23G pars plana vitrectomy for vitreal floaters: prospective assessment of subjective self-reported visual impairment and surgery-related risks during the course of treatment

Patient-reported outcomes in patients with vitreous floaters: A systematic literature review

Seeking treatment for bothersome vitreous floaters is patient driven. To measure the impact of floaters and treatment on an individual's quality of life, patient-reported outcome measurements (PROMs) are essential. We review all studies using a PROM for patients with floaters. We evaluated content coverage against quality-of-life domains previously identified in other ophthalmic disorders, and against a qualitative study investigating quality-of-life issues in patients with floaters. We assessed measurement properties of PROMs using an extensive range of psychometric quality criteria. We identified 59 studies using 28 different PROMs. Many PROMs were not specifically developed for patients with floaters. Floater-specific PROMs were mostly based on content validation from an ophthalmologist or researcher perspective; two included a patient perspective. Using the outcomes of the qualitative study, we found that the floater-specific PROMs were narrow in their content coverage, with most items relating to visual symptoms and activity limitations. Testing the psychometric quality of PROMs was rare, and when employed mostly limited to responsiveness and known group validity. The remarkable high number of floater-specific PROMs reveals a need for such measurements in ophthalmology. Unfortunately, reporting on psychometric quality is limited, and content development is most often done without patient involvement.

[Functional results and complications in the long-term follow-up after 25-gauge vitrectomy of epiretinal membrane]

BACKGROUND

Idiopathic epiretinal membranes can lead, among other things, to visual impairment and metamorphopsia. The treatment of choice is a pars plana vitrectomy with removal of the membrane. The improvement of visual acuity and postoperative complications have already been described in several studies.

OBJECTIVE

The aim of this retrospective study is to evaluate the long-term outcome of at least 3 years.

MATERIAL AND METHODS

In the period from 2011 to 2016, a total of 667 eyes underwent 25-gauge pars plana vitrectomy, membranectomy and peeling of the ILM (Internal limiting membrane) because of epiretinal membrane by the same surgeon. This study included 51 eyes from 51 patients who had returned to our clinic after at least 3 years. For the follow-up, data were collected after 3 months and then annually, if available. The mean follow-up time was 57 months (37-104 months). In the postoperative follow-up visual acuity, intraocular pressure and complications were recorded.

RESULTS

Of the 51 eyes included 34 had a 25-gauge pars plana vitrectomy with phacoemulsification and artificial lens implantation, 8 eyes without phako and 9 eyes were already pseudophakic. The most common complication in the follow-up period was a persistent macular edema with 5.9% (3 eyes) and a recurrence of epiretinal membrane in 5.9% of cases. The best corrected logMar visual acuity was 0.4 (0.1-1.3; n = 51) preoperatively, at the last examination 0.23 (0-1.0; n = 51, p < 0.001). Three months postoperatively, the logMar visual acuity was 0.29 (n = 41), after 1 year 0.25 (n = 35), 2 years 0.23 (n = 29), after 3 years 0.26 (n = 29), after 4 years 0.27 (n = 27), after 5 years 0.24 (n = 17) and after 6 years 0.24 (n = 13).

CONCLUSION

The 25-gauge pars plana vitrectomy is a low complication procedure for the removal of epiretinal membranes. The clearest increase in visual acuity can be seen within the first 3 months postoperatively, but then stabilizes. In the long-term follow up a change in visual acuity can also be found after more than 3 years.

[The Management of Vitreous Opacities]

The management of symptomatic vitreous opacities is often complicated in daily practice. The technically significantly improved surgical possibilities lead to an increased number of surgical interventions. The Nd:YAG laser vitreolysis is increasingly becoming a therapeutic option. Unfortunately, there are no comparative randomized studies on vitrectomy, Nd:YAG laser vitreolysis and a wait-and-see approach to spontaneous progress. This article gives an overview of this problem.

Das Management von Glaskörpertrübungen

Das Management von symptomatischen Glaskörpertrübungen stellt sich in der täglichen Praxis oft als kompliziert dar. Die Nd:YAG-Laser-Vitreolyse rückt als weitere therapeutische Option immer mehr in den Fokus. Vergleichende randomisierte Studien zur Vitrektomie, Nd:YAG-Laser-Vitreolyse und einer abwartenden Vorgehensweise zum Spontanverlauf gibt es leider nicht. Dieser Beitrag versucht, zu dieser Problematik einen Überblick zu geben.

[Classification of floater patients : Evaluation of a study database on the relationship between characteristics and impairment]

Subjective impairment of floater patients can only be partially quantified using ophthalmological test methods. In order to classify floater patients, patient-related characteristics associated with higher level of impairment should be identified. A data set of a prospective, multicenter single-arm primary study of 64 floater patients who underwent vitrectomy includes patient-related characteristics and information on subjective preoperative and postoperative (3 months after vitrectomy) impairment. Data on impairment were collected with a floater-specific questionnaire and condensed into self-rated impairment indices (SRI). Medians of the SRI were calculated for the manifestation of sociodemographic and ophthalmological parameters as well as for the classification of floaters on the study and second eye and tested for significance. Higher preoperative SRI were associated with professional activity, young age, reduced preoperative visual acuity, retinal alterations and higher refractive errors as well as floaters on the second eye. Higher postoperative SRI were found in combination with cataract and younger age. The SRI differences were only occasionally significant. Classification of floaters as documented by the surgeon and by SRI were significantly correlated only for patients without other visual comorbidities besides floaters. The primary study reported high preoperative subjective impairment and a significant decrease in SRI after vitrectomy for almost all patients. The current study showed that some individual patient-related characteristics tended to be associated with greater preoperative impairment and greater benefit from vitrectomy.