1
|
Hammer M, Muuss M, Schickhardt S, Scheuerle A, Khoramnia R, Łabuz G, Uhl P, Auffarth GU. Forward Light Scattering of the Vitreous Gel After Enzymatic Aging: An In Vitro Model to Study Vitreous Opacification. Invest Ophthalmol Vis Sci 2024; 65:36. [PMID: 38551585 PMCID: PMC10981431 DOI: 10.1167/iovs.65.3.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/04/2024] [Indexed: 04/01/2024] Open
Abstract
Purpose Symptomatic vitreous opacifications, so-called floaters, are difficult to objectively assess majorly limiting the possibility of in vitro studies. Forward light scattering was found previously to be increased in eyes with symptomatic floaters. Using an objective setup to measure forward light scattering, we studied the effects of enzymatically digesting the components of the vitreous body on straylight to develop an in vitro model of vitreous opacifications. Methods Fifty-seven porcine vitreous bodies were digested using hyaluronidase, collagenase, trypsin, and bromelain, as well as using a combination of hyaluronidase + collagenase and hyaluronidase + bromelain. A modified C-Quant setup was used to objectively assess forward light scattering. Results Depletion of hyaluronic acid majorly increased vitreous straylight (mean increase 34.4 deg2/sr; P = 0.01), whereas primarily digesting the vitreous gel with collagenase or trypsin did not significantly affect straylight. When collagenase or bromelain is applied in hyaluronic acid depleted vitreous gels, the increase in forward light scattering is reversed partially. Conclusions The age-related loss of hyaluronic acid primarily drives the increase in vitreous gel straylight induced by conglomerates of collagen. This process can be reversed partially by digesting collagen. This in vitro model allows the objective quantification and statistical comparison of straylight burden caused by vitreous opacities and, thus, can serve as a first testing ground for pharmacological therapies, as demonstrated with bromelain.
Collapse
Affiliation(s)
- Maximilian Hammer
- University Eye Clinic Heidelberg, Heidelberg, Germany
- The David J Apple Laboratory for Vision Research, Heidelberg, Germany
| | - Marcel Muuss
- University Eye Clinic Heidelberg, Heidelberg, Germany
- The David J Apple Laboratory for Vision Research, Heidelberg, Germany
| | - Sonja Schickhardt
- The David J Apple Laboratory for Vision Research, Heidelberg, Germany
| | | | | | - Grzegorz Łabuz
- University Eye Clinic Heidelberg, Heidelberg, Germany
- The David J Apple Laboratory for Vision Research, Heidelberg, Germany
| | - Philipp Uhl
- Institute for Pharmacy and Molecular Biotechnology, Heidelberg, Germany
| | - Gerd Uwe Auffarth
- University Eye Clinic Heidelberg, Heidelberg, Germany
- The David J Apple Laboratory for Vision Research, Heidelberg, Germany
| |
Collapse
|
2
|
Valentín-Bravo FJ. Vitreous opacities: A common but poorly understood phenomenon. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:47-48. [PMID: 37944643 DOI: 10.1016/j.oftale.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/26/2023] [Indexed: 11/12/2023]
Affiliation(s)
- F J Valentín-Bravo
- The Retina Clinic London, London, United Kingdom; Hospital Germans Trias i Pujol, Barcelona, Spain.
| |
Collapse
|
3
|
Wu G, Zhao W, Wong A, Lee DA. Patients with floaters: Answers from virtual assistants and large language models. Digit Health 2024; 10:20552076241229933. [PMID: 38362238 PMCID: PMC10868475 DOI: 10.1177/20552076241229933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 02/17/2024] Open
Abstract
Objectives "Floaters," a common complaint among patients of all ages, was used as a query term because it affects 30% of all people searching for eye care. The American Academy of Ophthalmology website's "floaters" section was used as a source for questions and answers (www.aao.org). Floaters is a visual obstruction that moves with the movement of the eye. They can be associated with retinal detachment, which can lead to vision loss. With the advent of large language model (LLM) chatbots ChatGPT, Bard versus virtual assistants (VA), Google Assistant, and Alexa, we analyzed their responses to "floaters." Methods Using AAO.org, "Public & Patients," and its related subsection, "EyeHealth A-Z": Floaters and Flashes link, we asked four questions: (1) What are floaters? (2) What are flashes? (3) Flashes and Migraines? (4) Floaters and Flashes Treatment? to ChatGPT, Bard, Google Assistant, and Alexa. The American Academy of Ophthalmology (AAO) keywords were identified if they were highlighted. The "Flesch-Kincaid Grade Level" formula approved by the U.S. Department of Education, was used to evaluate the reading comprehension level for the responses. Results Of the chatbots and virtual assistants, Google Assistant is the only one that uses the term "ophthalmologist." There is no mention of the urgency or emergency nature of floaters. AAO.org shows a lower reading level vs the LLMs and VA (p = .11). The reading comprehension levels of ChatGPT, Bard, Google Assistant, and Alexa are higher (12.3, 9.7, 13.1, 8.1 grade) vs the AAO.org (7.3 grade). There is a higher word count for LLMs vs VA (p < .0286). Conclusion Currently, ChatGPT, Bard, Google Assistant, and Alexa are similar. Factual information is present but all miss the urgency of the diagnosis of a retinal detachment. Translational relevance: Both the LLM and virtual assistants are free and our patients will use them to obtain "floaters" information. There may be errors of omission with ChatGPT and a lack of urgency to seek a physician's care.
