Laser Vitreolysis. A review.

Strands and vitreous adhesion bands can either be dissected noninvasively, transpupillarily by photodisruptive pulses of a Nd:YAG laser, operated in the photodisruptive mode, or invasively using an Er:YAG laser and specialized fibers. The previously used CO(2), Ho:YAG, and ultraviolet lasers have become less popular in the recent past. When using the transpupillary method, specialized contact lenses are required. Noninvasive methods avoid the risks incurred with invasive methods, but they require specialized knowledge, which is not available usually in vitreoretinal services. The invasive laser method provides a number of advantages typical of laser-tissue interaction. Advances in electrosurgical methods have opened the door to a new class of miniaturized electrosurgical equipment with which tissue dissection is made possible by plasma due to dielectrical breakdown which allows the pulse energy to be reduced to a very low level, resulting in a highly localized tissue effect. None of these methods has yet been considered for clinical use, mainly because the presently used mechanical methods are thought to be optimal by the majority of vitreoretinal surgeons.