Q-switched neodymium YAG laser vitreolysis in the therapy of posterior segment disease

We describe our experience of ten cases of posterior segment vitreolysis, using the short-pulse neodymium YAG (Yittrium Aluminium Garnate) laser. Eight patients had proliferative diabetic retinopathy, one patient had had an intraocular foreign body removed and one patient had had uveitis. Of the ten, five patients had macular traction retinal detachments, three patients had progressive traction retinal detachments threatening the macula and two patients had recurrent vitreous haemorrhages from mechanical traction on areas of fibrovascular proliferation. Eight of the patients were successfully treated. One macular retinal detachment failed to flatten and a tear was found which may have been iatrogenic. In one patient with a traction retinal detachment significant traction was relieved but the detachment failed to flatten completely. We discuss the indications, techniques, difficulties and complications. Our experience suggests that this technique has an important role in the treatment of selected patients, sparing patients conventional vitrectomy, or making possible the treatment of those for whom vitrectomy has been contraindicated or refused. Anterior defocussing of the YAG would be a useful modification of current laser systems and improved aiming systems desirable for the future.