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J Sebag - One of the best experts on this subject based on the ideXlab platform.
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Vitreous and Vision Degrading Myodesopsia.
Progress in retinal and eye research, 2020Co-Authors: J SebagAbstract:Macromolecules comprise only 2% of Vitreous, yet are responsible for its gel state, transparency, and physiologic function(s) within the eye. Myopia and aging alter collagen and hyaluronan association causing concurrent gel liquefaction and fibrous degeneration. The resulting Vitreous opacities and collapse of the Vitreous body during posterior Vitreous detachment are the most common causes for the visual phenomenon of Vitreous Floaters. Previously considered innocuous, the Vitreous opacities that cause Floaters sometimes impact vision by profoundly degrading contrast sensitivity function and impairing quality-of-life. While many people adapt to Vitreous Floaters, clinically significant cases can be diagnosed with Vision Degrading Myodesopsia based upon echographic assessment of Vitreous structure and by measuring contrast sensitivity function. Perhaps due to the ubiquity of Floaters, the medical profession has to date largely ignored the plight of those with Vision Degrading Myodesopsia. Improved diagnostics will enable better disease staging and more accurate identification of severe cases that merit therapy. YAG laser treatments may occasionally be slightly effective, but vitrectomy is currently the definitive cure. Future developments will usher in more informative diagnostic approaches as well as safer and more effective therapeutic strategies. Improved laser treatments, new pharmacotherapies, and possibly non-invasive optical corrections are exciting new approaches to pursue. Ultimately, enhanced understanding of the underlying pathogenesis of Vision Degrading Myodesopsia should result in prevention, the ultimate goal of modern Medicine.
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Assessment of Vitreous Structure and Visual Function after Neodymium:Yttrium-Aluminum-Garnet Laser Vitreolysis.
Ophthalmology, 2019Co-Authors: Justin Nguyen, Kenneth M P Yee, Jeannie Nguyen-cuu, Jonathan Mamou, Ronald H. Silverman, Jeffrey A. Ketterling, J SebagAbstract:Purpose Neodymium:yttrium–aluminum–garnet (Nd:YAG) laser treatment is performed on Vitreous Floaters, but studies of structural and functional effects with objective outcome measures are lacking. This study evaluated Nd:YAG laser effects by comparing participants with Vitreous Floaters who previously underwent laser treatment with untreated control participants and healthy persons without Vitreous Floaters using quantitative ultrasonography to evaluate Vitreous structure and by measuring visual acuity and contrast sensitivity function to assess vision. Design Retrospective, comparative study. Participants One eye was enrolled for each of 132 participants: 35 control participants without Vitreous Floaters, 59 participants with untreated Vitreous Floaters, and 38 participants with Vitreous Floaters previously Nd:YAG-treated. Of these, 25 were dissatisfied and sought vitrectomy; 13 were satisfied with observation. Methods The 39-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-39) to assess participant visual well-being, quantitative ultrasonography (QUS) to measure Vitreous echodensity, and best-corrected visual acuity (BCVA) and contrast sensitivity function (CSF) to evaluate vision. Main Outcome Measures Results of NEI-VFQ-39, QUS, BCVA, and CSF. Results Compared with control participants without Vitreous Floaters, participants with untreated Vitreous Floaters showed worse NEI-VFQ-39 results, 57% greater Vitreous echodensity, and significant (130%) CSF degradation (P Conclusions As a group, participants previously treated with Nd:YAG laser for bothersome Vitreous Floaters showed less dense Vitreous, but similar visual function as untreated control participants with Vitreous Floaters. Because some treated eyes showed less dense Vitreous and better visual function than those of untreated control participants, a prospective randomized study of Nd:YAG laser treatment of Vitreous is warranted, using uniform laser treatment parameters and objective quantitative outcome measures.
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Cost-Effectiveness of Limited Vitrectomy for Vision-Degrading Myodesopsia.
