy of YAG laser vitreolysis for the treatment of vitreous floaters: an overview. Advances in therapy 37(4): 1319-27 | Review | The currently available evidence offers some indications that YAG laser vitreolysis may be a viable option for the symptomatic relief of selected patients with bothersome complaints due to vitreous opacities. In particular cases with chronic Weiss rings may represent a patient group that will likely benefit the most from this procedure. On the other hand, notwithstanding how annoying the symptoms can be, the safety profile of this treatment seems far from optimal considering that the presence of vitreous floaters is not a vision-threatening condition. | Review article |
Koo EH, Haddock LJ, Bhardwaj N et al. (2017) Cataracts induced by neodymium-yttrium-aluminium-garnet laser lysis of vitreous floaters. The British journal of ophthalmology 101(6): 709-11 | Case series n=2 | Secondary cataract formation accompanied by loss of integrity of the posterior capsule is a potential complication of Nd:YAG laser vitreolysis for symptomatic floaters. | Small sample |
Lim JI (2017) YAG laser vitreolysis-is it as clear as it seems? JAMA ophthalmology 135(9): 924-5 | Review | Authors concluded that opacities close to the lens and underlying vital structures should not be treated with YAG laser because of the risk of damage to the lens and retina. In addition, thick membranes that require higher energies or eyes with vitreous haze, which could scatter laser energies, and perhaps very mobile opacities should also be excluded. Larger studies are needed to determine the true incidence of retinal tears, retinal pigment epithelium damage, and long-term effects from vaporising the vitreous. | Review article |
Little HL and Jack RL (1986) Q-switched neodymium: YAG laser surgery of the vitreous. Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie 224(3): 240-6 | Case series n=56 (59 eyes) Vitreous opacities, n=25 eyes | Vitreous results for Nd: YAG vitreous surgery are less dramatic than those obtained in posterior capsulotomies. This difference in visual results is explained by the presence of associated retinal pathology in eyes with vitreous pathology. The best results with treatment occurred in diabetic eyes having flat retinas with vitreous haemorrhage, with or without attachments of the posterior hyaloid to disc fronds. Eight of 18 such eyes had objective and subjective visual improvement. | Different indications were included and the sample for vitreous floaters was small. |
Liu XD, Wang Q and Zhao J (2020) Acute retinal detachment after Nd:YAG treatment for vitreous floaters and postertior capsule opacification: a case report. BMC ophthalmology 20(1): 157 | Case report n=1 | As myopic patients are at risk of developing retinal detachment; Nd:YAG vitreolysis and capsulotomy should be performed with caution. The laser energy should be as low as possible and careful focus is necessary to reduce interference to the retina. | Small sample |
Luo JH, An XJ and Kuang Y (2018) Efficacy and safety of yttrium-aluminium garnet (YAG) laser vitreolysis for vitreous floaters. The Journal of international medical research 46(11): 4465-71 | Case series n=30 | The results showed that YAG laser vitreolysis was a well-tolerated and effective treatment for vitreous floaters. Randomised, controlled trials involving large numbers of participants monitored over an extended follow up period are required to confirm these results. | Studies with larger samples or better design are included. |
Milston R, Madigan MC and Sebag, J (2016) Vitreous floaters: Etiology, diagnostics, and management. Survey of ophthalmology 61(2): 211-27 | Review | The current treatment options available for vitreous floaters are vitrectomy and Nd:YAG laser. Vitrectomy has a low-risk profile with an excellent success rate, as determined by objective measures of vision and standardized quantification of patient satisfaction. On the other hand, Nd:YAG laser for floaters remains an off-label procedure that is not commonly reported in the peer-reviewed literature. The response rate to laser is highly variable and, while the reported complications are minimal, rigorous study protocols have not been used. The advantages of Nd:YAG laser is that the eye remains closed and that vitreous components are torn and severed, but not removed. Centrally- suspended, single floaters might be candidates for laser lysis or displacement, but this remains to be demonstrated. | Review article |
Nguyen JH, Nguyen-Cuu J, Yu F et al (2019) Real-world assessment of vitreous structure and visual function after Nd:YAG laser vitreolysis. Ophthalmology, 126(11): 1517-26 | Non-randomised comparative study (retrospective) n=132 (38 with floaters that were treated by Nd:YAG, 35 without floaters, and 59 with untreated floaters) | As a group, patients previously treated with Nd:YAG for bothersome vitreous floaters had less dense vitreous, but similar visual function as untreated controls with vitreous floaters. Since some treated eyes had less dense vitreous and better visual function than untreated controls. | Limited data relating the efficacy of the procedure were reported. |
