Table 1.

Patient age (median, range)	65 (21–94) years
Patient sex	287 male, 281 female
Duration of symptoms (median, range)	12 (1–99) months
Length of follow-up (median, range)	20 (6–94) months
Baseline refractive status (median, range)
Myopia	181 eyes, −3.00 (−23.00 to −1.0) D
Hyperopia	101 eyes, +2.00 (+1.00 to +10.00) D
Baseline lens status (% of eyes)
Phakic	264 (45.7)
Pseudophakic	314 (54.3)
Quality of vitrectomy (% of eyes)
Complete	165 (28.4)
Subtotal	288 (49.6)
Core	128 (22)
Gauge (% of eyes)
20	106 (18.3)
23	200 (34.5)
25	254 (43.9)
27	19 (3.3)
Cutting speed (% of eyes)
<1500 cuts/min	148 (25.5)
1500–4000 cuts/min	269 (46.4)
>4000 cuts/min	163 (28.1)
Combined phacovitrectomy (% of phakic eyes)	91 (34.5)
Additional ILM peeling (% of eyes)	35 (6)

Table 1. Patient demographics, ocular features and surgical details.

Table 2.

		Retinal break formation		Postoperative RD development		Cataract formation
	Categorical (C) (referent category first) or scaled (S)	OR (%95 CI)	p value	OR (%95 CI)	p value	OR (%95 CI)	p value
Patient age^a	S (years)	1.02 (0.98–1.06)	0.273	0.94 (0.88–1)	0.060	0.98 (0.96–0.99)	0.044
Patient sex^a	C (female, male)	2.74 (1.07–7.03)	0.036	1.54 (0.31–7.66)	0.598	1.63 (0.99–2.68)	0.054
Refractive status	C (myopia, hyperopia)	NA		0.54 (0.17–1.67)	0.286	NA
Lens status	C (phakic, pseudophakic)	1.16 (0.26–5.19)	0.848	1.92 (0.26–14.38)	0.525	NA
Quality of vitrectomy	C (complete, core, subtotal)	0.05 (0.01–0.46)	0.009	NA		1.60 (0.74–3.45)	0.230
		0.23 (0.05–1.06)	0.059			0.78 (0.39–1.55)	0.476
Gauge	S (20, 23, 25 or smaller)	2.13 (0.70–6.46)	0.181	0.34 (0.05–2.42)	0.281	0.66 (0.28–1.52)	0.329
		0.27 (0.02–3.38)	0.313	0.09 (0.004–1.65)	0.103	1.1 (0.45–2.61)	0.855
Cutting speed	S (<1500, 1500–4000, >4000)	0.03 (0.003–0.29)	0.002	0.15 (0.01–2.33)	0.176	1.98 (0.97–4.07)	0.063
		0.12 (0.02–0.76)	0.025	1.9 (0.19–18.5)	0.578	1.34 (0.54–3.33)	0.526
Combined cataract extraction	C (absent, present)	0.90 (0.19–4.19)	0.898	NA		NA
Intraoperative complication	C (absent, present)	NA		1.91 (0.34–10.7)	0.460	NA

Table 2. Multivariate regression analyses of potential risk factors for the development of iatrogenic retinal breaks, postoperative retinal detachment and cataract.

OR odds ratio, CI conﬁdence interval, NA not applicable to be included in the regression model.
^aForced demographic covariates.

Table 3.

