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How effective is the laser to get rid of floaters. Not very!
Ocular Surgery News: February 25, 2016 link to article http://www.healio.com/ophthalmology/retina-vitreous/news/print/ocular-surgery-news/%7B37dfa8c1-1b74-4636-b1f1-6c1ddb3d7f58%7D/yag-laser-vitreolysis-vs-pars-plana-vitrectomy-for-vitreous-floaters?page=1
QUOTE FROM ARTICLE:
Although the idea of a clinic-based YAG laser operation is alluring for its perceived simplicity, we have the following concerns.
1. The energy delivered into the eye is not acceptable. The energy delivered to the eye in YAG vitreolysis compared with standard YAG capsulotomy is much greater. Van der Windt and colleagues state the typical required power is 2.5 mJ to 4.5 mJ, and they do not recommend exceeding 500 pulses per treatment session. They recognize multiple treatment sessions may be necessary. It is our opinion this level of energy being delivered into the eye is too great, putting the patient at unnecessarily high risk for postoperative inflammation, glaucoma and retinal tear/detachment.
2. The efficacy of YAG vitreolysis is also in question. Delaney and colleagues found that 38% of patients treated with YAG vitreolysis had a moderate reduction in symptoms while 62% had no improvement.
The alternative treatment for YAG vitreolysis, and what we recommend at Mercy in carefully selected cases, is small-gauge pars plana vitrectomy. This procedure yields much higher efficacy. In the same Delaney study, they reported 93.3% of eyes undergoing vitrectomy for floaters resulted in full resolution. By utilizing modern surgical equipment, now readily available in as small as 27 gauge and cut rates as high as 7,500 cuts/minute, very little energy is directed into the vitreous, and very little traction on the vitreous is exerted. Vitrectomy has the advantage that if a retinal tear develops intraoperatively, it should be easily identified and treated at the end of the case.
QUOTE FROM ARTICLE:
Although the idea of a clinic-based YAG laser operation is alluring for its perceived simplicity, we have the following concerns.
1. The energy delivered into the eye is not acceptable. The energy delivered to the eye in YAG vitreolysis compared with standard YAG capsulotomy is much greater. Van der Windt and colleagues state the typical required power is 2.5 mJ to 4.5 mJ, and they do not recommend exceeding 500 pulses per treatment session. They recognize multiple treatment sessions may be necessary. It is our opinion this level of energy being delivered into the eye is too great, putting the patient at unnecessarily high risk for postoperative inflammation, glaucoma and retinal tear/detachment.
2. The efficacy of YAG vitreolysis is also in question. Delaney and colleagues found that 38% of patients treated with YAG vitreolysis had a moderate reduction in symptoms while 62% had no improvement.
The alternative treatment for YAG vitreolysis, and what we recommend at Mercy in carefully selected cases, is small-gauge pars plana vitrectomy. This procedure yields much higher efficacy. In the same Delaney study, they reported 93.3% of eyes undergoing vitrectomy for floaters resulted in full resolution. By utilizing modern surgical equipment, now readily available in as small as 27 gauge and cut rates as high as 7,500 cuts/minute, very little energy is directed into the vitreous, and very little traction on the vitreous is exerted. Vitrectomy has the advantage that if a retinal tear develops intraoperatively, it should be easily identified and treated at the end of the case.
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