SURGICAL REMOVAL OF FLOATERS RISKS BLINDNESS

[John C Hagan III, MD, FACS, FAAO]

In the American Journal of Ophthalmology, one of the great world medical journals in the June 2011 there is an article and an editorial about using surgery (vitrectomy) to remove "ordinary'" annoying floaters.

1. Safety of vitrectomy for floaters. HS Tan and others  AJO, volume 151 #6 June 2011 page 2011
2. Safety of vitrectomy for floaters---How safe is it. CP wilkinson  same issue page 919

In 116 patients having surgical removal of floaters not to make they see better but because the floater "bothered" the person in 16.4% retinal holes/breaks developed; 2.5% developed retinal detachment; one case went almost completely blind; high or low pressure developed in 13% and 50% DEVELOPED CATARACTS.

In the Editorial the retina surgeon said that while some patients were very happy its risky surgery and both surgeons and patients should carefully consider these extremely serious statistics before considering this high risk surgery. THIS SUPPORTS MY STATED BELIEF THAT VITRECTOMY FOR COMMON FLOATERS IS RARELY JUSTIFIED.

JCH MD

[JohnHaganMD]

I don't know if any of the answers have been deleted or not. I use "=" to indicate I have read the discussion to that point and don't have additional comments. I believe that for 99% of the population of people with floaters (and I'm one of them) that the risks of surgical remove far outweigh the benefits.

[negentropy]

Dr. Hagan's answers have apparently been deleted for the most part and replaced with '-' or '+'.
Read into that what you will.

[John C Hagan III, MD, FACS, FAAO]

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[mnskeptic]

That means 99% of people got clearing of their vision, a pretty good outcome, really.  Its really too bad for that one percent, but day to day before the operation it wasn't all that pleasant for the other 99%.

Dr, you need to reconsider your attitude about this...  I can illustrate. I have had glasses since I was 7, they don't bother me, they are a part of who I am, so for me almost any risk to just get rid of them is unacceptable. Yes, they impact my sight, but I am so used to it I don't care.  I even like my glasses. That doesn't mean I should be against refractive surgery for everyone else or downplay the problems some people have with glasses or contacts. Can you get inside these people's heads and know what stress they are under, do you really know how bad their floaters are?  There is demand for floater treatment, the complication rates should provide medicine with a goal to improve on, not dismiss the treatment altogether.

[malog]

The study that was published by the AJO is only one of many and it illustrates how this procedure is becoming more accepted. The main risk of retinal tear, is reduced if the patient already has a PVD ( although a natural PVD carries a risk of about 15% of a tear as well ).
   The world of opthamology does not accept change well. The first acrylic IOL was implanted in 1949 by Sir Harold Ridley and he was ridiculed and scorned for 30 years.  http://www.eurotimes.org/06Oct/pdf/inyourgoodbooks.pdf

Here is tales of one surgeons efforts to introduce the IOL into his practice
http://crstoday.com/PDF%20Articles/1005/CRST1005_cs_History350.html

Charles D. Kelman, who came up with the idea of  phacoemulsification faced a similar reaction. When he died a friend wrote this “ Like the early proponents of intra ocular lenses, he selected patients carefully and kept his initial work quiet. And, like the implant surgeons, he was subjected to ridicule and great hostility from the ophthalmic establishment for years after introducing his procedure ”  

[John C Hagan III, MD, FACS, FAAO]

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[John C Hagan III, MD, FACS, FAAO]

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[John C Hagan III, MD, FACS, FAAO]

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[John C Hagan III, MD, FACS, FAAO]

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[JodieJ]

It's my understanding that some factors, such as retinal detachment rate, differ according to who is performing the surgery, with some surgeons having higher rates than others.  Cataract development is reported to be correlated with the patient's age (younger patients are less likely to develop cataracts.)

[malog]

http://www.ajo.com/article/S0002-9394(11)00039-0/abstract

[John C Hagan III, MD, FACS, FAAO]

Most vitrectomies are performed for reasons such as an eye full of blood, complex retinal detachments, macular surgery, etc. So the series on simple floaters would represent the best case scenario. However the study has some limitations that will UNDERSTATE the total complications the average follow up was only 10 months. With time there will be more complications. With 50% cataract formation many of these regular floater eyes will require cataract surgery which will have some complications and some will develop retinal detachments as a result of the cataract surgery.

JCH MD

[homecrafter]

Thank you Dr. Hagan for this information.  Can we assume that any and all Vitrectomy surgeries result in these same statistics ?  I guess I am thinking that the eye doesn't know the exact "reason" for the Vitrectomy when it is performed, so am I correct in this assumption ?

[John C Hagan III, MD, FACS, FAAO]

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