A New Pharmacological Vitreolysis through the Supplement of Mixed Fruit Enzymes for Patients with Ocular Floaters or Vitreous Hemorrhage-Induced Floaters

Global research trends in vitreous floaters from 1999 to 2023: a bibliometric analysis

PURPOSE

To characterize current global status and frontiers in the field of vitreous floaters research.

METHODS

The Web of Science Core Collection was used to retrieve the international scientific publications on vitreous floaters from 1999 to 2023. Scientometric data were analyzed and visualized using VOSviewer (1.6.18 Edition) and CiteSpace (6.3.R1).

RESULTS

A total of 547 articles with 8940 citations were identified. The annual number of publications and citations dramatically increased during the period. The USA was the most productive country with 26.33% of the total articles and 40.44% of the total citations. The USA collaborated more frequently with countries including China and Japan. The most productive affiliation was University of California System and the most productive author was Sebag Julia from the USA. Retina and BMC Ophthalmology published the highest percentage of articles (4.94%) while American Journal of Ophthalmology received the most citations (6.66%). The most frequent subject category was "Ophthalmology" (n = 356, 52%). "Vitrectomy", "vitreous floaters", "uveitis", "vitreous opacity", and "YAG vitreolysis" were the top 5 frequent keywords. The efficacy and safety of management for vitreous floaters turned out to be a recent research hot spot, especially the pharmacologic vitreolysis agents and Nd:YAG laser vitreolysis.

CONCLUSIONS

The optimized treatment of vitreous floaters emerged as a research hot spot. This study provides a broad insight of the status and frontiers in vitreous floaters, which might guide future research direction in this field.

Vision degrading myodesopsia from vitreous floaters in the young: An important aspect of myopia

Vitreous floaters are visual phenomena resulting from floating opacities inside the eye that disturb vision. The opacities consist of microscopic collagen fibers that aggregate in myopia and during aging. These collagen fibers are then seen as irregular, sometimes worm-like shadows or structures of a translucent to black color. Because of the floating aspect, they tend to follow the movements of the eye, causing distress and having a negative impact on a patient's quality of life due to degradation in contrast sensitivity function. This is referred to as vision degrading myodesopsia (VDM). The overall importance of floaters and their effect on quality of life gained attention in recent years. While the existence of floaters alone is labeled as harmless, there is an increasing group of young people suffering from VDM. This coincides with the growing prevalence of myopia. Indeed, myopia and myopic vitreopathy are the major causes of VDM in the young. This aspect of myopia, however, is often overlooked. We review the current research status in floater formation, quality of life impact, symptom assessment, localization and therapeutic options for vitreous floaters from the perspective of a myopic, potentially younger patient group.

Electromagnetic Iontophoresis: A Novel Nonsurgical Method for the Treatment of Dense Vitreous and Retinal Hemorrhages

Introduction

Vitreous, retinal, and suprochoroidal hemorrhages might develop secondary to trauma, retinal tear or detachment, neovascularization due to ischemic retina. If the clearance of retinal and vitreous hemorrhages can be accelerated, more effective treatments can be planned for the underlying pathology.

Case Presentations

We present 6 different cases with dense vitreous, preretinal, and subretinal hemorrhages due to Valsalva retinopathy, polypoid choroidal vasculopathy, diabetic retinopathy, neovascular age-related macular degeneration, retinitis pigmentosa with vasculitis, and myopic choroidal neovascularization. To accelerate the clearance of these dense intraocular hemorrhages, a novel nonsurgical method of electromagnetic iontophoresis (MagnoVision™) was used together with some appropriate medications in an outpatient setting without any complications or side effects. In all cases, liquefaction of the intraocular hemorrhage began by 5 days and mostly resolved by 10 days. This nonsurgical rapid clearance allowed us to diagnose and evaluate the underlying retinal and choroidal pathologies earlier and to treat them appropriately as early as possible.

Conclusion

Combined use of electromagnetic iontophoresis, subtenon platelet-rich plasma and bevacizumab injection, and oral bromelain can be considered as an effective and safe new treatment method for vitreous and retinal hemorrhages without any need for surgical intervention.

Forward Light Scattering of the Vitreous Gel After Enzymatic Aging: An In Vitro Model to Study Vitreous Opacification

Purpose

Symptomatic vitreous opacifications, so-called floaters, are difficult to objectively assess majorly limiting the possibility of in vitro studies. Forward light scattering was found previously to be increased in eyes with symptomatic floaters. Using an objective setup to measure forward light scattering, we studied the effects of enzymatically digesting the components of the vitreous body on straylight to develop an in vitro model of vitreous opacifications.

Methods

Fifty-seven porcine vitreous bodies were digested using hyaluronidase, collagenase, trypsin, and bromelain, as well as using a combination of hyaluronidase + collagenase and hyaluronidase + bromelain. A modified C-Quant setup was used to objectively assess forward light scattering.

Results

Depletion of hyaluronic acid majorly increased vitreous straylight (mean increase 34.4 deg2/sr; P = 0.01), whereas primarily digesting the vitreous gel with collagenase or trypsin did not significantly affect straylight. When collagenase or bromelain is applied in hyaluronic acid depleted vitreous gels, the increase in forward light scattering is reversed partially.

Conclusions

The age-related loss of hyaluronic acid primarily drives the increase in vitreous gel straylight induced by conglomerates of collagen. This process can be reversed partially by digesting collagen. This in vitro model allows the objective quantification and statistical comparison of straylight burden caused by vitreous opacities and, thus, can serve as a first testing ground for pharmacological therapies, as demonstrated with bromelain.