COMMENTARY

Weighing the Risks of Treating Floaters With Vitrectomy

Sophie J. Bakri, MD

Disclosures

March 19, 2021

In most clinical practices, floaters related to a posterior vitreous detachment are a common patient concern, especially in those with advancing age. Fortunately, floaters often become less symptomatic with time, and very few patients ultimately require surgical procedures to address them.

The need for intervention can arise when floaters become chronic and significant. A further consideration is that patients presenting with concurrent floaters and vitreous hemorrhage also have a greater risk for retinal tear.

When it comes to chronic, symptomatic vitreous floaters, it can be difficult to gauge whether we should intervene, and if so, determine the best intervention.

YAG laser vitreolysis can disrupt floaters but it does not remove them. The procedure is also known to have variable results.

Conversely, vitrectomy is seen as a more definitive surgery in this indication but one whose invasiveness is associated with relatively greater risks, such as intraoperative retinal tearing and postoperative retinal detachments.

In a recent retrospective analysis, investigators sought to define the risks of undergoing vitrectomy for floaters using the American Academy of Ophthalmology’s Intelligent Research in Sight (IRIS) Registry, a comprehensive eye disease database drawing from numerous US clinical ophthalmology practices. Their primary objective was to ascertain the rate of return to the operating room and reasons for reoperation among 17,615 eyes identified as having undergone vitrectomy for vitreous opacities only, without another retinal disease.

The investigators reported that 16.1% of eyes needed to return to the operating room for another surgical procedure within a year. The rate of return was 3.7% for a non-cataract procedure and 2.6% for retinal detachment. In phakic eyes, cataract is an expected complication of a vitrectomy, and the rate of cataract surgery was 12.4% within 1 year. Approximately 28% of patients in this registry cohort were already pseudophakic at vitrectomy.

This study confirms that although vitrectomy is safe in the majority of cases, there is an approximately 3% risk for retinal detachment in the first year. The risk for cataract surgery will also increase with time in these post-vitrectomy eyes. Although there is still much to learn about the postoperative outcomes of vitrectomy surgery, these findings nonetheless provide important information that we can use to appropriately counsel our patients.

Sophie J. Bakri, MD, a long-time contributor to Medscape, specializes in diseases and surgery of the retina and vitreous, including age-related macular degeneration. She also undertakes both clinical and translational research in the pathogenesis and treatment of retinal diseases.

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