u/Vincent6m

Abstract

Vitreous floaters affect >80% of people over 60, severely impairing quality of life, yet no safe and effective treatment exists. Nd/YAG laser vitreolysis requires dangerously high fluences, risking retinal injury, and fails to address the underlying pathological cascade. Here, we report a laser-triggered cluster nanobomb (PDN-C) for ultralow-fluence vitreolysis and homeostasis restoration. The nanobomb comprises a magnetic iron-oxide core and targeting-peptide-linked bullets. It actively penetrates the viscous vitreous and anchors to pathological collagen aggregates. Upon pulsed-laser irradiation at a fluence ∼1000-fold lower than clinical Nd/YAG therapy, the core converts the laser into localized microbubble cavitation that ejects the bullets and ablates >87% of collagen mass without retinal phototoxicity. Mechanistically, the ejected bullets achieve a dual-biochemical blockade of the pathogenic ROS-MMP axis: doxycycline inhibits MMP-driven type IV collagen degradation, while the ultrananozyme scavenges ROS, delaying vitreous liquefaction. By coupling precision photomechanical ablation with dynamic microenvironment remodeling, this nanobomb offers a highly effective and safe translational paradigm for vitreous floaters, addressing both the symptoms and the underlying disease pathology.

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Abstract

Topic

This systematic review and meta-analysis evaluated the effectiveness and safety of Nd:YAG laser vitreolysis in patients with primary symptomatic vitreous floaters.

Clinical Relevance

Symptomatic vitreous floaters may significantly impair visual quality and daily functioning despite preserved visual acuity. Nd:YAG vitreolysis may provide a less invasive therapeutic alternative to pars plana vitrectomy with a potentially more favorable safety profile.

Methods

This systematic review was conducted in accordance with the PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420251111180). PubMed, Embase, Scopus, and the Cochrane Library were systematically searched for eligible studies published between January 2000 and July 2025. Adult patients (≥18 years) treated with Nd:YAG vitreolysis for symptomatic vitreous floaters were included. The primary outcome was subjective visual improvement assessed using the National Eye Institute Visual Function Questionnaire–25 (NEI VFQ-25). Secondary outcomes included changes in best-corrected visual acuity (BCVA), contrast sensitivity, and adverse events. Random-effects meta-analyses were performed using the DerSimonian–Laird method.

Results

Fifteen studies involving 718 treated eyes met the inclusion criteria, including two randomized controlled trials and thirteen observational studies. Nd:YAG vitreolysis was associated with significant improvement in NEI VFQ-25 composite scores (pooled weighted mean difference [WMD] = +18.9 points; 95% CI, 15.7–21.7; p < 0.001), indicating improved vision-related quality of life. Contrast sensitivity also improved significantly following treatment (pooled standardized mean difference = –0.59; 95% CI, –0.83 to –0.35; p < 0.001), whereas BCVA remained unchanged (pooled WMD = 0.00 logMAR; 95% CI, –0.03 to 0.03). Reported adverse events were infrequent and generally transient, most commonly blurred vision and retinal hemorrhage, with no reported cases of permanent vision loss. The overall certainty of evidence was limited by methodological heterogeneity and the predominance of non-randomized study designs.

Conclusion

Nd:YAG laser vitreolysis was associated with significant improvement in patient-reported visual function and contrast sensitivity while maintaining stable visual acuity and a favorable safety profile. Although PPV remains more definitive, Nd:YAG vitreolysis may provide meaningful low-risk symptomatic relief in appropriately selected patients with vitreous floaters amenable to Nd:YAG vitreolysis. Future large, high-quality randomized controlled trials comparing Nd:YAG vitreolysis with PPV are warranted.

Abstract

Purpose : To quantitatively evaluate symptomatic vitreous opacities (SVOs) (floaters) in human eyes using an investigational non-contact Scanning Laser Ophthalmoscopy (SLO) and Optical Coherence Tomography (OCT) imaging platform.

Methods : Adults presenting with symptomatic vitreous opacities (floaters) were imaged with a novel non-contact AI-guided investigational SLO/OCT device in two independent clinical trials. The system simultaneously captured SLO sequences and volumetric OCT scans. A combination of manual and automated image analysis was used to localize the SVOs within the vitreous body and to quantify their size, opacity, morphology, and location relative to the retina.

Results : A total of 238 eyes from 135 subjects were analyzed. Both male (39.7%) and female (60.3%) subjects were enrolled, with the majority aged 65 years and older. Across both studies, a total of 1045 SLO and 966 OCT images were acquired, SVOs were visible in 943 SLO (90.2%) and 779 OCT (80.6%) scans. Opacities were quantified based on their size, opacity, and morphology; as well as location relative to the retina and motility during imaging.

Conclusions : Study showed that this novel non-contact AI-guided SLO/OCT imaging platform proved to be a useful tool to capture and quantify floaters. Findings provide the first in vivo quantitative database of floater morphology that suggests a positive correlation with patient-reported perception of floaters. These findings fill an existing gap in the understanding of floater morphology, providing a foundation for objective evaluation of floater severity and guiding future image-based treatment strategies to enhance patient quality of life.

This abstract was presented at the 2026 ARVO Annual Meeting, held in Denver, CO, May 3-7, 2026.

Abstract

Purpose : To compare the post-operative complication rates between 25-gauge and 27-gauge pars plana vitrectomy (PPV) for patients with symptomatic vitreous floaters.

Methods : The practice management system at Retina Associates of Cleveland, Inc. was used to acquire data on patients who received PPV for symptomatic floaters between January 2020 and March 2025 using CPT codes. Patients without a minimum 3 months of follow-up were excluded. 25-gauge and 27-gauge designation and incidence of post-operative complications of endophthalmitis (E), retinal detachment (RD), or vitreous hemorrhage (VH) were recorded. The complication rates were compared using a two-proportion z-test.

Results : 940 eyes were included in the study. Of which, 821 underwent PPV using a 25-gauge system and 119 underwent PPV using a 27-gauge system. 38 patients (4.63%) undergoing 25-gauge PPV developed post-operative complications (1 E, 18 RD, 19 VH) compared to 5 patients (4.20%) undergoing 27-gauge PPV (1 E, 3 RD, 1 VH). Using a two-proportion z-test, a z of 0.21 was compared with a p value of 0.84 to support a lack of a statistically significant difference in the results.

Conclusions : The complication rates between patients undergoing 25-gauge and 27-gauge PPV for symptomatic floaters differ slightly (4.63% and 4.20%, respectively), but were not found to be statistically significant. It is plausible that smaller wounds would lead to fewer complications, but this was not supported in this study. However, a limitation was the substantially smaller sample size of cases performed with the 27-gauge system (based on surgeon preference). In the future, this study would benefit from a larger number of patients and more balanced sample sizes between the two gauges used.

This abstract was presented at the 2026 ARVO Annual Meeting, held in Denver, CO, May 3-7, 2026.

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