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Letter to the Editor

Floaterectomy—Risks, Safety, and Future

Radke, Nishant MS1; Lam, Dennis S.C. MD, FRCS, FRCOphth2

Author Information
Asia-Pacific Journal of Ophthalmology: May 2017 - Volume 6 - Issue 3 - p 304
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Reply

We thank Dr. Tripathy for his interest in our article and appreciate the concerns raised.

We do not have data on the percentage and type of posterior vitreous detachment (PVD) in these patients, but this suggestion is indeed an interesting one to be incorporated in further studies.

The studies by Mason et al,1 Sebag et al,2 and Schulze-Key et al3 quoted in our study have already mentioned the risks of vitrectomy and the complications associated with it, thereby highlighting the need for a better and safer treatment, which we believe should also be cost effective and efficacious.

In his study, Sebag found that leaving a skirt of anterior vitreous behind coupled with no induction of PVD resulted in fewer complications. We based our hypothesis on this. All the risks and potential benefits were clearly conveyed, educational material shared, and informed consents obtained. Case selection was strictly based on patients who were still bothered by troublesome floaters after at least 3 months of observation.

We agree to the general notion that anterior floaters do not trouble patients much, but large floaters can still cause visual disturbances. Cases were selected only after an initial period of observation failed to relieve patients' symptoms. A good core vitrectomy, as discussed in our methodology, has resulted in a high level of satisfaction subjectively. We also performed intraoperative binocular indirect ophthalmoscopy, as explained in our methodology, to verify whether the fundus was normal for added safety. Intraoperative patient communication was also used to verify clearance of floaters beyond the surgeon's assessment.

Suturing of sclerotomies is against the current trend. Disposable single-use 23-gauge trocar cannula sets and good wound construction of sclerotomies are essential to achieve self-sealing wounds, thus avoiding hypotony. This method includes neither a complete vitrectomy nor vitreous base excision. Thus, a plug of vitreous near the base facilitates a self-sealing sclerotomy. We considered intraocular pressure less than 6 mm Hg as a cut off for the definition of hypotony.4

Three months is a short period of time, but wound healing is usually complete well before this time; the overlap of natural course plays an important role thereafter as a confounding variable. The decision to treat was made only after a careful case selection of highly motivated individuals who understood the complications associated with vitrectomy. The 6-month data have already been collected and are being analyzed. We hope the long-term outcomes will be as encouraging as the preliminary results as well. Overall, we still feel there is a lack of consensus and hence a multicenter, multinational trial has been proposed to address this contentious issue.

Nishant Radke MS

Dennis S.C. Lam MD, FRCS, FRCOphth

C-MER (Shenzhen) Dennis Lam Eye Hospital

Futian District, Shenzhen, China

C-MER (Shenzhen) Dennis Lam Eye Hospital

Futian District, Shenzhen, China

Dennis Lam & Partners Eye Center

Central, Hong Kong

REFERENCE

1. Mason JO 3rd, Neimkin MG, Mason JO 4th, et al. Safety, efficacy, and quality of life following sutureless vitrectomy for symptomatic vitreous floaters. Retina. 2014; 34:1055-1061.
2. Sebag J, Yee KM, Wa CA, et al. Vitrectomy for floaters: prospective efficacy analysis and retrospective safety profile. Retina. 2014;34: 1062-1068.
3. Schulz-Key S, Carlsson JO, Crafoord S. Longterm follow-up of pars plana vitrectomy for vitreous floaters: complications, outcomes, and patient satisfaction. Acta Ophthalmol. 2011;89:159-165.
4. Ahn SJ, Woo SJ, Ahn J, et al. Comparison of postoperative intraocular pressure changes between 23-gauge transconjunctival sutureless vitrectomy and conventional 20-gauge vitrectomy. Eye. 2012;26:796-802.
© 2017 by Asia Pacific Academy of Ophthalmology