Collapse
Affiliation(s)
- Gloria Wu
- Department of Ophthalmology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Weichen Zhao
- University of California, Davis, Davis, California, USA
| | - Adrial Wong
- University of California, Davis, Davis, California, USA
| | - David A Lee
- University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| |
Collapse
|
4
|
Valentín-Bravo FJ, Stanga PE, Martínez-Tapia SA, Mejía-Freire S, Stanga SEF, Usategui-Martín R, Andrés-Iglesias C, Pastor-Idoate S. Visualization and Identification of Silicone Oil Emulsification Using Dynamic Infrared Confocal Scanning Laser Ophthalmoscopy. Case Rep Ophthalmol 2024; 15:36-40. [PMID: 38196924 PMCID: PMC10776133 DOI: 10.1159/000535746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/26/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction Silicone oil (SO) is a crucial agent used as an intraocular tamponade in the treatment of complex vitreoretinal diseases. Despite its effectiveness, SO is prone to emulsification, which can lead to significant and sometimes irreversible complications in both the anterior and posterior segments of the eye. The detection and monitoring of SO emulsification are therefore of paramount importance. Traditional imaging modalities have limitations in visualizing SO, leading to the exploration of more advanced imaging techniques. This study introduces the application of dynamic infrared confocal scanning laser ophthalmoscopy (IRcSLO) for this purpose and evaluates its effectiveness. Case Presentation We report on 2 patients who underwent pars plana vitrectomy with subsequent SO injection for the management of retinal detachment. Postsurgery, both patients were imaged using the Heidelberg Retina Tomography Spectralis IRcSLO. The focus was on the visualization of the SO status, including the presence and distribution of emulsified SO droplets. The IRcSLO imaging technique demonstrated its capability to effectively visualize emulsified SO droplets. Interestingly, this was also true for cases where the SO had been removed. The emulsified droplets were observed as micron-sized, spherical entities with a nonuniform distribution throughout the vitreous cavity. Conclusion Dynamic IRcSLO has proven to be an effective imaging modality for visualizing the emulsification of SO, offering a novel perspective into the characterization of SO droplets. It facilitates the analysis of droplet count, motility, and precise localization within the vitreous cavity. The findings from the case presentations underscore the variability of SO emulsification patterns and the sensitivity of IRcSLO in detecting even minuscule emulsified droplets. This imaging technique has significant potential for future research, particularly in understanding the timing of emulsification, the factors contributing to it, and the development of possible preventive strategies. Additionally, it allows for a more in-depth analysis of the behavior of emulsified SO droplets across different SO viscosities, which could be instrumental in optimizing patient outcomes.