Noristani R, Schultz T and Dick HB (2016) Cataract formation after YAG laser vitreolysis: importance of femtosecond laser anterior capsulotomies in perforated posterior capsules. European journal of ophthalmology 26(6): e149-e151 | Case report n=1 | YAG laser vitreolysis presents a new and promising therapeutic approach for floaters. However, the complications are unknown. Authors describe the induction of cataract as a major complication. | Small sample |
Ruiz-Moreno JM (1998) Retinal detachment after vitreolysis with the Nd:YAG laser. Lasers and Light in Ophthalmology 8(4): 231-3 | Case series n=10 | Based on the results, authors did not think that vitreolysis by photodisruption with the Nd:YAG laser should be used for the treatment of vitreous floaters in pseudophakic patients, due to the high risk of causing serious complications, such as retinal detachment. | Small sample |
Ryan EH (2021) Current treatment strategies for symptomatic vitreous opacities. Current opinion in ophthalmology 32(3): 198-202 | Review | Patients with severe, persistent symptomatic vitreous opacities are highly motivated to seek relief of their symptoms. Pars plana vitrectomy appears to be far more effective than does YAG laser vitreolysis. Given the lack of readily available objective measurements of the density of vitreous opacities, a thorough history, good clinical examination, and excellent judgment is critical to creating a good outcome. Extra caution regarding recommending surgery should be exercised when the patient is phakic and or has not yet had a vitreous detachment. | Review article |
Sendrowski DP and Bronstein MA (2010) Current treatment for vitreous floaters. Optometry (St. Louis, Mo.) 81(3): 157-61 | Review | In terms of ''off-label'' treatment, laser and surgical options for vitreous floaters have not been adequately defined. The primary purpose of ''off-label'' laser and surgical options are the alleviation of symptoms associated with vitreous floaters. A secondary benefit may be the reduction of the patient's mental stress created by the floaters. Alternately, the primary risks of ''off-label'' use of laser and surgical options are the unwanted ocular complications of retinal tears, vitreoretinal haemorrhages, endophthalmitis, and retinal detachments. Currently, there are no clinical studies that provide adequate information about the ocular benefits or complications associated with such treatment options. Although patient symptomology from vitreous floaters can be reduced or in some cases alleviated by laser or surgical intervention, the patient benefit may not offset the potential risk from the procedure. The decision for treatment of symptomatic vitreous floaters should be done on a case-by-case basis. Patient annoyance, stress, and anxiety created by the vitreous floaters is an important factor in that decision-making process. | Review article |
Shah CP and Fine HF (2018) Management of floaters. Ophthalmic Surgery Lasers and Imaging Retina 49(6): 388-91 | Review | For those still bothered by a discrete floater after 6 months of observation, author will consider referring for YAG vitreolysis. Among those with more diffuse floaters or for those who have failed YAG vitreolysis, author will have several ongoing discussions about vitrectomy surgery, consciously focusing on the risks, and will proceed for the right patient, all the while hoping to do no harm. | Review article |
Shields RA, Cheng OT, Ruby AJ. et al. (2021) Retinal complications after yttrium-aluminum-garnet laser vitreolysis for vitreous floaters. Ophthalmic Surgery Lasers and Imaging Retina 52(11): 610-3 | Case series n=2 | The first patient developed a vitreous haemorrhage and subsequent branch retinal vein occlusion from laser damage to a major retinal venule. The second patient developed a temporal scotoma from a full-thickness retinal break in the posterior pole requiring laser retinopexy, As evidenced by the two cases presented here, extreme care must be taken during YAG laser vitreolysis in titrating the laser's power and selecting the distance of focus from the lens, retina, or both. | Small sample |
Singh IP (2020) Modern vitreolysis-YAG laser treatment now a real solution for the treatment of symptomatic floaters. Survey of ophthalmology 65(5): 581-8 | Review | The new illumination design, coupled with the modified laser energy delivery system, may represent an alternative option to vitrectomy in management of clinically significant floaters in carefully selected patients; however, randomised, controlled clinical trials with large cohorts and long-term follow-up are necessary to optimally assess the efficacy and safety of laser vitreolysis. | Review article |
