Nd:YAG Laser Vitreolysis For Primary Symptomatic Vitreous Floaters : A Systematic Review and Meta-analysis

This systematic review and meta-analysis evaluated the effectiveness and safety of 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. Nd:YAG vitreolysis may provide a less invasive therapeutic alternative to pars plana vitrectomy with a potentially more favorable safety profile.

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.

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.

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.