American journal of ophthalmology, 2019Co-Authors: Benjamin Rostami, Jeannie Nguyen-cuu, Alfredo A Sadun, Gary C. Brown, Melissa M. Brown, J SebagAbstract:PURPOSE Patients afflicted with clinically significant Vitreous Floaters suffer from vision-degrading myodesopsia, characterized by impairment in contrast sensitivity function (CSF) and decreased quality of life. This study determined the cost-effectiveness of limited vitrectomy for this condition. DESIGN Retrospective, interventional case series and third-party insurer cost-utility analysis. METHODS Sixty-seven patients suffering from unilateral Vitreous Floaters (20 non-myopic patients with posterior Vitreous detachment [PVD]; 17 myopic patients [>-2 diopters] without PVD; 30 myopic patients with PVD) completed the National Eye Institute Visual Function Questionnaire (VFQ-39) and were tested with best-corrected visual acuity (BCVA) and CSF measurements before and after limited vitrectomy. A reference case cost-utility analysis was performed. RESULTS The mean VFQ-39 increased 19% (P < 0.00001) after surgery, with general vision improving 27% for the entire group and 37% for non-myopic PVD (P < 0.00001 for each). VFQ-39 correlations with time tradeoff utilities indicated a 14.4% improvement in quality of life. Mean BCVA improved 13.5% postoperatively (P < 0.00001) and CSF improved 53% (P < 0.00001). The incremental patient value gain conferred by limited vitrectomy was 2.38 quality-adjusted life-years (QALYs), and the average cost-utility ratio in 2018 U.S. real dollars was $1,574/QALY. CONCLUSIONS Limited vitrectomy for vision-degrading myodesopsia is clinically effective, in that it improves BCVA, CSF, and patient well-being. It is also highly cost-effective ($1,574/QALY), with an average cost-utility ratio vs. no therapy that is superior to cataract surgery ($2,262/QALY), amblyopia therapy ($2,710/QALY), and retinal detachment repair ($45,304/QALY). Myopic patients without PVD had the lowest cost-utility ratio of all ($1,338/QALY).
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long term safety and efficacy of limited vitrectomy for vision degrading vitreopathy resulting from Vitreous Floaters
Ophthalmology Retina, 2018Co-Authors: J Sebag, Kenneth M P Yee, Justin Nguyen, Jeannie NguyencuuAbstract:Purpose Vitreous Floaters can lower visual acuity (VA) and degrade contrast sensitivity function (CSF). Limited vitrectomy improves VA and normalizes CSF, but long-term results in a large series with objective quantitative outcome measures are lacking. Design Case series. Participants One hundred ninety-five eyes of 145 patients (87 men, age = 57.6 ± 4.3 years; 58 women, age = 61.5 ± 12.0 years) reporting bothersome Vitreous Floaters were compared to 70 age-matched controls. Posterior Vitreous detachment (PVD) alone was the cause in 96/195 (49.2%), myopic vitreopathy alone was the cause in 30/195 (15.4%), PVD with myopic vitreopathy was the cause in 56/195 (28.7%), and asteroid hyalosis was the cause in 13/195 eyes (6.7%). Methods Limited vitrectomy with 25-gauge instruments was performed without surgical PVD induction, preserving 3 to 4 mm of retrolental Vitreous in phakic eyes. Follow-up averaged 32.6 ± 23.5 months (range, 3–115 months), with 2 years or more in 144 eyes, 3 years or more in 69 eyes, 4 years or more in 51 eyes, and 5 years or more in 24 eyes. Main Outcome Measures Visual acuity, 39-item National Eye Institute Visual Function Questionnaire (VFQ) results, CSF (Weber index), and quantitative ultrasonography results. Results After surgery, Vitreous echodensity decreased by 94.1% (P Conclusions Limited vitrectomy for Vision Degrading Vitreopathy decreases Vitreous echodensity, improves patient well-being, improves VA, and normalizes CSF. The long-term efficacy and safety profiles suggest this may be a safe and effective treatment for clinically significant Vitreous Floaters, warranting a prospective randomized trial.
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Long-Term Safety and Efficacy of Limited Vitrectomy for Vision Degrading Vitreopathy Resulting from Vitreous Floaters.