		Signiﬁcant reduction of everyday life discomfort		Signiﬁcant reduction of professional life discomfort		Signiﬁcant reduction of psychological discomfort		Satisfaction
	Categorical (C) (referent category first) or scaled (S)	OR (%95 CI)	p value	OR (%95 CI)	p value	OR (%95 CI)	p value	OR (%95 CI)	p value
Patient age^a	S (years)	1.01 (0.97–1.04)	0.771	0.99(0.94–1.04)	0.553	0.95 (0.87–1.04)	0.235	0.97 (0.95–1.00)	0.069
Patient sex^a	C (female, male)	1.14 (0.48–2.75)	0.766	1.71 (0.42–6.7)	0.453	4.6 (0.81–25.7)	0.085	0.93 (0.45–1.93)	0.970
Floater size	C (dense or huge, almostinvisible or small)	0.72(0.24–2.13)	0.551	0.55 (0.13–2.26)	0.406	3.53 (0.69–18.1)	0.131	0.42 (0.19–0.92)	0.022
Duration of symptoms	S (months)	NA		0.97 (0.95–1.01)	0.064	NA		NA
Quality of vitrectomy	C (complete, core, subtotal)	NA		NA		NA		NA
Gauge	S(20, 23, 25 or smaller)	1.51(0.48–4.84)	0.481	6.89 (0.67–70.4)	0.104	0.06 (0.004–0.99)	0.995	1.56 (0.53–4.61)	0.622
		1.89 (0.49–7.41)	0.357	0.95 (0.19–4.73)	0.950	0.08 (0.003–1.74)	0.107	1.28 (0.49–3.37)	0.507
Cutting speed	S (<1500, 1500–4000, >4000)	1.31 (0.45–3.85)	0.623	NA		14 (0.80–248.5)	0.072	NA
		1.44 (0.31–6.63)	0.640			4.9 (0.43–55.7)	0.201
Combined cataract extraction	C (absent, present)	NA		NA		0.22 (0.03–1.54)	0.127	NA
Intraoperative complication	C (absent, present)	NA		NA		NA		0.35 (0.11–1.07)	0.180
Postoperative complication	C (absent, present)	0.31 (0.13–0.76)	0.011	0.15 (0.03–0.73)	0.019	NA		0.44 (0.20–0.94)	0.156

Table 3. Multivariate regression analyses of potential factors affecting signiﬁcant reduction of everyday life discomfort, professional life discomfort, psychological discomfort and overallpatient satisfaction.

OR odds ratio, CI conﬁdence interval, NA not applicable to be included in the regression model.
^aForced demographic covariates.

