Vitreolysis Flashcards
What are vitreous floaters?
Small, mobile opacities within the vitreous humor of the eye
Commonly perceived as spots or strands that drift in the field of vision.
What are the causes of floaters?
- Age
- Myopia
- Uveitis
- Post-cataract surgery
- Diabetic eye disease
- Trauma
These factors can lead to changes in the vitreous humor, causing floaters.
What is the current therapy for dealing with floaters?
Primarily to deal with it; surgery like vitrectomy is not always performed electively for floaters
Vitrectomy is often reserved for more severe cases or complications.
What is Nd:YAG Vitreolysis?
Use of YAG laser to eliminate problematic floaters
A minimally invasive procedure aimed at reducing the visibility of floaters.
What is the mechanism of action for Nd:YAG Vitreolysis?
Plasma formation and optical breakdown to convert floater from solid to liquid and gas
Concentrated laser energy is essential to achieve effective photoconversion.
What happens to gas bubbles formed during Nd:YAG Vitreolysis?
They dissolve spontaneously
This is part of the process of converting floaters into plasma.
What is the imperative laser energy level for Nd:YAG Vitreolysis?
At least 2.2 mJ
Insufficient energy can result in fragmentation of the floater instead of conversion.
What are the considerations for Nd:YAG Vitreolysis?
- Location of floater (mid-vitreous is best)
- Type of floater (Weiss ring has better outcomes)
- Aphakic/phakic/pseudophakic status
These factors can influence the effectiveness of the procedure.
What is the power range for the Nd:YAG laser during the procedure?
4-10 mJ per pulse, with some studies using as high as 20 mJ per pulse
The power settings can vary based on the type of floater being treated.
What is the typical number of shots required for a Weiss ring during Nd:YAG Vitreolysis?
100-200 shots
This varies based on the individual case and response to treatment.
What is the typical number of shots required for an amorphous cloud during Nd:YAG Vitreolysis?
400-1000 shots
More shots may be needed due to the complexity of the floater.
What is the expected outcome of Nd:YAG Vitreolysis?
Usually requires 2 sessions for maximum reduction in floater awareness
Symptoms are typically improved but may not completely resolve.
What are some complications associated with Nd:YAG Vitreolysis?
- IOP spike
- Retinal damage
- Cataract formation
- Macular edema
- Retinal tear
Risks are low, estimated at 0.8%.
How can IOP spikes be avoided during Nd:YAG Vitreolysis?
- Proper patient selection
- Avoid excessive shots (>300 per eye)
- Use as few shots as possible for floaters near trabecula
- Avoid widening a capsulotomy
These strategies can help mitigate risks associated with the procedure.
What is the CPT code for Nd:YAG Vitreolysis?
67031
This code pertains to severing vitreous strands and performing laser surgery.
What are some frequently approved ICD-10 codes for vitreous opacities?
- H43.391-H43.399: Other vitreous opacities
- H43.811-H43.819: Vitreous degeneration
These codes are used for billing and insurance purposes.
What is the global period for Nd:YAG Vitreolysis?
90 days
Indicates the timeframe for follow-up and additional care related to the procedure.
What is the approximate Medicare reimbursement for Nd:YAG Vitreolysis?
$400
This amount can vary based on specific circumstances and regions.