Ophthalmology. Retina, 2018Co-Authors: J Sebag, Kenneth M P Yee, Justin Nguyen, Jeannie Nguyen-cuuAbstract:Vitreous Floaters can lower visual acuity (VA) and degrade contrast sensitivity function (CSF). Limited vitrectomy improves VA and normalizes CSF, but long-term results in a large series with objective quantitative outcome measures are lacking. Case series. One hundred ninety-five eyes of 145 patients (87 men, age = 57.6 ± 4.3 years; 58 women, age = 61.5 ± 12.0 years) reporting bothersome Vitreous Floaters were compared to 70 age-matched controls. Posterior Vitreous detachment (PVD) alone was the cause in 96/195 (49.2%), myopic vitreopathy alone was the cause in 30/195 (15.4%), PVD with myopic vitreopathy was the cause in 56/195 (28.7%), and asteroid hyalosis was the cause in 13/195 eyes (6.7%). Limited vitrectomy with 25-gauge instruments was performed without surgical PVD induction, preserving 3 to 4 mm of retrolental Vitreous in phakic eyes. Follow-up averaged 32.6 ± 23.5 months (range, 3-115 months), with 2 years or more in 144 eyes, 3 years or more in 69 eyes, 4 years or more in 51 eyes, and 5 years or more in 24 eyes. Visual acuity, 39-item National Eye Institute Visual Function Questionnaire (VFQ) results, CSF (Weber index), and quantitative ultrasonography results. After surgery, Vitreous echodensity decreased by 94.1% (P < 0.0001) and VFQ results improved by 19.3% (P < 0.0001). Preoperative VA was 0.68 ± 0.21, improving to 0.77 ± 0.19 after surgery (P < 0.0001). Preoperative CSF was degraded by 91.3% compared with controls (P < 0.0001), normalizing at 1, 3, 6, 12, 24, 36, and 48 months after surgery (P < 0.00005 for each). There were no cases of endophthalmitis. There were 3 retinal tears and 3 retinal detachments that underwent successful repair. Clinically significant Vitreous hemorrhage developed in 2 patients, clearing spontaneously. Two macular puckers and 4 recurrent Floaters from new PVD were cured by re-operation. Cataract surgery occurred in 21 of 124 patients (16.9%; mean age, 64 ± 7 years; none younger than 53 years), an average of 13.1 ± 6.8 months after vitrectomy. Limited vitrectomy for Vision Degrading Vitreopathy decreases Vitreous echodensity, improves patient well-being, improves VA, and normalizes CSF. The long-term efficacy and safety profiles suggest this may be a safe and effective treatment for clinically significant Vitreous Floaters, warranting a prospective randomized trial. Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Ghee Soon Ang - One of the best experts on this subject based on the ideXlab platform.
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Nd:YAG laser vitreolysis versus pars plana vitrectomy for Vitreous Floaters.
The Cochrane database of systematic reviews, 2017Co-Authors: Jan Kokavec, Justin C Sherwin, Alan Js Ang, Ghee Soon AngAbstract:The Vitreous is the clear jelly of the eye and contains fine strands of proteins. Throughout life the composition of this Vitreous changes, which causes the protein strands in it to bundle together and scatter light before it reaches the retina. Individuals perceive the shadows cast by these protein bundles as 'Floaters'. Some people are so bothered by Floaters that treatment is required to control their symptoms. Two major interventions for Floaters include Nd:YAG laser vitreolysis and vitrectomy. Nd:YAG laser vitreolysis involves using laser energy to fragment the Vitreous opacities via a non-invasive approach. Vitrectomy involves the surgical replacement of the patient's Vitreous (including the symptomatic Vitreous Floaters) with an inert and translucent balanced salt solution, through small openings in the pars plana. To compare the effectiveness and safety of Nd:YAG laser vitreolysis to pars plana vitrectomy for symptomatic Vitreous Floaters. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), MEDLINE Ovid (1946 to 17 January 2017), Embase Ovid (1947 to 17 January 2017), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 17 January 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 17 January 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 17 January 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 17 January 2017. We did not use any date or language restrictions in the electronic searches for trials. We also searched conference proceedings to identify additional studies. We included only randomised controlled trials (RCTs) that compared Nd:YAG laser vitreolysis to pars plana vitrectomy for treatment of symptomatic Floaters. We planned to use methods recommended by Cochrane. The primary outcome we planned to measure was change in vision-related quality of life from baseline to 12 months, as determined by a vision-related quality of life questionnaire. The secondary outcomes we planned to measure were best corrected logMAR or Snellen visual acuity at 12 months for the treated eye(s) and costs. Adverse outcomes we planned to record were the occurrence of sight-threatening complications by 12 months (asymptomatic retinal tears, symptomatic retinal tears, retinal detachment, cataract formation, and endophthalmitis). No studies met the inclusion criteria of this review. There are currently no RCTs that compare Nd:YAG laser vitreolysis with pars plana vitrectomy for the treatment of symptomatic Floaters. Properly designed RCTs are needed to evaluate the treatment outcomes from the interventions described. We recommend future studies randomise participants to either a Nd:YAG laser vitreolysis group or a vitrectomy group, with participants in each group assigned to either receive treatment or a sham intervention. Future studies should follow participants at six months and 12 months after the intervention. Also they should use best corrected visual acuity (BCVA) using an Early Treatment of Diabetic Retinopathy Study (ETDRS) chart read at 4 metres, vision-related quality of life (VRQOL), and adverse outcomes as the outcome measures of the trial.
