Yttrium aluminum garnet (YAG) laser vitreolysis (YLV) has recently gained prominence for the treatment of symptomatic vitreous opacities (floaters) and may be considered as an alternative to pars plana vitrectomy.
YAG laser vitreolysis has previously been compared to sham and been found to be safe and efficacious. Pre-treatment examination should be centered on the patient history, in particular impact on activities of daily living (ADL). Furthermore, active inflammation (vitritis) and active retinal pathology (posterior uveitis) should be ruled out before considering treatment. In general, eyes with a recent posterior vitreous detachment should be monitored for at least 6-12 months to allow for neuroadaptation prior to considering YLV. In eyes with pre-existing lattice degeneration or retinal holes, laser retinopexy should be considered prior to YVL. Strong lenticular astigmatism can be a challenge for the procedure as it may make focusing the laser difficult. The ideal candidates for YLV are as follows:
Enface swept source vitreous OCT (Zeiss Plex Elite, Carl Zeiss Meditec, Germany) demonstrating a hyperreflective diffuse opacity in the vitreous cavity of the patient depicted in Figure 18.2.1.
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