Tozer K, Johnson M, Sebag J. Vitreous aging and posterior vitr-eous detachment. In: Sebag J, editors. Vitreous—in health and disease. New York: Springer-Verlag; 2014. p. 131–50.
Gale J, Ikuno Y. Myopic vitreopathy. In: Sebag J, editors. Vitr-eous—in health and disease. New York: Springer-Verlag; 2014. p. 113–29.
Roufail ED, Polkinghorne P. Vitreous floaters. Compr Ophthal-mol Update. 2006;7:171–7.
Henry CR, Smiddy WE, Flynn HW Jr. Pars plana vitrectomy for vitreous floaters: is there such a thing as minimally invasive vitreoretinal surgery? Retina. 2014;34:1043–5.
Wagle AM, Lim WY, Yap TP, Neelam K, Au Eong KG. Utility values associated with vitreous floaters. Am J Ophthalmol. 2011;152:60–5 e1.
de Nie KF, Crama N, Tilanus MA, Klevering BJ, Boon CJ. Pars plana vitrectomy for disturbing primary vitreous floaters: clinical outcome and patient satisfaction. Graefes Arch Clin Exp Oph-thalmol. 2013;251:1373–82.
Zou H, Liu H, Xu X, Zhang X. The impact of persistent visually disabling vitreous floaters on health status utility values. Qual Life Res. 2013;22:1507–14.
Delaney YM, Oyinloye A, Benjamin L. Nd:YAG vitreolysis and pars plana vitrectomy: surgical treatment for vitreous floaters. Eye (Lond). 2002;16:21–6.
Tan HS, Mura M, Lesnik Oberstein SY, Bijl HM. Safety of vitrectomy for floaters. Am J Ophthalmol. 2011;151:995–8.
Schulz-Key S, Carlsson JO, Crafoord S. Longterm follow-up of pars plana vitrectomy for vitreous floaters: complications, out-comes and patient satisfaction. Acta Ophthalmol. 2011;89:159–65.
Tsai WF, Chen YC, Su CY. Treatment of vitreous floaters with neodymium YAG laser. Br J Ophthalmol. 1993;77:485–8.
Little HL, Jack RL. Q switched neodymium: YAG laser surgery of the vitreous. Graefes Arch Clin Exp Ophthalmol. 1986; 224:240–6.
Moore JK, Kitchens JW, Smiddy WE, Mavrofrides EC, Gregorio G. Retinal breaks observed during pars plana vitrectomy. Am J Ophthalmol. 2007;144:32–6.
Covert DJ, Henry CR, Bhatia SK, Croskrey J, Sanchez CR, Han DP. Intraoperative retinal tear formation and postoperative rheg-matogenous retinal detachment in transconjunctival cannulated vitrectomy systems compared with the standard 20-gauge system. Arch Ophthalmol. 2012;130:186–9.
Tan HS, Mura M, de Smet MD. Iatrogenic retinal breaks in 25-gauge macular surgery. Am J Ophthalmol. 2009;148:427–30.
Hikichi T, Kosaka S, Takami K, et al. Incidence of retinal breaks in eyes undergoing 23-gauge or 20-gauge vitrectomy with
Mura M, Barca F, Dell'Omo R, Nasini F, Peiretti E. Iatrogenic retinal breaks in ultrahigh-speed 25-gauge vitrectomy: a pro-spective study of elective cases. Br J Ophthalmol. 2016;100: 1383–7.
Rizzo S, Genovesi-Ebert F, Belting C. Comparative study between a standard 25-gauge vitrectomy system and a new ultrahigh-speed 25-gauge system with duty cycle control in the treatment of various vitreoretinal diseases. Retina. 2011;31: 2007–13.
Sebag J, Yee KM, Wa CA, Huang LC, Sadun AA. Vitrectomy for floaters: prospective efficacy analyses and retrospective safety profile. Retina. 2014;34:1062–8.
Mason JO, Neimkin MG. Safety, efficacy, and quality of life following sutureless vitrectomy for symptomatic vitreous floaters. Retina. 2014;34:1055–61.
Ling CA, Weiter JJ, Buzney SM, Lashkari K. Competing theories of cataractogenesis after pars plana vitrectomy and the nutrient theory of cataractogenesis: a function of altered aqueous fluid dynamics. Int Ophthalmol Clin. 2005;45:173–98.
Cheng L, Azen SP, El-Bradey MH, et al. Duration of vitrectomy and postoperative cataract in the vitrectomy for macular hole study. Am J Ophthalmol. 2001;132:881–7.
Schiff WM, Chang S, Mandava N, Barile GR. Pars plana vitrectomy for persistent, visually significant vitreous opacities. Retina. 2000;20:591–6.
Kim YK, Moon SY, Yim KM, Seong SJ, Hwang JY, Park SP. Psychological distress in patients with symptomatic vitreous floaters. J Ophthalmol. 2017;2017:3191576.
Cipolletta S, Beccarello A, Galan A. A psychological perspective of eye floaters. Qual Health Res. 2012;22:1547–58.
Mura M, Engelbrecht LA, de Smet MD, Papadaki TG, van den Berg TJ, Tan HS. Surgery for floaters. Ophthalmology. 2011;118:1894–e1.
Shah CP, Heier JS. YAG laser vitreolysis vs sham YAG vitreo-lysis for symptomatic vitreous floaters: a randomized clinical trial. JAMA Ophthalmol. 2017;135:918–23.

CME

Management of Vitreous Floaters: An International Survey. The European VitreoRetinal Society Floaters Study Report

Authors: Ece Ozdemir Zeydanli, MD; Barbara Parolini, MD; Sengul Ozdek MD, FEBO; Silvia Bopp, MD; Ron A. Adelman, MD, MPH; Ferenc Kuhn, MD; Giampaolo Gini, MD; Ahmed Sallam, MD; Nur F. Bryan Aksakal, MD
CME Released: 4/20/2020
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 4/20/2021, 11:59 PM EST

Start Activity

Target Audience and Goal Statement

This activity is intended for ophthalmologists, vitreoretinal surgeons, and other physicians caring who treat and manage patients with symptomatic floaters.

The goal of this activity is to describe the efficacy and safety of pars plana vitrectomy (PPV) for symptomatic floaters (581 eyes), according to results from a retrospective survey study by the European VitreoRetinal Society of 48 vitreoretinal surgeons from 16 countries.

Upon completion of this activity, participants will be able to:

Describe symptomatic improvement after PPV for symptomatic floaters, according to results from a retrospective survey study
Determine safety outcomes after PPV for symptomatic floaters, according to results from a retrospective survey study
Identify clinical implications of the efficacy and safety of PPV for symptomatic floaters, according to results from a retrospective survey study

Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Faculty

Ece Ozdemir Zeydanli, MD

Polatlı State Hospital
Ankara, Turkey

Disclosures

Disclosure: Ece Ozdemir Zeydanli, MD, disclosed has no relevant financial relationships.