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nd yag laser vitreolysis versus pars plana vitrectomy for Vitreous Floaters
Cochrane Database of Systematic Reviews, 2017Co-Authors: Jan Kokavec, Justin C Sherwin, Alan Js Ang, Ghee Soon AngAbstract:Background The Vitreous is the clear jelly of the eye and contains fine strands of proteins. Throughout life the composition of this Vitreous changes, which causes the protein strands in it to bundle together and scatter light before it reaches the retina. Individuals perceive the shadows cast by these protein bundles as 'Floaters'. Some people are so bothered by Floaters that treatment is required to control their symptoms. Two major interventions for Floaters include Nd:YAG laser vitreolysis and vitrectomy. Nd:YAG laser vitreolysis involves using laser energy to fragment the Vitreous opacities via a non-invasive approach. Vitrectomy involves the surgical replacement of the patient's Vitreous (including the symptomatic Vitreous Floaters) with an inert and translucent balanced salt solution, through small openings in the pars plana. Objectives To compare the effectiveness and safety of Nd:YAG laser vitreolysis to pars plana vitrectomy for symptomatic Vitreous Floaters. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), MEDLINE Ovid (1946 to 17 January 2017), Embase Ovid (1947 to 17 January 2017), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 17 January 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 17 January 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 17 January 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 17 January 2017. We did not use any date or language restrictions in the electronic searches for trials. We also searched conference proceedings to identify additional studies. Selection criteria We included only randomised controlled trials (RCTs) that compared Nd:YAG laser vitreolysis to pars plana vitrectomy for treatment of symptomatic Floaters. Data collection and analysis We planned to use methods recommended by Cochrane. The primary outcome we planned to measure was change in vision-related quality of life from baseline to 12 months, as determined by a vision-related quality of life questionnaire. The secondary outcomes we planned to measure were best corrected logMAR or Snellen visual acuity at 12 months for the treated eye(s) and costs. Adverse outcomes we planned to record were the occurrence of sight-threatening complications by 12 months (asymptomatic retinal tears, symptomatic retinal tears, retinal detachment, cataract formation, and endophthalmitis). Main results No studies met the inclusion criteria of this review. Authors' conclusions There are currently no RCTs that compare Nd:YAG laser vitreolysis with pars plana vitrectomy for the treatment of symptomatic Floaters. Properly designed RCTs are needed to evaluate the treatment outcomes from the interventions described. We recommend future studies randomise participants to either a Nd:YAG laser vitreolysis group or a vitrectomy group, with participants in each group assigned to either receive treatment or a sham intervention. Future studies should follow participants at six months and 12 months after the intervention. Also they should use best corrected visual acuity (BCVA) using an Early Treatment of Diabetic Retinopathy Study (ETDRS) chart read at 4 metres, vision-related quality of life (VRQOL), and adverse outcomes as the outcome measures of the trial.
Nived Moonasar - One of the best experts on this subject based on the ideXlab platform.
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Pars plana vitrectomy relieves the depression in patients with symptomatic Vitreous Floaters.
International journal of ophthalmology, 2020Co-Authors: Junhong Jiang, Nived Moonasar, Zhong LinAbstract:AIM To investigate the depressive state among the patients with symptomatic Vitreous Floaters (SVF), as well as its change after SVF removal via vitrectomy surgery. METHODS Twenty-eight eyes of 28 patients who underwent 27-gauge pars plana vitrectomy (PPV) for SVF were included. Thirty-nine eyes of 39 age- and gender-matched healthy volunteers without SVF were also recruited as a healthy control. Center for Epidemiologic Studies Depression (CES-D) was used to assess volunteers and patients' depression (before and 1wk after PPV). RESULTS The CES-D score was 18.3±8.6 for patients, and was 12.4±6.0 for healthy control (P=0.003). Patients were significantly more likely to be in a depressive state (53.6%, defined as CES-D score ≥16) than the healthy control (20.5%, P=0.005). For patients with SVF, the CES-D score was negatively correlated with their age (rs=-0.42, P=0.025). After PPV, both the CES-D score (11.9±5.4 vs 18.3±8.6, P
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pars plana vitrectomy relieves the depression in patients with symptomatic Vitreous Floaters
International Journal of Ophthalmology, 2020Co-Authors: Junhong Jiang, Nived Moonasar, Zhong LinAbstract:AIM To investigate the depressive state among the patients with symptomatic Vitreous Floaters (SVF), as well as its change after SVF removal via vitrectomy surgery. METHODS Twenty-eight eyes of 28 patients who underwent 27-gauge pars plana vitrectomy (PPV) for SVF were included. Thirty-nine eyes of 39 age- and gender-matched healthy volunteers without SVF were also recruited as a healthy control. Center for Epidemiologic Studies Depression (CES-D) was used to assess volunteers and patients' depression (before and 1wk after PPV). RESULTS The CES-D score was 18.3±8.6 for patients, and was 12.4±6.0 for healthy control (P=0.003). Patients were significantly more likely to be in a depressive state (53.6%, defined as CES-D score ≥16) than the healthy control (20.5%, P=0.005). For patients with SVF, the CES-D score was negatively correlated with their age (rs=-0.42, P=0.025). After PPV, both the CES-D score (11.9±5.4 vs 18.3±8.6, P<0.001) and proportion of depressive state (18.5% vs 53.6%, P=0.005) were significantly decreased. CONCLUSION This study suggests that symptoms of Vitreous Floaters have an apparently negative impact on patients' psychological state. The PPV can effectively relieve the depressive state for patients with SVF.
