u/Saheim

Posting this for posterity. When I experienced frill following my limited vitrectomy, I was frantically searching for accounts of whether this could improve or not. It wasn't hard to find accounts of improvement from PVD-induced vitrectomies, but few accounts existed for limited/core vitrectomy patients.

I am not precisely sure when this happened, but sometime around week 3-4 post-op, I forgot about my frill. And then I realized I had forgotten about it, checked for it, and could not find it. I have now put myself in several environments where I could reliably observe it, and I can only see a hint of it with dramatic head/eye movement. It was an anatomical improvement, not adaptation.

I do now have residual strands that are bothersome. I think it's unlikely these will improve on their own. I may seek revision surgery, but it feels foolish given the risks/benefits. Still, if you had a limited/core vitrectomy and see a bit of frill, you should be hopeful about improvement. I was told over the first 6 weeks, the residual vitreous remodels and typically patients experience their final outcome.

Hey everyone—really hate to be making this post.

Quite a few recent patients, starting from ~August 2025, have undergone limited vitrectomy at Coastal Eye. While the procedure has been highly effective at removing floaters, most have been left with residual strands of vitreous that can be seen outdoors in central vision. These are not problematic indoors, but they are significant.

Patients prior to that date seem to not have been having this problem, so older reviews may not reflect it. For this reason, I also do not believe this is an issue with limited vitrectomy per say. I want to clarify further that to my knowledge, no one has had problematic frill from this practice (myself included).

If you are currently scheduled with Coastal Eye for limited vitrectomy, I would encourage you to ask about this particular outcome being a possibility. Sorry for this bummy news. Be well.

Thought I'd write one of these for those looking for some cope/hope lol. It's a bit technical so bear with me.

PulseMedica is a Canadian medtech company developing an automated femtosecond laser system for detecting and treating symptomatic vitreous opacities (SVOs). I had some time to review their recent patent filing (link), and there were some nuances I wasn't aware of that are pretty interesting.

Detection

The system uses a CNN operating on sequences of M SLO frames simultaneously rather than single images. Running detection across a frame sequence is what allows it to pick up low-contrast diffuse opacities — strands, dots, speckle — that single-frame object detection tends to miss. Younger patients with clear natural lenses should actually present better optical conditions for SLO imaging than older patients with any lenticular scattering, meaning detection sensitivity should be higher, not lower, in younger eyes.

The patent also describes a gaze target display that directs the patient through a controlled eye movement pattern during the imaging phase. This is doing a few things simultaneously: displacing the vitreous relative to stationary retinal structures makes SVOs easier to isolate algorithmically, and sweeping the full vitreous volume through the imaging field helps ensure all floaters are captured before treatment planning begins. But it goes further than that — the system actively predicts SVO trajectory and generates a moving target calculated to at least partially counteract floater motion during treatment itself. So the gaze display isn't just diagnostic; it's also a motion management tool.

3D Localization and Treatment Planning

SLO gives x-y position; OCT captures depth. Together they provide full 3D localization of each floater. The volumetric OCT data is used to construct a geometric surface model of the SVO, which is then enclosed in a defined target volume that drives the laser scan pattern. The approach is geometry-agnostic — strands, blobs, dots, and multi-component floaters are each segmented into their own target volumes with independently optimized scan parameters. For those worried about strand or speckle floaters specifically, the patent explicitly describes successful detection and targeting of these morphologies.

Safety

The femtosecond pulse regime — 10⁻¹⁵s, 1-20 µJ/pulse — is physically quite different from YAG vitreolysis. YAG operates at nanosecond timescales and generates an acoustic shockwave that's responsible for cataract and retinal risk. Femtosecond photodisruption produces thermal spread on the order of microns with no shockwave, which is what makes treatment near the lens and retina feasible at these power levels. In younger patients, the more gel-like vitreous actually dampens SVO drift which in theory works in favor of targeting accuracy.

Beyond the pulse physics, there are several overlapping safety layers worth understanding. OCT continuously measures floater depth relative to the retinal surface and laser firing is gated on whether that position falls within a defined safe zone. Cumulative energy per retinal region is tracked, with safety zones tightening dynamically as treatment proceeds. The system can also deliberately fire into vitreous adjacent to the floater to generate small photoionization bubbles that act as physical barriers, slowing SVO drift during treatment. And sitting entirely outside the main control loop, independent failsafe hardware monitors laser parameters and eye movement on a separate circuit and can cut firing autonomously if any parameter falls outside safe bounds.

For floaters in genuinely unsafe zones — close to the lens or retina — the patent also describes a nanoparticle-mediated pathway using hyaluronan-coated gold nanoparticles (HA-AuNPs) that have an affinity for vitreous collagen. (This is probably a nod to Felix Savauge's research, and given they've both filed recently in the US patent system, they are likely collaborating at some level). Once bound to the floater, illumination at an appropriate wavelength causes rapid nanobubble formation that ablates the collagen at power levels well below what direct femtosecond ablation would require. The laser can be intentionally defocused anterior or posterior to the floater depending on which unsafe structure it's adjacent to, delivering sufficient power to the nanoparticle-laden floater while keeping fluence at the lens or retina within safe limits. It's not the primary treatment pathway, but it meaningfully extends the addressable anatomy. It's just cool to see that they included this in the patent, they are clearly thinking about it.

TL;DR

Targeting has always been the bottleneck for treating floaters, and it's why YAG is pretty mid. The combination of gaze-assisted volumetric mapping, multi-frame ML detection enabling real-time 3D tracking, layered safety architecture, and femtosecond precision can solve it. Nothing is proven at scale in humans yet, and I want to be clear that a compelling patent is not a clinical outcome. But the physics are sound, the engineering approach is coherent, and unlike a lot of what gets floated in this space, there's real scientific depth behind the team. I think it takes more coping to be against PulseMedica than to be cautiously optimistic about it.

Sharing some cool photos from the patent below.

https://preview.redd.it/o1l7kzxkvsxg1.png?width=1128&format=png&auto=webp&s=164ad1949eb478bd207217dea8e91373dd1a1dac

https://preview.redd.it/hq8fzyxkvsxg1.png?width=940&format=png&auto=webp&s=1a150409e7d803c72b79e49c31a8411a4d670cb2

https://preview.redd.it/gn5az0ykvsxg1.png?width=660&format=png&auto=webp&s=68b3e4d5941c3f169dcd7747489810177b07f87e

https://preview.redd.it/qjzkvzxkvsxg1.png?width=796&format=png&auto=webp&s=14cfd4a29096b6e654cbc015ef4cfd3bffe9285e