Barbara Parolini, MD

EyeCare Clinic
Brescia, Italy

Disclosures

Disclosure: Barbara Parolini, MD, disclosed has no relevant financial relationships.

Sengul Ozdek MD, FEBO

Gazi University School of Medicine
Ankara, Turkey

Disclosures

Disclosure: Sengul Ozdek MD, FEBO, has disclosed no relevant financial relationships.

Silvia Bopp, MD

Capio Augenklinik Universitätsallee
Bremen, Germany

Disclosures

Disclosure: Silvia Bopp, MD, has disclosed the following relevant financial relationships:
Served as a speaker or a member of a speakers bureau for: Allergan, Inc.; Bayer AG; Novartis Pharmaceuticals Corporation

Ron A. Adelman, MD, MPH

Yale University School of Medicine
New Haven, Connecticut, United States

Disclosures

Disclosure: Ron A. Adelman, MD, MPH, has disclosed no relevant financial relationships.

Ferenc Kuhn, MD

Helen Keller Foundation for Research and Education
Birmingham, Alabama, United States

Disclosures

Disclosure: Ferenc Kuhn, MD, has disclosed no relevant financial relationships.

Giampaolo Gini, MD

Eye Unit
Southampton University Hospital
Southampton, United Kingdom

Disclosures

Disclosure: Giampaolo Gini, MD, has disclosed no relevant financial relationships.

Ahmed Sallam, MD

Jones Eye Institute
University of Arkansas for Medical Sciences
Little Rock, Arkansas, United States

Disclosures

Disclosure: Ahmed Sallam, MD, has disclosed no relevant financial relationships.

Nur F. Bryan Aksakal, MD

Gazi University School of Medicine
Department of Public Health
Ankara, Turkey

Disclosures

Disclosure: Nur F. Bryan Aksakal, MD, has disclosed no relevant financial relationships.

Editor

Sobha Sivaprasad, MD

Editor
Eye

Disclosures

Disclosure: Sobha Sivaprasad, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Allergan, Inc.; Bayer AG; Boehringer Ingelheim Pharmaceuticals, Inc.; Heidelberg Pharma GmbH; Optos; Roche
Served as a speaker or a member of a speakers bureau for: Allergan, Inc.; Bayer AG; Novartis Pharmaceuticals Corporation; Optos
Received grants for clinical research from: Allergan, Inc.; Bayer AG; Boehringer Ingelheim Pharmaceuticals, Inc.; Novartis Pharmaceuticals Corporation; Optos

CME Author

Laurie Barclay, MD

Freelance writer and reviewer
Medscape, LLC

Disclosures

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Reviewer

Hazel Dennison, DNP, RN, FNP, CPHQ, CNE

Associate Director
Accreditation and Compliance
Medscape, LLC

Disclosures

Disclosure: Hazel Dennison, DNP, RN, FNP, CPHQ, CNE, has disclosed no relevant financial relationships.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

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From Eye

CME

Management of Vitreous Floaters: An International Survey. The European VitreoRetinal Society Floaters Study Report

Authors: Ece Ozdemir Zeydanli, MD; Barbara Parolini, MD; Sengul Ozdek MD, FEBO; Silvia Bopp, MD; Ron A. Adelman, MD, MPH; Ferenc Kuhn, MD; Giampaolo Gini, MD; Ahmed Sallam, MD; Nur F. Bryan Aksakal, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 4/20/2020

Valid for credit through: 4/20/2021, 11:59 PM EST

processing....

Abstract and Introduction

Abstract

Background/objectives To evaluate the efficacy and safety of pars plana vitrectomy for symptomatic floaters. Subjects/methods Forty-eight vitreoretinal surgeons from 16 countries provided information on 581 eyes who underwent vitrectomy for floaters in this retrospective survey study conducted by European VitreoRetinal Society. Percentage symp-tomatic improvement, incidence of retinal tears/detachment and post-vitrectomy cataract surgery, and the factors associated with satisfaction and complications were investigated.

Results Ninety-two percent were satisfied with the results, with 86.3% reporting complete resolution of daily-life symptoms. Overall satisfaction was lower in patients with smaller vitreous opacities at presentation (OR:0.4). Iatrogenic retinal breaks occurred in 29 eyes (5%). Core vitrectomy and cut rates of 1500–4000 or >4000 cuts/min were associated with lower risk of retinal breaks than complete vitrectomy (OR:0.05) and cut rates < 1500 cuts/min (OR: 0.03, 0.12, respectively). Fourteen eyes (2.4%) developed retinal detachment at a median of 3 months; and 84 (48.6%) developed cataract at a median of 16 months post-vitrectomy.