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A comparison between topical and retrobulbar anesthesia in 27-gauge vitrectomy for Vitreous Floaters: a randomized controlled trial
BMC ophthalmology, 2018Co-Authors: Rui Zhang, Zhong Lin, Qi Hua Liang, Nived MoonasarAbstract:To compare the safety and efficacy of topical anesthesia versus retrobulbar anesthesia in 27-gauge pars plana vitrectomy (PPV) for Vitreous Floaters. 30 patients with Vitreous Floaters were randomized into Group T (topical anesthesia, proparacaine eye drop) and Group R (retrobulbar anesthesia), and underwent 27-gauge PPV. A 5-point visual analogue pain scale (VAPS) was used to assess patients' pain experience of anesthesia and surgery procedure (during surgery, 2 h and 1 day after surgery). The VAPS of anesthesia procedure was 1.27 ± 0.59 for patients in Group R, while it was all 0 for patients in Group T (p < 0.001). There was no significant difference for VAPS during surgery (Group T: 1.13 ± 0.74, Group R: 0.67 ± 0.62, p = 0.67), 2 h (Group T: 0.80 ± 1.01, Group R: 0.67 ± 0.62, p = 0.67) and 1 day (Group T: 0.20 ± 0.41, Group R: 0.27 ± 0.46, p = 0.68) after surgery between these two groups. Only one patient (6.7%) in Group T required additional topical anesthesia during the surgery. Most of the patients reported the pain experience came from initial trocar insertion in both groups. None of the patients required post operative analgesia in both groups. No intraoperative or postoperative complications were noted in both groups. This study suggested that topical anesthesia is a safe and effective anesthetic approach for patients with Floaters who underwent 27-gauge PPV. ClinicalTrials.gov NCT03049163 . Registered 8 February 2017.
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A comparison between topical and retrobulbar anesthesia in 27-gauge vitrectomy for Vitreous Floaters: a randomized controlled trial
BMC, 2018Co-Authors: Rui Zhang, Zhong Lin, Qi Hua Liang, Nived MoonasarAbstract:Abstract Background To compare the safety and efficacy of topical anesthesia versus retrobulbar anesthesia in 27-gauge pars plana vitrectomy (PPV) for Vitreous Floaters. Methods 30 patients with Vitreous Floaters were randomized into Group T (topical anesthesia, proparacaine eye drop) and Group R (retrobulbar anesthesia), and underwent 27-gauge PPV. A 5-point visual analogue pain scale (VAPS) was used to assess patients’ pain experience of anesthesia and surgery procedure (during surgery, 2 h and 1 day after surgery). Results The VAPS of anesthesia procedure was 1.27 ± 0.59 for patients in Group R, while it was all 0 for patients in Group T (p
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Surgical Outcomes of 27-Gauge Pars PLana Vitrectomy for Symptomatic Vitreous Floaters.
