Vitreous gel fills the eyeball, helping maintain its shape. Posterior vitreous detachment occurs when the vitreous gel pulls away from the retina, to which it attaches at the back of the eyeball. This often occurs as part of the aging process, when the vitreous liquefies at the center and the gel around the outside collapses into the liquefied center. Small pieces of gel floating in the center appear as small dots or strings called floaters. Vitreous detachment requires no treatment unless it’s severe or causes problems with the retina.
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If the vitreous pulls a small part of the retina away from the eyeball, a retina tear or detachment occurs. Small tears on the periphery of the retina may be treated with laser, done as an office outpatient procedure. Laser seals the retina back to the wall of the eye, preventing a more serious retinal detachment.
A specific type of laser, called an Nd:YAG laser, also may be used in very rare cases to break up vitreous floaters that severely disrupt vision, the University of Illinois Eye and Ear Infirmary Eye Digest reports. The Eye Digest states that this procedure helps in only one third of cases, and that the improvement is moderate at best. Nearly 8 percent of patients report a worsening of symptoms.
Posterior vitreous detachment also may cause a hole in the retina over the macula, the central part of vision on the retina, called a macular hole, which seriously disrupts vision, a macular pucker, or wrinkle in the retina over the macula or a retinal detachment, which can affect the macula or other parts of the retina. Vitrectomy, removal of the vitreous in a surgical procedure and replacement with a sterile saline solution can treat macular hole or retinal detachment and improve vision.
In rare cases, vitrectomy may be used to treat severe floaters, although the procedure has known risks, such as the development of cataracts, hemorrhage in the eye and retinal detachment. Vitrectomy has a high success rate in treating severe floaters, improving vision in over 90 percent of patients, the Eye Digest reports.
Cryotherapy, a freezing technique done as an office procedure, is done to repair small tears caused by posterior vitreous detachment. Cryotherapy takes just a few minutes and causes little discomfort, says the University of Michigan Kellogg Eye Center. Pneumatic retinopexy, sometimes done as an office procedure, places a small gas bubble in the eye to hold the torn retina in place in some cases.