late adverse events

Report
Complications of Laser Vitreolysis
Scott Geller MD
Feike Gerbrandy 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
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
•
1 eye presumed lens opacity
unconfirmed by a second
ophthalmologist
•
•
•
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
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
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:
Groep 2:
direct complications 2.6%
3x retinal hit
1x traumatic cataract
late adverse events:
1x retinal detachment (0,66%),
1x elevated IOP (0,66%).
direct complications 0%
0x retinal hit
0x traumatic cataract
late adverse events:
2x retinal detachment (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
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:
Groep 2:
direct complications 2.6%
3x retinal hit
1x traumatic cataract
late adverse events:
1x retinal detachment (0,66%),
1x elevated IOP (0,66%).
direct complications 0%
0x retinal hit
0x traumatic cataract
late adverse events:
2x retinal detachment (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
Safety of Floaterlaser or YAG vitreolysis, the
learning curve of 500 eyes
Feike Gerbrandy, MD
Background:
Floaterlaser, YAG vitreolysis or nebulotrypsia is a laser treatment of vitreous
floaters. Worldwide there are only a handfull of ophthalmologists able to
perform this treatment. They founded the International Society of Vitreous
Laser Surgery (ISVLS).
The members of the ISVLS cooperate in research and treatment protocols.
Feike Gerbrandy started doing floaterlaser in 2009. Since then he has treated
about 750 eyes
In a recent study by his team (submitted for publication) about 86% of patients
are satisfied with the result.
These data show that most disturbing floaters can be succesfully treated by
laser.
As with many treatments: after the pioneers have showed the way followers will
come: more ophthalmologists will want to learn floaterlaser.
Feike Gerbrandy, Amsterdam
www.floaterlaser.nl
Safety of Floaterlaser or YAG vitreolysis, the
learning curve of 500 eyes
First 500 cases were analysed for complications:
First 150 eyes (group 1) were compared with following 350 (group 2):
Group 1:
Group 2:
direct complications 2.6%
3x retinal hit
1x traumatic cataract
late adverse events:
direct complications 0%
0x retinal hit
0x traumatic cataract
late adverse events:
1x retinal detachment (0,66%),
1x elevated IOP (0,66%).
2x retinal detachment (0,57%)
4x elevated IOP (1,14%)
Feike Gerbrandy, Amsterdam
www.floaterlaser.nl
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.
This clearly illustrates the learning curve of this
technique.
Conclusion: Floaterlaser of YAG vitreolysis or
nebulotrypsia is a low risk and safe procedure if
performed by an experienced ophthalmologist. The
patient demand for this procedure is increasing.
Feike Gerbrandy, Amsterdam
www.floaterlaser.nl
Floaterlaser
Gerbrandy
Number of
eye
satisfied
Not
satisfied
Retinal
detachme
nt
blind
Follow up
Laser
255
85.1%
14.9%
0.39%
0%
343 day
11.2
month
PPV
341
88.4%
8.89%
6.16%
2.6%
550 day
18
months
Feike Gerbrandy, Amstelveen
Basiscursus Floaterlaser 2013
Morgen 10.30 Zaal 1
Feike Gerbrandy
Opsis Oogziekenhuis Amsterdam
www.floaterlaser.nl
Feike Gerbrandy, Amsterdam

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