Singh IP (2018) Novel OCT application and optimized YAG laser Enable visualisation and treatment of mid- to posterior vitreous floaters. Ophthalmic surgery, lasers & imaging retina 49(10): 806-11 | Case series n=2 | The results suggest that, with proper equipment, training and technique, laser vitreolysis may be an effective and safe treatment for mid- to posterior vitreous floaters. Prospective, randomised clinical trials are in progress and needed to confirm these findings. | Small sample |
Stonecipher KG (2016) Laser vitreolysis for floaters: this safe and effective procedure is well within the scope of any ophthalmologist. Cataract & Refractive Surgery, 48-50 | Review | Laser vitreolysis has become a positive addition to clinical practice. The treatment is safe, effective and painless with a very low complication rate. The bottom line is that the procedure has enabled scores of patients to achieve functional improvements in their vision and greatly improved their quality of life the process. | Review article |
Su D, Shah CP and Hsu J (2020) Laser vitreolysis for symptomatic floaters is not yet ready for widespread adoption. Survey of ophthalmology 65(5): 589-91 | Review | Treatment with laser vitreolysis, the use of an Nd:YAG laser to vaporise the collagenous vitreous opacities appears to be used more frequently; however, data regarding long-term safety and effectiveness are lacking. Laser vitreolysis of symptomatic floaters should not be routinely performed without additional studies documenting its safety and long-term efficacy. | Review article |
Sun IT, Lee TH and Chen CH (2017) Rapid cataract progression after Nd:YAG vitreolysis for vitreous floaters: a case report and literature review. Case Reports in Ophthalmology 8(2): 321-325 | Case report and literature review n=1 | Although Nd:YAG vitreolysis has been reported as an effective and less invasive treatment for symptomatic vitreous floaters, it should be used carefully, especially in phakic eyes. Crystalline lens injuries and rapid cataract progression may occur following Nd:YAG vitreolysis. While dealing with this type of complicated cataract, we should be aware of the possibility of posterior lens capsule rupture during surgery and the need for combined vitrectomy. Further prospective studies are necessary to evaluate the efficacy and safety of Nd:YAG vitreolysis. | Small sample |
Tassignon MJ, Stempels N and Brihaye M. (1989) Indications for Q-switched Nd-YAG laser in vitreous pathology. Lasers and Light in Ophthalmology 2(3): 163-72 | Case series n=71 eyes vitreous floaters, n=3 eyes | Nd: YAG laser treatment should be considered as the first choice in important vitreous floaters. This treatment has several advantages over vitrectomy. | Small sample |
Thompson JT (2018) Much ado about nothing (or something): what is the role of vitrectomy and Yttrium-Aluminum-Garnet laser for vitreous floaters? Ophthalmology Retina 2(9): 879-80 | Review | The appropriate use of vitrectomy and YAG laser vitreolysis for symptomatic vitreous floaters remains uncertain. Contrast sensitivity testing using the Freiberg vision test may provide further quantitative evidence of visual impairment. This information can assist in making a decision about whether to recommend vitrectomy or YAG vitreolysis for symptomatic vitreous floaters. Randomised studies with long-term follow-up are needed to define the optimal treatment and to refine the indications for treating symptomatic vitreous floaters. | Review article |
Tsai WF, Chen YC and Su CY (1993) Treatment of vitreous floaters with neodymium YAG laser. The British journal of ophthalmology 77(8): 485-8 | Case series n=15 | Although authors confined the indications for treatment to very strict criteria, by accumulating samples and experience, Nd-YAG laser may prove to be a safe and ideal method for treatment of all persistent vitreous floaters in the future. | Small sample |
Van der Veken A, Van de velde F, Smeets B et al. (1997) Nd:YAG laser posterior hyaloidotomy for the treatment of a premacular vitreous floater. Bull Soc Belge Ophtalmol, 265: 39-43 | Case report n=1 | The finding suggests that a fragment of the neurosensory retina became detached together with the internal limiting membrane in the process of the vitreous collapse. | Single case report |
Vandorselaer T, Van De Velde F an; Tassignon MJ (2001) Eligibility criteria for Nd-YAG laser treatment of highly symptomatic vitreous floaters. Bulletin de la Societe belge d'ophtalmologie: 15-9 | Case series n=9 | Vitreous floaters are frequently found in daily practice and may occasionally cause important visual and psychological impairment. The Nd-YAG laser is currently the most innocuous and least invasive technique for treating highly symptomatic floaters. Vitreolysis is successful in case of well-suspended condensations. Ill-suspended floaters are associated with a low success rate. If 1 or 2 laser sessions are unsuccessful, vitrectomy remains the only alternative. | Small sample |
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