Neodymium-Doped Yttrium-Aluminum-Garnet Laser Vitreolysis for Primary Symptomatic Vitreous Floaters: A Systematic...

This systematic review and meta-analysis evaluated the effectiveness and safety of neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser vitreolysis in patients with primary symptomatic vitreous floaters.

Symptomatic vitreous floaters may significantly impair visual quality and daily functioning despite preserved visual acuity. Neodymium-doped yttrium-aluminum-garnet vitreolysis may provide a less invasive therapeutic alternative to pars plana vitrectomy (PPV) with a potentially more favorable safety profile.

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and prospectively registered in PROSPERO (CRD420251111180). PubMed, Embase, Scopus, and the Cochrane Library were searched for 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 (CS), and adverse events. Random-effects meta-analyses were performed using the DerSimonian and Laird method.

Fifteen studies involving 718 treated eyes met the inclusion criteria, including 2 randomized controlled trials and 13 observational studies. Neodymium-doped yttrium-aluminum-garnet vitreolysis was associated with significant improvement in NEI VFQ-25 composite scores (pooled weighted mean difference [WMD] = +15.0 points; 95% confidence interval [CI], 7.4-22.6; P < 0.001). Contrast sensitivity also improved significantly after treatment (pooled standardized mean difference = -0.62; 95% CI, -0.81 to -0.43; P < 0.001), whereas BCVA remained unchanged (pooled WMD = 0.00; logarithm of the minimum angle of resolution; 95% CI, -0.03 to 0.03). Adverse events were infrequent and transient, most commonly blurred vision and retinal hemorrhage, with no cases of permanent vision loss. The overall certainty of evidence was limited by methodological heterogeneity and the predominance of nonrandomized study designs.

Neodymium-doped yttrium-aluminum-garnet laser vitreolysis was associated with significant improvement in patient-reported visual function and CS 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.

The authors have no proprietary or commercial interest in any materials discussed in this article.