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Complications of Laser Vitreolysis

Scott Geller MD Feike Gerbrandy MD Fort Myers, Florida Amsterdam, Netherlands.

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Complications of Laser Vitreolysis

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  1. Scott Geller MDFeikeGerbrandy MD Fort Myers, Florida Amsterdam, Netherlands In spite of two decades of reports of successful outcomes for laser vitreolysis, the Ophthalmic community has been slow to adopt this treatment modality, in part due to lack of large clinical studies of complication rates. We reviewed the medical records of 3 Ophthalmologists who performed laser vitreolysis during the year 2011 on 542 eyes of 502 patients. • Surgeon 1 (SG) • 25 years experience • LASAG Microruptor II YAG • 691 sessions • 219 patients • 232 eyes average • 4.7 mJ/pulse • 435 p/session • Surgeon 2 (JK) • 12 years experience • Ellex YAG • 308 sessions • 140 patients • 140 eyes average • 8.0 mJ/pulse • 150 p/session • Surgeon 3 (FG) • 3 years experience • Zeiss Visulase YAG • 302 session • 143 patients • 170 eyes average • 6.8 mJ/pulse • 378 p/session Complications of Laser Vitreolysis OBSERVED COMPLICATIONS • 3 eyes elevated IOP (>30) 1 phakic, 2 pseudophakic; 7050 mJ total average engergy • 2 patients (1 phakic, 1 pseudophakic) returned to normal IOP after 5 months medical therapy • 1 patient required cyclodialysis surgery after 2 months unsuccessful (IOP 36) medical therapy • 3 eyes elevated IOP(2phakic, 1 pseudophakic), 12419 mJ total average energy • 2 eyes retinal hematoma with no visual sequelae (1 eye had BRVO 3.5 months post laser) • 1 eye retinal tear 2 weeks post laser 2 sessions 2729 mJ 806 pulses • 1 eye presumed lens opacity unconfirmed by a second ophthalmologist CONCLUSION Experienced surgeons have a very low complication rate Retinal detachment is NOT a significant issue with laser vitreolysis Elevated intraocular pressure is a major concern, more so with high power/pulse settings in pseudophakes

  2. Safety of Floaterlaser or YAG vitreolysis, the learning curve of 500 eyes Complicaties van eerste 150 ogen (1) vergeleken met volgende 350 ogen(2): Groep 1: direct complications 2.6% 3x retinal hit 1x traumatic cataract late adverseevents: 1x retinaldetachment (0,66%), 1x elevated IOP (0,66%). Groep 2: direct complications 0% 0x retinal hit 0x traumatic cataract late adverseevents: 2x retinaldetachment (0,57%) 4x elevated IOP (1,14%) Conclusie: YAG vitreolysis heeft laag risico indien uitgevoerd door een ervaren oogarts. Er is een lange leercurve. Dit pleit ervoor dat floaterlaser als subspecialisme door een beperkt aantal ervaren oogartsen moet worden uitgevoerd. Oogdrukstijging staat los van ervaring. Feike Gerbrandy, Amstelveen

  3. Safety of Floaterlaser or YAG vitreolysis, the learning curve of 500 eyes Complicaties van eerste 150 ogen (1) vergeleken met volgende 350 ogen(2): Groep 1: direct complications 2.6% 3x retinal hit 1x traumatic cataract late adverseevents: 1x retinaldetachment (0,66%), 1x elevated IOP (0,66%). Groep 2: direct complications 0% 0x retinal hit 0x traumatic cataract late adverseevents: 2x retinaldetachment (0,57%) 4x elevated IOP (1,14%) Conclusie: YAG vitreolysis heeft laag risico indien uitgevoerd door een ervaren oogarts. Er is een lange leercurve. Dit pleit ervoor dat floaterlaser als subspecialisme door een beperkt aantal ervaren oogartsen moet worden uitgevoerd. Oogdrukstijging staat los van ervaring. Feike Gerbrandy, Amsterdam www.floaterlaser.nl

  4. Safety of Floaterlaser or YAG vitreolysis, the learning curve of 500 eyesFeike Gerbrandy, MD Background: Floaterlaser, YAG vitreolysisornebulotrypsia is a laser treatment of vitreous floaters. Worldwidethere are only a handfull of ophthalmologistsable to performthistreatment. Theyfounded the International Society of Vitreous Laser Surgery (ISVLS). The members of the ISVLS cooperate in research and treatmentprotocols. Feike Gerbrandy starteddoing floaterlaser in 2009. Sincethenhe has treatedabout 750 eyes In a recent studybyhis team (submittedforpublication)about 86% of patients are satisfiedwith the result. These data show that most disturbingfloaters canbesuccesfullytreatedby laser. As withmanytreatments: after the pioneers have showed the wayfollowerswillcome: more ophthalmologistswill want to learn floaterlaser. Feike Gerbrandy, Amsterdam www.floaterlaser.nl

  5. Safety of Floaterlaser or YAG vitreolysis, the learning curve of 500 eyes First 500 cases wereanalysedforcomplications: First 150 eyes (group 1) werecomparedwithfollowing 350 (group 2): Group 1: direct complications 2.6% 3x retinal hit 1x traumatic cataract late adverseevents: 1x retinaldetachment (0,66%), 1x elevated IOP (0,66%). Group 2: direct complications 0% 0x retinal hit 0x traumatic cataract late adverseevents: 2x retinaldetachment (0,57%) 4x elevated IOP (1,14%) Feike Gerbrandy, Amsterdam www.floaterlaser.nl

  6. Safety of Floaterlaser or YAG vitreolysis, the learning curve of 500 eyes Evaluation: In the first 150 eyes the lens or retina was hit in 2.6% of eyes, versus 0% in the following 350 eyes. Thisclearlyillustrates the learning curve of thistechnique. Conclusion: Floaterlaser of YAG vitreolysisornebulotrypsia is a low risk and safe procedure ifperformedbyanexperiencedophthalmologist. The patientdemandforthis procedure is increasing. Feike Gerbrandy, Amsterdam www.floaterlaser.nl

  7. Feike Gerbrandy, Amstelveen

  8. Basiscursus Floaterlaser 2013Morgen 10.30 Zaal 1 Feike Gerbrandy Opsis Oogziekenhuis Amsterdam www.floaterlaser.nl Feike Gerbrandy, Amsterdam

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