NdYAG LASER VITREOLYSIS Franc ALAMUN MD Andreja VESELICA

Nd-YAG LASER VITREOLYSIS Franc ŠALAMUN, MD Andreja VESELICA, MD Medical Center VID, Nova Gorica 11. slovenski oftalmološki kongres Portorož 2016

Options for floaters treatment • Do nothing…“try to live with it” • Perform YAG Laser Vitreolysis • Perform Vitrectomy

Nd-YAG laser vitreolysis • Simple outpatient base procedure which vaporizes strands and opacities

Pioneers • Prof. Aron Rosa (Paris), Prof. Franz Fankhauser (Bern), 1980 s

Operation principle • laser light creates small plasma explosions in the vitreus in order to vaporize collagen and HA molecules • gas which is produced is absorbed in the eye

Patients selection • Ideal: older than 45 with Weiss type PVD • To avoid: young patients with thin dense multiple dots floaters close to the retina

Contraindications • Not associated with active retinal pathology • Not associated with active inflammation. • Floaters present less than 2 months • Flashes of light suggesting an incomplete posterior vitreous detachment

Technical specifications • Ellex ULTRA Q Reflex Nd-YAG laser • Pulse duration 4 ns, spot 8 µm, energy 2 -5 m. J, 500 max shots

Safety rules • Do not treat closer that 4 mm from the retina • Do not treat closer than 3 mm from the lens • Don‘t treat over the macula

Possible complications • Shock wave contusion of retina • Retinal hemmorhage • Traumatic cataract • Increased IOP • Uveitis

Results from literature • 85 % success (112 eyes) Geller S. Nd-YAG laser treatment effective for floaters. OSN, Dec. 1, pg. 37, 2001. • 92 % success (200 eyes) Karickhoff JR. Laser Treatment of Eye Floaters, 2 nd Edition. Washington Medical Publishing. 2006. • 93 % success (296 eyes) Singh IP. Vitreous floaters - an under appreciated and under treated problem: patient satisfaction and complications of YAG vitreolysis. Paper presented at: ASCRS/ASOA Symposium & Congress; April 17 -21, 2015; San Diego, CA.

Our results • From february 2016 we treated 10 patients • 9 patients noticed improvement • 3 patients are very satisfied • Learning curve with no side effects

Conclusion …Too early for our own conclusions…

THANK YOU! Franc ŠALAMUN, MD Andreja VESELICA, MD Medical Center VID, Nova Gorica