<h4>Background</h4>The vitreous is the clear jelly of the eye and contains fine strands of proteins. Throughout life the composition of this vitreous changes, which causes the protein strands in it to bundle together and scatter light before it reaches the retina. Individuals perceive the shadows cast by these protein bundles as 'floaters'. Some people are so bothered by floaters that treatment is required to control their symptoms. Two major interventions for floaters include Nd:YAG laser vitreolysis and vitrectomy. Nd:YAG laser vitreolysis involves using laser energy to fragment the vitreous opacities via a non-invasive approach. Vitrectomy involves the surgical replacement of the patient's vitreous (including the symptomatic vitreous floaters) with an inert and translucent balanced salt solution, through small openings in the pars plana.<h4>Objectives</h4>To compare the effectiveness and safety of Nd:YAG laser vitreolysis to pars plana vitrectomy for symptomatic vitreous floaters.<h4>Search methods</h4>We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), MEDLINE Ovid (1946 to 17 January 2017), Embase Ovid (1947 to 17 January 2017), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 17 January 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 17 January 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 17 January 2017 and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 17 January 2017. We did not use any date or language restrictions in the electronic searches for trials. We also searched conference proceedings to identify additional studies.<h4>Selection criteria</h4>We included only randomised controlled trials (RCTs) that compared Nd:YAG laser vitreolysis to pars plana vitrectomy for treatment of symptomatic floaters.<h4>Data collection and analysis</h4>We planned to use methods recommended by Cochrane. The primary outcome we planned to measure was change in vision-related quality of life from baseline to 12 months, as determined by a vision-related quality of life questionnaire. The secondary outcomes we planned to measure were best corrected logMAR or Snellen visual acuity at 12 months for the treated eye(s) and costs. Adverse outcomes we planned to record were the occurrence of sight-threatening complications by 12 months (asymptomatic retinal tears, symptomatic retinal tears, retinal detachment, cataract formation, and endophthalmitis).<h4>Main results</h4>No studies met the inclusion criteria of this review.<h4>Authors' conclusions</h4>There are currently no RCTs that compare Nd:YAG laser vitreolysis with pars plana vitrectomy for the treatment of symptomatic floaters. Properly designed RCTs are needed to evaluate the treatment outcomes from the interventions described. We recommend future studies randomise participants to either a Nd:YAG laser vitreolysis group or a vitrectomy group, with participants in each group assigned to either receive treatment or a sham intervention. Future studies should follow participants at six months and 12 months after the intervention. Also they should use best corrected visual acuity (BCVA) using an Early Treatment of Diabetic Retinopathy Study (ETDRS) chart read at 4 metres, vision-related quality of life (VRQOL), and adverse outcomes as the outcome measures of the trial.

Floater Floaters or eye floaters are small dots in the field of vision of a person. They are transparent and between the eye's vitreous humour or between the vitreous and retina. Their medical name is muscae volitantes (Latin for 'flying flies'), or mouches volantes (French for 'flying flies').[1] All people will get them over time,[2] but not all will notice them. Nearsighted people can notice them earlier.[3] It might be possible to get these by debris falling into the eye. They are common in most people. They would constantly be seen by looking at the sky or a source of a light. They are not to be confused with Afterimages or Blue field entopic phenomenon. They can appear in various different shapes, such as strands, dots, rods, and cobwebs. Additionally, there is a ring shaped floaters named the Weiss Ring,[4] they are sometimes seen if the vitreous releases from the back of the eye.

[Muscae volitantes--from early observations to Purkinje's explanation]. The subjective visual phenomena known as "muscae volitantes" ("floating flies") were already known to the Greeks. Galen (2nd c. A.D.) explained them within his theory of vision as circumscript condensations of the aqueous. This opinion prevailed in Arab medicine and even in the science of the Renaissance and later. When, in the 17th c., Galen's theory, according to which the crystalline lens was the organ of visual perception, was replaced by Kepler's insight that the image of the outer world is formed on the retina, scholars such as Dechales and Morgagni came near the truth. In 1823, Purkinĕ identified the muscae as opacities floating in the vitreous. Published in Gesnerus (1990)

Vitreous floaters, characterized by the perception of spots or shadows in the visual field, commonly result from posterior vitreous detachment and can cause chronic symptoms in affected patients. The diagnosis of posterior vitreous detachment is typically determined clinically and can sometimes be confirmed with optical coherence topography (OCT) [1 ▪▪ ] . The objective of this review is to review management options for symptomatic vitreous floaters. Symptoms of vitreous floaters may be mild or may significantly affect patient quality of life. Observation is the most common management strategy. Procedural management options include pars plana vitrectomy (PPV) and neodymium-doped yttrium aluminium garnet (Nd:YAG) vitreolysis. PPV is considered the most definitive management option for vitreous floaters. PPV, however, carries inherent risks, notably infection, cataract formation, and retinal detachment [2] . Nd:YAG laser vitreolysis is a less invasive alternative with studies demonstrating varied success [1 ▪▪ ,3,4] . This review provides insights into the current state of knowledge regarding the management of vitreous floaters and can guide clinical decision-making.

Floaters are a common presenting ophthalmic symptom that may accompany sight-threatening disorders. In most cases, they are often secondary to benign, degenerative changes in the vitreous. In this review, we briefly examine the anatomy of the vitreous and describe how degenerative vitreous change contributes to the development of floaters. The causality of floaters in the presence and absence of a posterior vitreous detachment is reviewed, as is the clinical significance of these symptoms and signs in relation to their predictive value for determining the presence of sight-threatening retinal tears and/or detachment. Finally, a brief review of management options for debilitating floaters is presented.

Degenerative vitreous opacities (also known as myodesopsia) can cause permanent and relevant visual impairment. Neodymium-YAG laser vitreolysis is an alternative treatment option to pars plana vitrectomy for the treatment of disturbing degenerative vitreous opacities. This article critically discusses the different causes of vitreous opacities, the symptoms and functional impairments as well as clinical patient management. The aim is to support patient-oriented care and counselling of patients with vitreous opacities.