Intraoperative Characteristics and Postoperative Complications of Primary Vitrectomy for Vitreous Floaters

To investigate patient characteristics, operative patterns, and postoperative complications to aid in the discussion of the safety profile of pars plana vitrectomy (PPV) for visually symptomatic floaters.

Preoperative characteristics, intraoperative techniques, and postoperative outcomes were reviewed for patients receiving PPV for floaters. Data were collected on the postoperative course, including incidence, timing, and management of complications.

Clinical and surgical data on 413 eyes of 288 patients were analyzed (362 complete operative reports available for review). The mean (±SD) age of patients was 65.8 ± 9.6 years. A total of 125 patients (43.4%) underwent PPV for floaters in both eyes. Most eyes were pseudophakic (n = 315, 76.3%), and most had a posterior vitreous detachment (PVD) (n = 364, 88.1%) at the time of PPV. Only 30 eyes (8.3%) had PVD induced at the time of vitrectomy. Most eyes underwent 25-gauge PPV (n = 367, 98.9%). Sub-Tenon block anesthesia was administered with most procedures (n = 329, 90.9%), and most eyes received postprocedure subconjunctival antibiotics (n = 334, 91.3%). Intraoperative endolaser was performed in 34/362 eyes (9.4%). Most eyes underwent sutureless surgery (n = 337, 93.1%), and the majority received aqueous/balanced salt solution tamponade (n = 300, 82.6%). After the procedure, 279 eyes (67.6%) had more than 6 months of follow-up, with 382 eyes (92.5%) achieving a best-corrected visual acuity of 20/20 to 20/30. The most severe complication was endophthalmitis, which was encountered in 5 eyes (1.2%). Vitreous hemorrhage (VH) occurred in 23 eyes (5.6%), and postoperative retinal tear/retinal detachment (RD) occurred in 7 eyes (1.7%).

This is the largest retrospective case series describing operative patterns and outcomes associated with PPV for floaters. Rates of serious postoperative complications, including endophthalmitis, VH, and retinal tear/RD requiring surgery, were low. Certain surgical patterns were associated with higher rates of complications. In carefully selected patients counseled on serious complications, PPV for floaters is relatively safe and achieves good visual outcomes.