Stefaniya K Boneva, Justin H Nguyen, Jonathan Mamou, Kenneth M Yee, Cameron Hoerig, Ronald H Silverman, Jeffrey A Ketterling, Paulo Eduardo Stanga, Dan Z Reinstein, Alfredo A Sadun, J Sebag
{"title":"玻璃体飞蚊导致视力退化性肌失视的临床治疗：观察与有限屈光玻璃体切除术。","authors":"Stefaniya K Boneva, Justin H Nguyen, Jonathan Mamou, Kenneth M Yee, Cameron Hoerig, Ronald H Silverman, Jeffrey A Ketterling, Paulo Eduardo Stanga, Dan Z Reinstein, Alfredo A Sadun, J Sebag","doi":"10.1016/j.oret.2025.05.014","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Design: </strong>Retrospective nonrandomized interventional clinical study.</p><p><strong>Subjects: </strong>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%).</p><p><strong>Methods: </strong>OBS alone was performed in 362 cases. Sutureless 25-gauge limited refractive vitrectomy (LRV) without surgical PVD was performed in 289 eyes.</p><p><strong>Main outcome measures: </strong>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).</p><p><strong>Results: </strong>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]).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":" ","pages":""},"PeriodicalIF":5.7000,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical Management of Vision Degrading Myodesopsia from Vitreous Floaters: Observation vs. Limited Refractive Vitrectomy.\",\"authors\":\"Stefaniya K Boneva, Justin H Nguyen, Jonathan Mamou, Kenneth M Yee, Cameron Hoerig, Ronald H Silverman, Jeffrey A Ketterling, Paulo Eduardo Stanga, Dan Z Reinstein, Alfredo A Sadun, J Sebag\",\"doi\":\"10.1016/j.oret.2025.05.014\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Design: </strong>Retrospective nonrandomized interventional clinical study.</p><p><strong>Subjects: </strong>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%).</p><p><strong>Methods: </strong>OBS alone was performed in 362 cases. Sutureless 25-gauge limited refractive vitrectomy (LRV) without surgical PVD was performed in 289 eyes.</p><p><strong>Main outcome measures: </strong>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).</p><p><strong>Results: </strong>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]).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>\",\"PeriodicalId\":19501,\"journal\":{\"name\":\"Ophthalmology. Retina\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.7000,\"publicationDate\":\"2025-05-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Ophthalmology. 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引用次数: 0
摘要
目的：通过对玻璃体结构和视觉功能的客观量化，对临床上明显的玻璃体漂浮物（视力退化性肌失视）进行管理，以区分可以观察到的病例（OBS）和需要手术治疗的病例，并确定OBS患者的特征。设计：回顾性非随机介入临床研究。对象：393例患者651只眼，其中男性220例，女性173例；年龄57.3±14.7岁，主诉为飞蚊症。病因为玻璃体后脱离（PVD）；252/651, 38.7%)，近视玻璃体病变(MV；133/651, 20.4%)， PVD+MV联合（210/651,32.3%）。随访= 23.9±29.0个月。方法：对362例患者进行单纯观察。对289只眼进行无缝线25号有限屈光性玻璃体切除术（LRV）。主要观察指标：玻璃体超声密度定量测定，对比敏感度（CS）采用Freiburg对比试验（%W）；患者用NEI视觉功能问卷（VFQ-25）报告结果。结果：651例患者中有362例（55.6%）选择OBS；平均年龄55.0岁)，其中289/651例为LRV (44.4%；平均年龄60.1岁)。OBS患者玻璃体超声密度低43.7%(688±170 AU vs 1222±356 AU)；1年后，研究开始时的CS与OBS组相当，在选择LRV之前恶化。术后超声密度下降59.6%（494±64 AU）。结论：玻璃体漂浮物致视力退化性肌失视患者可通过观察或玻璃体切除术治疗。目的玻璃体超声密度和对比敏感度的定量测定有助于选择观察对象。这些患者年龄较小，有晶状体，有无PVD的近视玻璃体病变的飞蚊，玻璃体回声密度较低，对比敏感度较好。
Clinical Management of Vision Degrading Myodesopsia from Vitreous Floaters: Observation vs. Limited Refractive Vitrectomy.
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.
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.
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