The lack of floater perception in eyes with asteroid hyalosis and its direct implications on laser vitreolysis.

IF 1.9 Q2 OPHTHALMOLOGY
Elie Zaher, Yonatan Blumenthal, Eytan Z Blumenthal
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引用次数: 0

Abstract

Purpose: To present a novel optical model explaining why the vast majority of patients with Asteroid Hyalosis (AH) do not perceive any floaters. This changes our understanding of floater perception and undermines the operation mode of YAG laser vitreolysis.

Methods: Relying on a previously published model of floater perception based on astronomical equations of a solar eclipse, and on ultrasound images of the vitreous in three eyes with AH, we explain why such patients do not perceive floaters in spite of opaque bodies filling their entire vitreous, to the point of, in severe cases of AH, obscuring the fundus view during ophthalmoscopy.

Main outcome measures: Developing an optical model of light rays that can quantify the maximal distance upon which a vitreous floater or opacity will cast a shadow on the retina.

Results: Calculations using the proposed model demonstrated that with a 3 mm pupil, for a floater located between 1.5 mm and 2 mm from the retina, its shortest diameter must be > 215 microns and > 286 microns, respectively, to be perceived. Since AH floaters, based on ultrasound imaging, do not exist in the most peripheral 1.5 mm of the vitreous, it becomes understandable why these patients are asymptomatic.

Conclusions: Based on the proposed model and our findings, we deduced that even large, degenerative floaters whose width is usually narrower than a large retinal vein (125 microns), must be located very close to the retina and hence are not the floaters that are aimed at when performing YAG laser vitreolysis. We speculate that in successful cases, YAG vitreolysis works by a different mechanism, most likely a shock wave that displaces floaters further away from the retina. Hence, vitreolysis might not necessarily require the laser be aimed at the floaters, as symptomatic floaters may be located in the outer 1.5-2.0 mm of the vitreous body, a very risky zone for YAG laser shots.

小行星状透明变性眼球缺乏漂浮物感知及其对激光玻璃体溶解的直接影响。
目的:提出一种新的光学模型,解释为什么绝大多数小行星眼病(AH)患者感觉不到任何漂浮物。这改变了我们对漂浮物感知的理解,并破坏了YAG激光玻璃体溶解的操作模式:方法:根据之前发表的基于日食天文方程的浮游物感知模型,以及三只AH患者眼睛玻璃体的超声波图像,我们解释了为什么此类患者在不透明体充满整个玻璃体的情况下不会感知到浮游物,严重的AH患者甚至会在眼底镜检查时遮挡眼底视线:主要结果测量:建立一个光线光学模型,该模型可量化玻璃体漂浮物或不透明体在视网膜上投射阴影的最大距离:结果:使用所提出的模型进行的计算表明,在瞳孔为 3 毫米的情况下,距离视网膜 1.5 毫米和 2 毫米之间的玻璃体漂浮物,其最短直径必须分别大于 215 微米和大于 286 微米才能被感知。由于根据超声波成像,玻璃体最外围 1.5 毫米处不存在 AH 漂浮物,因此可以理解为什么这些患者没有症状:根据所提出的模型和我们的研究结果,我们推断出,即使是宽度通常比视网膜大静脉(125 微米)还要窄的大型退行性浮游物,其位置也一定非常靠近视网膜,因此并不是进行 YAG 激光玻璃体溶解术时所针对的浮游物。我们推测,在成功的病例中,YAG 玻璃体溶解是通过不同的机制起作用的,很可能是冲击波将浮游物移到离视网膜更远的地方。因此,玻璃体溶解不一定需要将激光对准浮游物,因为有症状的浮游物可能位于玻璃体外侧1.5-2.0毫米处,这是YAG激光照射的高风险区。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.50
自引率
4.30%
发文量
81
审稿时长
19 weeks
期刊介绍: International Journal of Retina and Vitreous focuses on the ophthalmic subspecialty of vitreoretinal disorders. The journal presents original articles on new approaches to diagnosis, outcomes of clinical trials, innovations in pharmacological therapy and surgical techniques, as well as basic science advances that impact clinical practice. Topical areas include, but are not limited to: -Imaging of the retina, choroid and vitreous -Innovations in optical coherence tomography (OCT) -Small-gauge vitrectomy, retinal detachment, chromovitrectomy -Electroretinography (ERG), microperimetry, other functional tests -Intraocular tumors -Retinal pharmacotherapy & drug delivery -Diabetic retinopathy & other vascular diseases -Age-related macular degeneration (AMD) & other macular entities
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