Collapse
Affiliation(s)
| | - Paulo Eduardo Stanga
- The Retina Clinic London, London, UK
- Department of Ophthalmology, University College of London, London, UK
| | | | | | | | - Ricardo Usategui-Martín
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain
- Department of Biology, University of Valladolid, Valladolid, Spain
| | | | - Salvador Pastor-Idoate
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain
| |
Collapse
|
5
|
Lin T, Shi C, Wu B, Pazo EE, Shen L. Vision degrading myodesopsia assessed with optos ultra-widefield scanning laser ophthalmoscope. BMC Ophthalmol 2023; 23:425. [PMID: 37864149 PMCID: PMC10588225 DOI: 10.1186/s12886-023-03166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND To investigate the diagnostic sensitivity of Optos imaging for vision degrading myodesopsia (VDM). METHODS A total of 420 eyes from 345 patients with VDM were collected in this cross-sectional study. All eyes were classified as having posterior vitreous detachment (PVD) or not having PVD. The sensitivity of Optos imaging for the visibility of vitreous floaters was evaluated. The associated factors with the visibility of vitreous floaters on Optos images were analyzed in univariate and multivariate logistic regression analyses. RESULTS The mean age of all patients was 56.19 ± 13.89 years old, and 66.67% of patients were female. The vitreous floaters were visible on the ultrasound B scan in all eyes, but only in 47.62% of Optos images (55.29% in eyes with PVD and 15% in eyes without PVD). In the multiple binary logistic regression analysis, age (OR = 1.094, 95%CI = 1.063-1.125, P < 0.001), spherical equivalent (OR = 0.869, 95%CI = 0.791-0.955, P = 0.004) and the distance of the floaters from the retina (OR = 1.191, 95%CI = 1.059-1.339, P = 0.003) were significantly correlated with the visibility of vitreous floaters on Optos images. On Optos images, 25.71% of VDM eyes presented additional retinal abnormalities. CONCLUSIONS Optos imaging has a low sensitivity for vitreous floaters, particularly in eyes without PVD. On Optos imaging, floaters were more visible in older patients, eyes with greater myopia, and floaters that were further from the retina.
Collapse
Affiliation(s)
- Tiezhu Lin
- Ophthalmology Department, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
- He Eye Specialist Hospital, Shenyang, Liaoning, China
| | - Cheng Shi
- He Eye Specialist Hospital, Shenyang, Liaoning, China
- Dalian Medical University, Dalian, Liaoning Province, China
| | - Bing Wu
- He Eye Specialist Hospital, Shenyang, Liaoning, China
- Dalian Medical University, Dalian, Liaoning Province, China
| | | | - Lijun Shen
- Ophthalmology Department, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China.
| |
Collapse
|
6
|
Sharma A, Wu L, Bloom S, Stanga P, Khaqan HA, Garcia-Aguirre G, Cheung JY, Rezaei KA. RWC Update: Intruding Scleral Buckle; Vitrectomy for Floaters; Group-Type Congenital Pigmented Nevi of the RPE. Ophthalmic Surg Lasers Imaging Retina 2023; 54:500-503. [PMID: 37708226 DOI: 10.3928/23258160-20230817-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
|
7
|
Maltsev DS, Kulikov AN, Shaimova VA, Burnasheva MA, Vasiliev AS. Spotlight on Lattice Degeneration Imaging Techniques. Clin Ophthalmol 2023; 17:2383-2395. [PMID: 37605766 PMCID: PMC10440085 DOI: 10.2147/opth.s405200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023] Open
Abstract
Lattice degeneration (LD), routinely diagnosed with indirect ophthalmoscopy, is one of the most common and clinically significant peripheral retinal findings. In this review, we have summarized the data on currently available imaging techniques which help to improve diagnosis and our understanding of LD pathogenesis. Ultra-wide field imaging provides reliable color fundus capturing for the primary diagnosis of LD and may also be used as a screening tool. Wide-field imaging can be used for targeted documentation of LD lesions using true colors and with minimal optical distortions. Information on the status of the vitreoretinal interface, including detection of retinal holes, detachments, and vitreous tractions, can be obtained with peripheral structural optical coherence tomography (OCT) or scanning laser ophthalmoscopy in retro-mode. These techniques clarify the associated risks of rhegmatogenous retinal detachment. Fundus autofluorescence can provide details on atrophic changes. However, the risk of retinal detachment by means of this technique requires further investigation. OCT angiography may be successfully performed for some lesions. Taken together, OCT and OCT angiography demonstrate thinning of the choroid, alteration of local choroidal microcirculation, and, in severe lesions, involvement of the sclera. OCT angiography confirms loss of retinal microcirculation within LD lesion, which was previously shown with fluorescein angiography. In conclusion, despite relatively simple primary diagnosis, imaging of LD lesions remains challenging due to their peripheral localization. However, several new strategies, including ultra-wide field imaging, peripheral OCT, and scanning laser ophthalmoscopy, make LD imaging possible on a routine basis, improving diagnosis and understanding of LD pathogenesis.
