YAG Laser Vitreolysis – Floater Busting Ellex Nanopulse Laser Innovations Symposium ECSRS 2012, Milan, Italy Jaap J. Dito / Feike Gerbrandy Opsis Amstelveen The Netherlands www.floaterlaser.nl Question 1 Who would have thought, 10 years ago, that cataract could be treated with laser therapy? Question 1 continued Who would have thought, 10 years ago, that cataract could be treated with laser therapy? Yes 97% No 3% Question 2 Today, how many people think that floaters can be treated with YAG laser therapy? Opsis , Amstelveen, The Netherlands Question 2 Today, how many people think that floaters can be treated with YAG laser therapy? No 97% Yes 3% Feike Gerbrandy, Amstelveen Floaters: Treatment Options 1. Observation only: “nothing to worry about, just ignore them” 2. Surgical removal of the vitreous (vitrectomy) • highly invasive procedure that carries a significant risk of complications, such as retinal detachment, macular edema, anterior vitreous detachment and residual floaters • may also cause an impression of shadows across the visual pathways Feike Gerbrandy, Amstelveen Floaters: Treatment Options 3. YAG Laser Vitreolysis • Vaporize the clumps and cut a “peep hole” through the membranes using a nanopulse YAG laser • Painless, outpatient based procedure • High success rate • The method is not generally taught or endorsed by medical schools – difficult to perform; long learning curve Feike Gerbrandy, Amstelveen My Experience with YAG Laser Vitreolysis • • • • • • +300 eyes treated Low complication rate Effective for 70-95% of floaters Decreased symptoms; never complete resolution High degree of patient satisfaction Strong patient uptake: internet access = high patient awareness • Patients travel from Belgium, Canada, Indonesia, Russia, Ukraine, etc…) Feike Gerbrandy, Amstelveen Best Results with Weiss Ring • 44 eyes (17 pseudophakic, 25 phakic) • Follow up over 298 days (31721 days) • Floater score = 8.01 to 2.3 • Succes 95.5% Floater score is a subjective scale from 1-10. • 1 no complants • 10 severe complaints Treatment Guidelines • • Complaints of floaters; refer or treat only pseudophakic eyes in the beginning Indication for YAG laser treatment • complaints > 3 months • subjective floaterscore of 5.5 or higher • Safe distance from retina or lens Feike Gerbrandy, Amstelveen Treatment Guidelines continued • Purpose of the treatment is to minimize the symptoms, not to completely remove them • More info on www.floaterlaser.nl Complications/Side Effects • • • • • • 305 eyes (415 laser treatments) 2.6% 3x retina hit (last with patient 92) 1x traumatic cataract (patient 25) 2x increased intraocular pressure recent 1x retinal detachment (pseudophakic, s-15) vitrectomy rate 3.9% (up until now…) Patient Feedback: Results questionaire 2011 - 138 questionnaires sent (all to patients with > 6mths follow up) Response rate: 67% (93/138) Average symptom score = 7.88 to 3.85 ( visual analogue scale 110) Satisfaction 3.82 (on a scale 1-5) Average no. of treatments 1.27 per eye • • - 89% would choose this treatment again 89% would refer other people for this treatment Bias 1: non-responders were not contacted Bias 2: Not all treatments completed Opsis, Amstelveen, The Netherlands Nanosecond YAG Laser Technology for the Treatment of Floaters Ultra Q microsurgical YAG laser (Ellex, www.ellex.com) Laser Source: Q-switched Nd: YAG Wavelength: 1064 nm Energy: 0.3 to 10 mJ, single pulse, continuously variable Pulse Duration: 4 ns Nanosecond YAG Laser Technology for the Treatment of Floaters Ultra Q microsurgical YAG laser (Ellex, www.ellex.com) • • • Nd:YAG lasers emit high energy - potential risk of damage to surrounding ocular tissue The Ultra Q™ produces optical breakdown at lower energy with fewer shots and less cumulative energy = minimal risk Ultra Q™ achieves ultra-low energy optical breakdown (in air) of approx. 1.8mJ, compared to other YAG lasers at 3 to 4mJ. Nanosecond YAG Laser Technology for the Treatment of Floaters Ultra Q microsurgical YAG laser (Ellex, www.ellex.com) • Traditionally, YAG lasers have not been designed for use in the posterior chamber • Ellex has a new delivery system under development to help reduce the risks involved in performing YAG laser vitreolysis and hopes to be able to make it available more widely in the near future. Question 2 Today, how many people think that floaters can be treated with YAG laser therapy? Opsis , Amstelveen, The Netherlands Question 2 Today, how many people think that floaters can be treated with YAG laser therapy? No 75% Yes 25% Feike Gerbrandy, Amstelveen Question 2 Who thinks floaters cannot be treated effectively with YAG laser vitreolysis? Yes 75% No 25% Feike Gerbrandy, Amstelveen Question 2 Who thinks floaters cannot be treated effectively with YAG laser vitreolysis? Yes 65% No 35% Feike Gerbrandy, Amstelveen Question 2 Who thinks floaters cannot be treated effectively with YAG laser vitreolysis? Yes 50% No 50% Feike Gerbrandy, Amstelveen Question 2 Who thinks floaters cannot be treated effectively with YAG laser vitreolysis? No 35% Yes 65% Feike Gerbrandy, Amstelveen Question 2 Who thinks that, in 10 years, floaters will be treated routinely and effectively with YAG laser therapy? No 5% Yes 95% Feike Gerbrandy, Amstelveen Question 2 Who thinks that, in 10 years, floaters will be treated routinely and effectively with YAG laser therapy? No 5% Yes 95% Goals • Commence Vitreous Floaters Study Group AAO 2011 www.vitrousfloatersstudygroup.com • • • Publication of results Evidence for efficacy and safety Presentation AAO 2012 (Geller, Karickhoff Gerbrandy) Future Treatment: YAG laser therapy will become first choice in treatment of floaters Thank you for your attention Jaap J. Dito / Feike Gerbrandy Opsis Amstelveen The Netherlands www.floaterlaser.nl Feike Gerbrandy, Amstelveen
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