46.1General Considerations

Nontransparent material in the vitreous cavity casts a shadow on the retina; the closer the material to the tissue of vision, the more circumscribed (less fuzzy) the shadow. The visual disturbance is not objective; even more subjective is the way the individual’s brain processes it. Some people are bothered by a single, tiny floater; others do not recognize the presence even of those that the ophthalmologist can readily see at the slit lamp. Persons with synchysis scintillans (asteroid hyalosis) may have so many of these calcium or cholesterol bodies that the fundus is impossible to examine in fine detail (see Fig. 46.1), yet they do not complain and many of them decline surgery.

•One of the unintended consequences of a vitrectomy that is “nonvitrectomizing,” minimal, or core (see Table 27.2) is that vitreous is left behind, which – as part of a normal aging process or induced by the surgery itself – may develop floaters, potentially requiring another vitrectomy that would easily have been avoidable had a more complete vitreous been done the first time.

•YAG capsulectomy is a potential source of bothersome floaters.

46.1.1 Indication for Surgery

Many of the people complaining of vitreous floaters have full vision at the moment when the acuity is taken1; as a result, ophthalmologists often refuse to offer surgery, claiming that the risk-benefit ratio justifies this. This argument is wrong, for two

1 Operating on an eye with full vision always raises the stakes, for the surgeon as well as for the patient. The VA will not improve after surgery; even in the best circumstances, it remains the same. However, the number of letters the patient reads on a visual chart is only one of the measures based on which indications should be considered.

F. Kuhn, Vitreoretinal Surgery: Strategies and Tactics,

DOI 10.1007/978-3-319-19479-0_46