Journal of ophthalmology, 2017Co-Authors: Zhong Lin, Rui Zhang, Qi Hua Liang, Ke Lin, Yu Shu Xiao, Nived MoonasarAbstract:To report the surgical outcomes of 27-gauge pars plana vitrectomy (PPV) for symptomatic Vitreous Floaters. 47 eyes of 47 patients (39 males, 83.0%) with symptomatic Vitreous Floaters who underwent 27-gauge PPV and followed up for more than 6 months were included. The mean age was 34.7 ± 13.5 years. No operative complication occurred. At first day postoperatively, the intraocular pressure (IOP) was significantly lower than that at other time points (8.6 ± 2.7 mmHg, p < 0.001). 28 (59.6%) eyes had transient hypotony (IOP < 8 mmHg). All were recovered within 1 week postoperatively. The BCVA of 41 eyes (41/47, 87.2%) remained unchanged or improved. Postoperative complications occurred in two eyes: one (2.1%) had endophthalmitis and one (2.1%) had retinal detachment. No clinical significant cataract was observed in the 42 postoperative phakic eyes. 91.5% of the patients were satisfied with the surgery outcome. Besides, 91.3% of the patients felt that the Floaters were removed completely or only had an acceptable residual. Visual acuity of most patients remained unchanged or improved following 27-gague pars plana vitrectomy for symptomatic Vitreous Floaters, resulting in high patient satisfaction. However, this treatment should be performed with great caution since severe postoperative complications may still occur. This trial is registered with NCT03049163.
Zhong Lin - One of the best experts on this subject based on the ideXlab platform.
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Pars plana vitrectomy relieves the depression in patients with symptomatic Vitreous Floaters.
International journal of ophthalmology, 2020Co-Authors: Junhong Jiang, Nived Moonasar, Zhong LinAbstract:AIM To investigate the depressive state among the patients with symptomatic Vitreous Floaters (SVF), as well as its change after SVF removal via vitrectomy surgery. METHODS Twenty-eight eyes of 28 patients who underwent 27-gauge pars plana vitrectomy (PPV) for SVF were included. Thirty-nine eyes of 39 age- and gender-matched healthy volunteers without SVF were also recruited as a healthy control. Center for Epidemiologic Studies Depression (CES-D) was used to assess volunteers and patients' depression (before and 1wk after PPV). RESULTS The CES-D score was 18.3±8.6 for patients, and was 12.4±6.0 for healthy control (P=0.003). Patients were significantly more likely to be in a depressive state (53.6%, defined as CES-D score ≥16) than the healthy control (20.5%, P=0.005). For patients with SVF, the CES-D score was negatively correlated with their age (rs=-0.42, P=0.025). After PPV, both the CES-D score (11.9±5.4 vs 18.3±8.6, P
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pars plana vitrectomy relieves the depression in patients with symptomatic Vitreous Floaters
International Journal of Ophthalmology, 2020Co-Authors: Junhong Jiang, Nived Moonasar, Zhong LinAbstract:AIM To investigate the depressive state among the patients with symptomatic Vitreous Floaters (SVF), as well as its change after SVF removal via vitrectomy surgery. METHODS Twenty-eight eyes of 28 patients who underwent 27-gauge pars plana vitrectomy (PPV) for SVF were included. Thirty-nine eyes of 39 age- and gender-matched healthy volunteers without SVF were also recruited as a healthy control. Center for Epidemiologic Studies Depression (CES-D) was used to assess volunteers and patients' depression (before and 1wk after PPV). RESULTS The CES-D score was 18.3±8.6 for patients, and was 12.4±6.0 for healthy control (P=0.003). Patients were significantly more likely to be in a depressive state (53.6%, defined as CES-D score ≥16) than the healthy control (20.5%, P=0.005). For patients with SVF, the CES-D score was negatively correlated with their age (rs=-0.42, P=0.025). After PPV, both the CES-D score (11.9±5.4 vs 18.3±8.6, P<0.001) and proportion of depressive state (18.5% vs 53.6%, P=0.005) were significantly decreased. CONCLUSION This study suggests that symptoms of Vitreous Floaters have an apparently negative impact on patients' psychological state. The PPV can effectively relieve the depressive state for patients with SVF.
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A comparison between topical and retrobulbar anesthesia in 27-gauge vitrectomy for Vitreous Floaters: a randomized controlled trial
BMC ophthalmology, 2018Co-Authors: Rui Zhang, Zhong Lin, Qi Hua Liang, Nived MoonasarAbstract:To compare the safety and efficacy of topical anesthesia versus retrobulbar anesthesia in 27-gauge pars plana vitrectomy (PPV) for Vitreous Floaters. 30 patients with Vitreous Floaters were randomized into Group T (topical anesthesia, proparacaine eye drop) and Group R (retrobulbar anesthesia), and underwent 27-gauge PPV. A 5-point visual analogue pain scale (VAPS) was used to assess patients' pain experience of anesthesia and surgery procedure (during surgery, 2 h and 1 day after surgery). The VAPS of anesthesia procedure was 1.27 ± 0.59 for patients in Group R, while it was all 0 for patients in Group T (p < 0.001). There was no significant difference for VAPS during surgery (Group T: 1.13 ± 0.74, Group R: 0.67 ± 0.62, p = 0.67), 2 h (Group T: 0.80 ± 1.01, Group R: 0.67 ± 0.62, p = 0.67) and 1 day (Group T: 0.20 ± 0.41, Group R: 0.27 ± 0.46, p = 0.68) after surgery between these two groups. Only one patient (6.7%) in Group T required additional topical anesthesia during the surgery. Most of the patients reported the pain experience came from initial trocar insertion in both groups. None of the patients required post operative analgesia in both groups. No intraoperative or postoperative complications were noted in both groups. This study suggested that topical anesthesia is a safe and effective anesthetic approach for patients with Floaters who underwent 27-gauge PPV. ClinicalTrials.gov NCT03049163 . Registered 8 February 2017.