Collapse
Affiliation(s)
- Dmitrii S Maltsev
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Alexei N Kulikov
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Venera A Shaimova
- Academy of Postgraduate Education of the Federal Scientific and Clinical Center of Specialized Medical Care and Medical Technologies, Moscow, Russia
- “Center Zreniya”, Chelyabinsk, Russia
| | - Maria A Burnasheva
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | | |
Collapse
|
8
|
Ngo WK, Keshet Y, Salcedo-Ledesma A, Walia J, Ledesma-Gil G, Spaide RF. THE WAY PATIENTS SEE FLOATERS: Widefield Dynamic Scanning Laser Ophthalmoscopy Imaging of Vitreous Abnormalities. Retina 2023; 43:1240-1245. [PMID: 36977315 DOI: 10.1097/iae.0000000000003786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
PURPOSE To investigate the use of dynamic widefield scanning laser ophthalmoscopy (SLO) and B-scan ultrasonography in imaging vitreous abnormalities in patients with complaints of floaters. METHODS Twenty-one patients underwent both dynamic SLO and B-scan ultrasonography to image their vitreous abnormalities. After reviewing these videos, patients graded each imaging technique on a scale of 1 to 10, based on how closely it represented their visual perception of floaters. RESULTS The mean age of the patients (12 women and nine men) was 47.7 ± 18.5 years. The patients graded a median score of nine for SLO imaging (mean = 8.43) compared with a median score of 5 (mean = 4.95) for ultrasound ( P = 0.001). Widefield SLO imaging demonstrated three-dimensional interconnectivity within the condensations of the formed vitreous that exhibited translational and rotational movements with eye saccades. CONCLUSION Floaters are a common complaint, but it is difficult to know whether imaging findings of the vitreous correlate to what patients perceive. Widefield SLO seems to image vitreous abnormalities related to how patients perceive their own floaters better than B-scan ultrasonography. Despite the term "floaters", the vitreous abnormalities in the videos seemed to be manifestations of a complex three-dimensional degeneration of the vitreous framework.
Collapse
Affiliation(s)
- Wei Kiong Ngo
- Vitreous Retina Macula Consultants of New York, New York, New York
| | | | | | | | | | | |
Collapse
|
9
|
Stanga PE, Valentin Bravo FJ, Reinstein UI, Stanga SFE, Marshall J, Archer TJ, Reinstein DZ. New Terminology and Methodology for the Assessment of the Vitreous, Its Floaters and Opacities, and Their Effect on Vision: Standardized and Kinetic Anatomical and Functional Testing of Vitreous Floaters and Opacities (SK VFO Test). Ophthalmic Surg Lasers Imaging Retina 2023; 54:306-315. [PMID: 37184989 DOI: 10.3928/23258160-20230412-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To introduce VFO and SK VFO Test: new, more representative terminology for symptoms of vitreous floaters/opacities (VFO) and new standardized kinetic (SK) anatomical-functional assessment. MATERIALS AND METHODS Eight eyes underwent before-after limited vitrectomy (LV): best-corrected visual acuity, low-luminance visual acuity, Minnesota Low Vision Reading Chart near visual acuity in logMAR, contrast sensitivity function (CV1000E), and straylight measurements (SM) (HDA/LDA/C-Quant). SK infrared confocal scanning laser ophthalmoscopy (SK IRcSLO) and swept-source widefield optical coherence tomography (SS-WF-OCT) identified VFO and posterior vitreous detachment (PVD). SK IRcSLO was performed with gaze directed towards the extreme superior, inferior, and lateral directions. RESULTS Anatomical-functional results after LV improved in 7 eyes (87.5%): objective scatter index (27.34%), disturbance index (47.97%) and C-Quant Log units (2.26%). Pre-LV SK IRcSLO and SS-WFOCT imaging identified dynamic well-defined VFO and PVD status (100%). A residual asymptomatic anterior cortical vitreous-induced shadowing ripple effect was detected post-LV. CONCLUSIONS This is the first objective-standardized test accounting for VFO kinesis and intermittent effect. There is potential for personalizing treatment and establishing best candidates for laser or surgery. [Ophthalmic Surg Lasers Imaging Retina 2023;54:306-315.].
