Clinical Management of Vision Degrading Myodesopsia from Vitreous Floaters: Observation vs. Limited Refractive Vitrectomy.

Abstract

Purpose: To manage clinically significant vitreous floaters, called vision degrading myodesopsia, using objective quantification of vitreous structure and visual function, in order to distinguish cases that can be observed (OBS) from those that merit surgery, and define the profile of OBS patients.

Design: Retrospective nonrandomized interventional clinical study.

Subjects: There were 651 eyes in 393 patients (220 men and 173 women; aged 57.3 ± 14.7 years) with the chief complaint of floaters. Etiologies were posterior vitreous detachment (PVD; 252 of 651, 38.7%), myopic vitreopathy (MV; 133 of 651, 20.4%), and combined PVD + MV (210 of 651, 32.3%).

Methods: OBS alone was performed in 362 cases. Sutureless 25-gauge limited refractive vitrectomy (LRV) without surgical PVD was performed in 289 eyes.

Main outcome measures: Vitreous echodensity was measured by quantitative ultrasonography, contrast sensitivity (CS) with Freiburg Acuity Contrast Testing (%W); patient-reported outcomes with NEI Visual Function Questionnaire 25 (VFQ-25).

Results: OBS was chosen in 362 of 651 (55.6%; mean age 55.0 years), and LRV was elected in 289 of 651 (44.4%; mean age 60.1 years). Observation cases had 43.7% less vitreous echodensity (688 ± 170 AU vs. 1222 ± 356 AU; P < 0.0001), 35.7% better CS (2.90%W ± 1.33%W vs. 4.51%W ± 1.56%W; P < 0.0001), and better VFQ-25 (79.2 ± 6.0 vs. 77.2 ± 5.2; P < 0.01). Subjects initially choosing OBS who converted to surgery >1 year later had comparable CS to the OBS group at study entry, which worsened before electing LRV. Postoperatively, echodensity decreased by 59.6% (to 494 ± 64 AU, P < 0.0001), CS improved by 45.7% (to 2.45 ± 1.12%W, P < 0.0001), and VFQ-25 improved by 6.3% (to 82.0 ± 9.0, P < 0.0001). Sequelae of LRV included vitreous hemorrhage (0.7%), retinal tears (2.8%), retinal detachment (2.4%), macular pucker surgery (1.4%), recurrent floaters (5.2%), and cataract surgery (35.8%; average age = 62.7 ± 6.7 years, on average 23.7 months post-vitrectomy; below age 50 only 3 of 37 (8.1%) underwent cataract surgery [average follow-up = 28.9 months for all 37 patients]).

Conclusions: Patients with vision degrading myodesopsia from vitreous floaters can be managed by OBS or vitrectomy. Objective quantitative measures of vitreous echodensity and CS aid patient selection for OBS. These patients were younger and phakic, had floaters from myopic vitreopathy without PVD, and had less vitreous echodensity, as well as better CS.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.