Practical applications of vitreous imaging for the treatment of vitreous opacities with YAG vitreolysis

Abstract

PurposeTo demonstrate the methodology and e cacy of using scanning laser ophthalmoscopy (SLO) and dynamic optical coherence tomography (OCT) to identify and treat symptomatic vitreous oaters using yttrium-aluminum garnet laser vitreolysis (YLV). MethodsThis is a case series highlighted from a cross-sectional retrospective study conducted at the Vitreous Retina Macula Specialists of Toronto. 40 eyes from 35 patients were treated with YLV between November 2018 -December 2020 for symptomatic oaters and imaged with SLO and dynamic OCT. Patients were re-treated with YLV if they reported ongoing signi cant vision symptoms during follow-up which correlated to visible opacities on exam and or imaging. Three cases will be highlighted to present the practical applications of SLO and dynamic OCT imaging for YLV treatment.Results 40 treated eyes were enrolled in this study, with 26 eyes (65%) requiring at least one repeat YLV treatment following the rst treatment due to ongoing symptomatic oaters.Case 1 demonstrates a dense, solitary vitreous opacity that has been localized with dynamic OCT imaging to track its movements and retinal shadowing with the patient's eye movements. Case 2 shows the utility of adjusting the xation target to monitor the movement of vitreous opacities in real-time. Case 3 exhibits an association between decreased symptom burden and vitreous opacity density after YLV. ConclusionImage-guided YLV facilitates the localization and con rmation of vitreous opacities. SLO and dynamic OCT of the vitreous can provide a real-time evaluation of oater size, movement, and morphology, to help clinicians target treatment and monitoring of symptomatic oaters.