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A comparison between topical and retrobulbar anesthesia in 27-gauge vitrectomy for Vitreous Floaters: a randomized controlled trial
BMC, 2018Co-Authors: Rui Zhang, Zhong Lin, Qi Hua Liang, Nived MoonasarAbstract:Abstract Background To compare the safety and efficacy of topical anesthesia versus retrobulbar anesthesia in 27-gauge pars plana vitrectomy (PPV) for Vitreous Floaters. Methods 30 patients with Vitreous Floaters were randomized into Group T (topical anesthesia, proparacaine eye drop) and Group R (retrobulbar anesthesia), and underwent 27-gauge PPV. A 5-point visual analogue pain scale (VAPS) was used to assess patients’ pain experience of anesthesia and surgery procedure (during surgery, 2 h and 1 day after surgery). Results The VAPS of anesthesia procedure was 1.27 ± 0.59 for patients in Group R, while it was all 0 for patients in Group T (p
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Surgical Outcomes of 27-Gauge Pars PLana Vitrectomy for Symptomatic Vitreous Floaters.
Journal of ophthalmology, 2017Co-Authors: Zhong Lin, Rui Zhang, Qi Hua Liang, Ke Lin, Yu Shu Xiao, Nived MoonasarAbstract:To report the surgical outcomes of 27-gauge pars plana vitrectomy (PPV) for symptomatic Vitreous Floaters. 47 eyes of 47 patients (39 males, 83.0%) with symptomatic Vitreous Floaters who underwent 27-gauge PPV and followed up for more than 6 months were included. The mean age was 34.7 ± 13.5 years. No operative complication occurred. At first day postoperatively, the intraocular pressure (IOP) was significantly lower than that at other time points (8.6 ± 2.7 mmHg, p < 0.001). 28 (59.6%) eyes had transient hypotony (IOP < 8 mmHg). All were recovered within 1 week postoperatively. The BCVA of 41 eyes (41/47, 87.2%) remained unchanged or improved. Postoperative complications occurred in two eyes: one (2.1%) had endophthalmitis and one (2.1%) had retinal detachment. No clinical significant cataract was observed in the 42 postoperative phakic eyes. 91.5% of the patients were satisfied with the surgery outcome. Besides, 91.3% of the patients felt that the Floaters were removed completely or only had an acceptable residual. Visual acuity of most patients remained unchanged or improved following 27-gague pars plana vitrectomy for symptomatic Vitreous Floaters, resulting in high patient satisfaction. However, this treatment should be performed with great caution since severe postoperative complications may still occur. This trial is registered with NCT03049163.
Jan Kokavec - One of the best experts on this subject based on the ideXlab platform.
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Nd:YAG laser vitreolysis versus pars plana vitrectomy for Vitreous Floaters.
