Pars Plana Vitrectomy for Symptomatic Vitreous Floaters: Another Look

Abstract

Primary symptomatic vitreous opacities, often referred to as ‘floaters,’ are a common presenting complaint, which until recently was not often considered for surgical intervention. Increasing concerns regarding safety and the underwhelming subjective improvements of vitreolysis encourages us to reevaluate the spectrum of treatment for symptomatic vitreous floaters. The purpose of this study is to determine the safety and patient satisfaction level for those who undergo pars plana vitrectomy (PPV) for primary symptomatic vitreous opacities (floaters). Given the increasing use of sutureless small-gauge vitrectomy, an updated appraisal of the risks and subjective improvement of vitrectomy for vitreous floaters is critical. This was a retrospective study of 54 patients (average age 68) who underwent 23-gauge PPV between 2014 and 2017. Follow-up was done post-operatively on an average schedule of 1 day, 10 days, 6 weeks, and 3 months, with at least one visit being with a different surgeon in the practice. For concordance, both the primary and non-operating surgeons confirmed the objective absence of any residual visually significant vitreous opacities. Best corrected visual acuities were assessed pre-op and at each following visit using Snellen eye chart examinations. Adverse intraoperative and post-operative outcomes were recorded at follow-up (average 12.63 months, range 1.03 – 37.78) There were no sight-threatening complications in 100% of patients (n=54). There was objective improvement in vitreous floaters in 100% of patients as confirmed by the primary surgeon and non-operative surgeon, with 100% of patients surveyed noting subjective improvements in floaters affecting ADL following floaterectomy. Three patients (5.6%) developed epiretinal membrane, one patient developed posterior uveitis (1.8%), and one patient developed a vitreous hemorrhage (1.8%). There were no cases of endophthalmitis, cataracts, or retinal tears. Visual acuities did not significantly change after PPV. PPV is a safe and efficacious surgical therapy to remove floaters and improves patient quality of life. These rates compare favorably to previous reported rates in the literature of PPV for floaters and vitreolysis for floaters. This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.