EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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125 EW RETINA Clinical recommendations For physicians who are starting out with this procedure Dr. Shah recom- mended practicing on a model eye because it's the first time that they'll be vaporizing tissue in three dimen- sions. "We're accustomed to lasering the retina or the posterior capsule or the iris," he said. "This is the first time that you're lasering something that is bouncing all around every time you hit it." Dr. Shah recommended starting with pseudophakic patients with Weiss ring floaters. "Weiss rings are the most fibrous; they tend to absorb the energy and vaporize February 2018 Eye with a Weiss ring floater Watch an eye with a floater undergoing YAG vitreolysis on EWAR Eye after it has undergone YAG vitreolysis to treat Weiss ring floater Source: Chirag Shah, MD nicely," Dr. Shah said. Choosing pseudophakic patients is important because while practitioners often think that laser beams fire forward and the energy carries forward, for a YAG laser, the cone of energy comes back toward the surgeon, so you're at a greater risk of hitting the crystalline lens than of hitting the retina. You want to have a larger margin between what you're hitting and the crystalline lens than you do between what you're hitting and the retina. "In our study we required a 3 mm buffer between the Weiss ring floater and the retina and 5 mm between the Weiss ring and the pos- terior surface of the crystalline lens, as measured by B-scan ultrasound," he said. Dr. Shah hopes that practi- tioners come away from the trial with a new appreciation of the YAG vitreolysis procedure. "I think many of us discount the procedure," he said, adding that this trial lends some credence to its efficacy and safety. This small trial showed that patients are moderately improved with a single session of YAG vitre- olysis, and there was a good safety profile. More studies are needed, and Dr. Shah would like to see a large multicenter randomized controlled trial to better understand which floater types and which patient types are ideal for this procedure. EW Reference 1. Shah CP, et al. YAG laser vitreolysis vs. sham YAG vitreolysis for symptomatic vitreous floaters: a randomized clinical trial. JAMA Ophthalmol. 2017;135:918–923. Editors' note: Dr. Shah has financial interests with Ellex (Adelaide, Austra- lia). Contact information Shah: cpshah@eyeboston.com ASCRS.org/center-for-learning