Conclusions Pars plana vitrectomy resulted in high patient satisfaction with relatively low rate of severe complications in a large group of patients. The procedure may be safer when core vitrectomy and cut rates > 1500 cuts/min are favoured. Proper patient selection and informed consent are the most important aspects of surgery.

Introduction

Vitreous floaters are caused by degenerative or pathologic alterations in the vitreous ultrastructure and perceived as shadows or fly-like obscurations to vision ^[1-3]. While patients with floaters often improve over time because of peripheral displacement of vitreous opacities or cognitive adaption ^[4], there remain a subgroup with persistent symptoms. Physicians often underestimate how much of an impact floaters may have on patients’ life; however, recent studies indicated that they can be highly debilitating ^[5-7]. In one study, the negative impact of the floaters was so severe that the patients were willing to accept a 7% risk of blindness to get rid of them ^[5].
Two treatment options have been advocated to date: Nd: YAG vitreolysis and pars plana vitrectomy (PPV) ^[8-12]. Nd: YAG vitreolysis appears to have limited efficacy, often leaving a significant amount of residues that cause persistence of the symptoms ^[8]. In addition, there is a potential risk of laser damage to the retina. Conversely, PPV is curative, since vitreous opacities can be permanently removed. Although reported complication rates are relatively low, vitrectomy is invasive and development of iatrogenic retinal breaks and cataract are concerns^[9,10]. As floater treatment is mostly patient-driven with lack of objective signs to support the indication of the surgery, it is still a debate whether the symptoms of the patients justify the potential risks.

In this study, members of the European VitreoRetinal Society (EVRS) retrospectively reported the outcome and safety for treatment of vitreous floaters. This study aimed to investigate the post-treatment patient satisfaction levels and complications of PPV for vitreous floaters in a large set of patients.

Page 1 of 5

Methods

CME Information

Abstract and Introduction
Methods
Results
Discussion
Summary

Disclaimer

The educational activity presented above may involve simulated, case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient, whether living or deceased, is intended or should be inferred. The material presented here does not necessarily reflect the views of Medscape, LLC, or any individuals or commercial entities that support companies that support educational programming on medscape.org. These materials may include discussion of therapeutic products that have not been approved by the US Food and Drug Administration, off-label uses of approved products, or data that were presented in abstract form. These data should be considered preliminary until published in a peer-reviewed journal. Readers should verify all information and data before treating patients or employing any therapies described in this or any educational activity. A qualified healthcare professional should be consulted before using any therapeutic product discussed herein.

Table 1.

Table 2.

Table 3.

References

Faculty and Disclosures

Faculty

Ece Ozdemir Zeydanli, MD

Barbara Parolini, MD

Sengul Ozdek MD, FEBO

Silvia Bopp, MD

Ron A. Adelman, MD, MPH

Ferenc Kuhn, MD

Giampaolo Gini, MD

Ahmed Sallam, MD

Nur F. Bryan Aksakal, MD

Editor

Sobha Sivaprasad, MD

CME Author

Laurie Barclay, MD

CME Reviewer

Hazel Dennison, DNP, RN, FNP, CPHQ, CNE

CME

Management of Vitreous Floaters: An International Survey. The European VitreoRetinal Society Floaters Study Report

Target Audience and Goal Statement

Disclosures

Faculty

Ece Ozdemir Zeydanli, MD

Barbara Parolini, MD

Sengul Ozdek MD, FEBO

Silvia Bopp, MD

Ron A. Adelman, MD, MPH

Ferenc Kuhn, MD

Giampaolo Gini, MD

Ahmed Sallam, MD

Nur F. Bryan Aksakal, MD

Editor

Sobha Sivaprasad, MD

CME Author

Laurie Barclay, MD

CME Reviewer

Hazel Dennison, DNP, RN, FNP, CPHQ, CNE

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Management of Vitreous Floaters: An International Survey. The European VitreoRetinal Society Floaters Study Report

Abstract and Introduction

Abstract

Introduction

Table of Contents