Limited vitrectomy may improve contrast sensitivity function (CSF) and reduce vitreous echodensity in patients with vision degrading myodesopsia, according to a study published in the American Journal of Ophthalmology. This finding has particular clinical significance for patients with multifocal intraocular lenses (MFIOLs) due to an established association between MFIOLs and degradation in CSF, according to the report.  

Researchers collected data from 180 eyes of 180 patients (95 women, mean age 62.7±12.8 years) with symptomatic vitreous floaters. The cohort consisted of  patients with MFIOLs (n=55), patients with monofocal intraocular lenses (MIOLs) (n=60) and patients who were phakic (n=65). The team obtained ultrasonography, best corrected visual acuity (BCVA), and CSF measurements from all participants. A total of 86 patients elected to have limited vitrectomy (18 MFIOL, 33 MIOL, and 35 phakic eyes). At baseline, these participants had 68% greater vitreous echodensity and 21% worse CSF than the remaining control individuals (P <.0001 for all).

The team noted that limited vitrectomy decreased vitreous echodensity and improved CSF in the MFIOL, MIOL, and phakic groups (55% and 37%; 51% and 48%; 52% and 43%, respectively, P <.0001 for all).  National Eye Institute Visual Function Questionnaire score also revealed improved visual well-being in a subset analysis of 12 MFIOL participants with respect to composite score, driving and mental health (11%, 23%, and 23% improvements, respectively). However, these values failed to reach statistical significance.  


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This study introduces a new therapeutic option for physicians to manage dissatisfied patients with MFIOL pseudophakia if there is evidence of increased vitreous density and CSF degradation with a diagnosis of vision degrading myodesopsia. “All patients with CSF-degrading vitreous opacities benefitted from limited vitrectomy, including those with MFIOL,” according to the investigators. “Since MFIOL eyes had 37% improvement in CSF, patients with MFIOL and vision degrading myodesopsia merit consideration of vitrectomy.”

Study limitations include failure to perform pre-cataract surgery evaluations or distinguish between different MFIOL types or consider refractive powers.

Reference 

Nguyen JH, Yee KMP, Nguyen-Cuu J, Mamou J, Sebag J. Vitrectomy improves contrast sensitivity in multifocal pseudophakia with vision degrading myodesopsia. Am J Ophthalmol. Published online May 10, 2022. doi:10.1016/j.ajo.2022.05.003