The Cochrane database of systematic reviews, 2017Co-Authors: Jan Kokavec, Justin C Sherwin, Alan Js Ang, Ghee Soon AngAbstract:The Vitreous is the clear jelly of the eye and contains fine strands of proteins. Throughout life the composition of this Vitreous changes, which causes the protein strands in it to bundle together and scatter light before it reaches the retina. Individuals perceive the shadows cast by these protein bundles as 'Floaters'. Some people are so bothered by Floaters that treatment is required to control their symptoms. Two major interventions for Floaters include Nd:YAG laser vitreolysis and vitrectomy. Nd:YAG laser vitreolysis involves using laser energy to fragment the Vitreous opacities via a non-invasive approach. Vitrectomy involves the surgical replacement of the patient's Vitreous (including the symptomatic Vitreous Floaters) with an inert and translucent balanced salt solution, through small openings in the pars plana. To compare the effectiveness and safety of Nd:YAG laser vitreolysis to pars plana vitrectomy for symptomatic Vitreous Floaters. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), MEDLINE Ovid (1946 to 17 January 2017), Embase Ovid (1947 to 17 January 2017), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 17 January 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 17 January 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 17 January 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 17 January 2017. We did not use any date or language restrictions in the electronic searches for trials. We also searched conference proceedings to identify additional studies. We included only randomised controlled trials (RCTs) that compared Nd:YAG laser vitreolysis to pars plana vitrectomy for treatment of symptomatic Floaters. We planned to use methods recommended by Cochrane. The primary outcome we planned to measure was change in vision-related quality of life from baseline to 12 months, as determined by a vision-related quality of life questionnaire. The secondary outcomes we planned to measure were best corrected logMAR or Snellen visual acuity at 12 months for the treated eye(s) and costs. Adverse outcomes we planned to record were the occurrence of sight-threatening complications by 12 months (asymptomatic retinal tears, symptomatic retinal tears, retinal detachment, cataract formation, and endophthalmitis). No studies met the inclusion criteria of this review. There are currently no RCTs that compare Nd:YAG laser vitreolysis with pars plana vitrectomy for the treatment of symptomatic Floaters. Properly designed RCTs are needed to evaluate the treatment outcomes from the interventions described. We recommend future studies randomise participants to either a Nd:YAG laser vitreolysis group or a vitrectomy group, with participants in each group assigned to either receive treatment or a sham intervention. Future studies should follow participants at six months and 12 months after the intervention. Also they should use best corrected visual acuity (BCVA) using an Early Treatment of Diabetic Retinopathy Study (ETDRS) chart read at 4 metres, vision-related quality of life (VRQOL), and adverse outcomes as the outcome measures of the trial.
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nd yag laser vitreolysis versus pars plana vitrectomy for Vitreous Floaters
Cochrane Database of Systematic Reviews, 2017Co-Authors: Jan Kokavec, Justin C Sherwin, Alan Js Ang, Ghee Soon AngAbstract:Background The Vitreous is the clear jelly of the eye and contains fine strands of proteins. Throughout life the composition of this Vitreous changes, which causes the protein strands in it to bundle together and scatter light before it reaches the retina. Individuals perceive the shadows cast by these protein bundles as 'Floaters'. Some people are so bothered by Floaters that treatment is required to control their symptoms. Two major interventions for Floaters include Nd:YAG laser vitreolysis and vitrectomy. Nd:YAG laser vitreolysis involves using laser energy to fragment the Vitreous opacities via a non-invasive approach. Vitrectomy involves the surgical replacement of the patient's Vitreous (including the symptomatic Vitreous Floaters) with an inert and translucent balanced salt solution, through small openings in the pars plana. Objectives To compare the effectiveness and safety of Nd:YAG laser vitreolysis to pars plana vitrectomy for symptomatic Vitreous Floaters. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), MEDLINE Ovid (1946 to 17 January 2017), Embase Ovid (1947 to 17 January 2017), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 17 January 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 17 January 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 17 January 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 17 January 2017. We did not use any date or language restrictions in the electronic searches for trials. We also searched conference proceedings to identify additional studies. Selection criteria We included only randomised controlled trials (RCTs) that compared Nd:YAG laser vitreolysis to pars plana vitrectomy for treatment of symptomatic Floaters. Data collection and analysis We planned to use methods recommended by Cochrane. The primary outcome we planned to measure was change in vision-related quality of life from baseline to 12 months, as determined by a vision-related quality of life questionnaire. The secondary outcomes we planned to measure were best corrected logMAR or Snellen visual acuity at 12 months for the treated eye(s) and costs. Adverse outcomes we planned to record were the occurrence of sight-threatening complications by 12 months (asymptomatic retinal tears, symptomatic retinal tears, retinal detachment, cataract formation, and endophthalmitis). Main results No studies met the inclusion criteria of this review. Authors' conclusions There are currently no RCTs that compare Nd:YAG laser vitreolysis with pars plana vitrectomy for the treatment of symptomatic Floaters. Properly designed RCTs are needed to evaluate the treatment outcomes from the interventions described. We recommend future studies randomise participants to either a Nd:YAG laser vitreolysis group or a vitrectomy group, with participants in each group assigned to either receive treatment or a sham intervention. Future studies should follow participants at six months and 12 months after the intervention. Also they should use best corrected visual acuity (BCVA) using an Early Treatment of Diabetic Retinopathy Study (ETDRS) chart read at 4 metres, vision-related quality of life (VRQOL), and adverse outcomes as the outcome measures of the trial.