Collapse
|
10
|
Marquez MA, Nadelson A, Magraner M, Haddock LJ, Fortun JA. Dynamic Infrared Imaging of Vitreous Floaters. Clin Ophthalmol 2023; 17:1169-1177. [PMID: 37089579 PMCID: PMC10120865 DOI: 10.2147/opth.s399684] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/10/2023] [Indexed: 04/25/2023] Open
Abstract
Background and Objective To evaluate the use of dynamic infrared (IR) imaging as a tool for the objective evaluation of symptomatic vitreous floaters and to correlate it with the patient symptomatology. Study Design/Materials and Methods Retrospective study that examined 66 eyes of 44 patients with symptomatic and asymptomatic vitreous opacities. Patients were imaged using the Heidelberg Spectralis dynamic infrared (IR) image in video mode to record the vitreous movements and shadow artifacts within 30 degrees of the center of the macula. Patients were also asked how symptomatic their vitreous floaters were from absent to severe. After reviewing IR videos and OCT, a grading system was created to evaluate the floaters and a masked reader was asked to evaluate the videos and OCT based on the grading system created. Results A total of 66 eyes were identified and examined with the IR videos, 50 were symptomatic, and 16 were asymptomatic. After masked review and analysis of the IR videos, there were 4 characteristics that correlated with the patient's symptoms: size, location, movement, and density of obscuration of the OCT B Scan by the vitreous opacity. A table with grading of these characteristics was created to analyze how symptomatic patients were. A masked grader was asked to grade the videos and OCT using the grading system created. A positive correlation was found between the masked grader and the symptoms of patients. (0.70039; p < 0.00001). Conclusion Dynamic IR video capture of vitreous opacities is a new imaging technique that can qualitatively assess vitreous opacities in a way that correlates to a patient's symptoms. This imaging modality can provide a qualitative assessment of the patient's severity of symptoms based on the location, density, and movement of the visualized vitreous opacities in the imaged video.
Collapse
Affiliation(s)
- Marilyn A Marquez
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Allie Nadelson
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Maria Magraner
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Luis J Haddock
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jorge A Fortun
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
- Correspondence: Jorge A Fortun, Email
| |
Collapse
|
11
|
A New Pharmacological Vitreolysis through the Supplement of Mixed Fruit Enzymes for Patients with Ocular Floaters or Vitreous Hemorrhage-Induced Floaters. J Clin Med 2022; 11:jcm11226710. [PMID: 36431188 PMCID: PMC9695351 DOI: 10.3390/jcm11226710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: Ocular floaters caused by vitreous degeneration or blood clots may interfere with various visual functions. Our study investigated the pharmacologic effects of oral supplementation of mixed fruit enzymes (MFEs) for treating spontaneous symptomatic vitreous opacities (SVOs) and those secondary to vitreous hemorrhage (VH). Methods: 224 patients with monocular symptomatic vitreous opacities (SVOs) were recruited between September and December 2017 and received oral supplementation of MFEs (190 mg bromelain, 95 mg papain, and 95 mg ficin) for 3 months in a double-blind clinical trial. Participants were divided according to the etiology of the SVOs, spontaneous (experiment 1) versus VH (experiment 2), and then randomly assigned into four treatments groups: one group received oral vitamin C, as a placebo; and the other 3 groups received 1 capsule per day (low dose), 2 capsules per day (middle dose), or 3 capsules per day (high dose) of MFEs. The number of SVOs was determined at baseline and then 1, 2, and 3 months after initiating treatment. Further, in cases secondary to VH, the changes in corrected distance visual acuity (CDVA) were assessed after 3 months. Second, we compared the free radical scavenging capabilities of each substance: vitamin C, bromelain, papain, ficin, and MFEs (combination of bromelain, papain, and ficin) by DDPH assay. Finally, SVOs-related symptoms and satisfaction with the treatments were evaluated at the last follow-up visit Results: In experiment 1, the disappearance rate of SVOs was 55%, 62.5%, and 70% after taking 1, 2, and 3 capsules daily, respectively (total p < 0.001), in a dose-dependent manner. In experiment 2, the disappearance rate of VH-induced SVOs was 18%, 25%, and 56% (p < 0.001) after 1, 2, and 3 capsules of the supplement daily, respectively. Additionally, the patients’ vision elevated from 0.63LogMAR to 0.19LogMAR (p = 0.008). Conclusions: A pharmacological approach using a high dose of oral supplementation with MFEs (bromelain, papain, and ficin) was effective in reducing vitreous opacities, even after intraocular hemorrhage. Furthermore, pharmacologic vitreolysis with MFEs supplementation showed high patient satisfaction, and also improved CDVA in patients with vitreous hemorrhage-induced floaters
Collapse
|