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 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

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: direct complications 2.6% 3x retinal hit 1x traumatic cataract late adverse events: 1x retinal detachment (0,66%), 1x elevated IOP (0,66%). Groep 2: 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

Feike Gerbrandy, Amsterdam 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 adverse events: 1x retinal detachment (0,66%), 1x elevated IOP (0,66%). Groep 2: 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

Feike Gerbrandy, Amsterdam 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

Feike Gerbrandy, Amsterdam 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: direct complications 2.6% 3x retinal hit 1x traumatic cataract late adverse events: 1x retinal detachment (0,66%), 1x elevated IOP (0,66%). Group 2: direct complications 0% 0x retinal hit 0x traumatic cataract late adverse events: 2x retinal detachment (0,57%) 4x elevated IOP (1,14%) Feike Gerbrandy, Amsterdam www.floaterlaser.nl

Feike Gerbrandy, Amsterdam 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

Feike Gerbrandy, Amstelveen Floaterlaser Gerbrandy Number of eye satisfied Not satisfied Retinal detachment 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