vitreolysis

Vitreolysis is a medical procedure aimed at reducing visual symptoms from vitreous floaters by using laser energy to disrupt opacities within the vitreous body. The term most commonly refers to laser vitreolysis, usually performed with a neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. The goal is to fragment or displace clouded vitreous strands and opacities that obscure vision, with the intention of improving visual quality without removing the vitreous gel.

Indications and patient selection: Vitreolysis is considered for patients with symptomatic, localized floaters who have good retinal health and no active retinal pathology. It is less suitable for dense, diffuse opacities or when there is dense vitreous hemorrhage, significant media distortion, or a high risk of retinal tears.

Procedure overview: The treatment is typically carried out in a clinical setting under topical anesthesia. A contact lens or similar focusing device may be used to help target the floaters. Laser energy is delivered in small increments to create precise disruptions in the opacities while carefully avoiding the retina, lens, and other structures. Multiple pulses are often required. Post-treatment monitoring commonly includes intraocular pressure assessment and, in some cases, short courses of anti-inflammatory eye drops.

Efficacy and risks: Evidence for durable, consistent improvement is variable, and results are patient dependent. Some individuals report partial or complete relief of floaters, while others note little change. Potential risks include retinal injury or detachment, cataract progression, increased intraocular pressure, inflammation, and, rarely, infection. Because risks exist and benefits are uncertain, vitreolysis is not universally recommended and should be discussed thoroughly with an ophthalmologist.

Alternatives and prognosis: Observation is appropriate for many floaters. Surgical options, such as pars plana vitrectomy, offer more definitive removal of the vitreous but carry higher risks, including cataract formation and retinal detachment. Enzymatic vitreolysis has been explored but is not widely adopted.