Fig. 46.1 Vitreous opacity interfering with fundus visualization. Why certain people, especially those with synchysis scintillans, are not bothered by floaters that actually prevent the ophthalmologist from seeing fine retinal details is rather mysterious

reasons. First, the vision is determined by whether the opacity is in the visual axis or not. If the floater is outside the visual axis, the VA is indeed full, but as the gel moves, a split second later, it may drop significantly. Second, the only person who can truly determine how this undulating vision is bothersome is the patient himself.

Every ophthalmologist/VR surgeon has the right to refuse vitrectomy for floaters – but then they will have to refer the person to a colleague who is willing to objectively discuss the benefits and risks with the patient and perform the operation if the patient so decides.

Pearl

A vitreous floater is the classic example of the “who owns the eyeball?” question: the person does. As long as the risks of PPV are properly explained and the person accepts them, surgery should not be denied just because the ophthalmologist considers the floater too insignificant a problem (see Sect. 5.5). Conversely, VR surgeons may feel an urge to remove the cloudy vitreous in synchysis scintillans because they cannot see retinal details or are unable to perform laser treatment (see above).

46.1.2 Timing of Surgery

This is as elective a surgery as it can be: select a date that is mutually agreeable.

46.2Surgical Technique

A standard PPV is to be performed, with detachment of the posterior cortical vitreous. There is no need to aim for a total vitrectomy.