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Cunha M, Elhaddad O, Yahalomi T, Avadhanam V, Tole D, Darcy K, Levinger E, Tuuminen R, Achiron A. Type 1 and type 2 diabetes predisposed to higher Nd:YAG capsulotomy rates following cataract surgery: analysis of 53,471 consecutive cases. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00057-7. [PMID: 38513717 DOI: 10.1016/j.jcjo.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/01/2024] [Accepted: 02/25/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To assess the effect of diabetes type on Nd:YAG capsulotomy rates following cataract surgery. DESIGN A retrospective cohort study. METHODS All patients who underwent cataract extraction at the Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK, between 2003 and 2017 were included. The Nd:YAG capsulotomy rate following cataract surgery was assessed and compared between nondiabetic, type 1 diabetes (T1D), and type 2 diabetes (T2D) patients. Multivariate Cox regression analysis controlling for age and sex was used to estimate hazard ratios for Nd:YAG laser capsulotomies. RESULTS Included were 53,471 consecutive cataract surgeries. Overall, 42,651 eyes (79.8%) were in nondiabetic patients, 823 eyes (1.5%) were in T1D patients, and 9,997 eyes (18.7%) were in T2D patients. The mean follow-up time was 6.8 ± 4.2 years. In univariate analysis, the eyes of T1D patients (p < 0.001) and T2D patients (p = 0.003) had significantly higher Nd:YAG laser capsulotomy rates than the eyes of nondiabetic patients. In Cox regression analysis adjusted for the patient's age and sex, DM1 (HR 1.692, 95%CI 1.390-2.059, P<0.001) and DM2 (HR 1.157, 95%CI 1.075-1.244, P<0.001) remained significantly predictive for higher Nd:YAG laser capsulotomy rates. CONCLUSION In our large cohort study, patients with T1D and T2D were predisposed to high risk for Nd:YAG capsulotomy following cataract surgery. This study may be beneficial and raise awareness regarding the assessment of posterior capsular opacification development in pseudophakic diabetic patients, particularly those with T1D. The significance of ophthalmology screening for diabetes individuals is further supported by this issue.
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Affiliation(s)
- Mariana Cunha
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland; Medical School, São Paulo State University (UNESP), São Paulo, Brazil
| | - Omar Elhaddad
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tal Yahalomi
- Department of Ophthalmology, Samson Assuta Ashdod Hospital and Faculty of Health Sciences, Ben-Gurion University of the Negev, Negev, Israel.
| | - Venkata Avadhanam
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Derek Tole
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Kieran Darcy
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Eliya Levinger
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland; Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
| | - Asaf Achiron
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Borkenstein AF, Borkenstein EM, Machado E, Fitzek H, Rattenberger J, Schennach R, Kothleitner G. Micro-Computed Tomography (µCT) as a Tool for High-Resolution 3D Imaging and Analysis of Intraocular Lenses: Feasibility and Proof of the Methodology to Evaluate YAG Pits. Ophthalmol Ther 2023; 12:447-457. [PMID: 36481844 PMCID: PMC9834457 DOI: 10.1007/s40123-022-00622-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Posterior capsule opacification (PCO) is the most frequent late sequelae after successful cataract surgery. Neodymium:yttrium aluminum garnet (Nd:YAG) laser capsulotomy is considered the gold standard and a well-accepted, safe, and effective measure in treating PCO. However, iatrogenic damage of the intraocular lens (IOL) due to inappropriate focusing is a quite common side effect. These permanent defects (YAG pits) can critically affect overall optical quality. METHODS In this laboratory study, we used the micro-computed tomography (µCT) technique to obtain high-resolution 3D images of the lens and the YAG pits. RESULTS To the best of our knowledge, this is the first description of a detailed analysis of IOLs with µCT technology. This non-destructive technique seems to be ideal for comparative studies, measuring dimensions of the damage, and visualizing shooting channels within the material. CONCLUSION µCT is excellently suited to examine an IOL in detail, analyze optics and haptics in three dimensions, and to describe all kinds of changes within the IOL without damaging it.
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Affiliation(s)
- A. F. Borkenstein
- Borkenstein & Borkenstein private practice, Privatklinik Der Kreuzschwestern Graz, Kreuzgasse 35, 8010 Graz, Austria
| | - E. M. Borkenstein
- Borkenstein & Borkenstein private practice, Privatklinik Der Kreuzschwestern Graz, Kreuzgasse 35, 8010 Graz, Austria
| | - E. Machado
- grid.410413.30000 0001 2294 748XInstitute of Solid State Physics, University of Technology Graz, Petersgasse 16/2, 8010 Graz, Austria
| | - H. Fitzek
- grid.410413.30000 0001 2294 748XInstitute of Electron Microscopy and Nanoanalysis, University of Technology Graz, Steyrergasse 17, 8010 Graz, Austria
| | - J. Rattenberger
- grid.410413.30000 0001 2294 748XInstitute of Electron Microscopy and Nanoanalysis, University of Technology Graz, Steyrergasse 17, 8010 Graz, Austria
| | - R. Schennach
- grid.410413.30000 0001 2294 748XInstitute of Solid State Physics, University of Technology Graz, Petersgasse 16/2, 8010 Graz, Austria
| | - G. Kothleitner
- grid.410413.30000 0001 2294 748XInstitute of Electron Microscopy and Nanoanalysis, University of Technology Graz, Steyrergasse 17, 8010 Graz, Austria
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Borkenstein AF, Borkenstein EM, Omidi P, Langenbucher A. Evaluating impact of Nd: YAG laser associated defects on optical quality of hydrophilic and hydrophobic intraocular lenses using visualization of light propagation and USAF test targets. BMC Ophthalmol 2022; 22:494. [PMID: 36527032 PMCID: PMC9756656 DOI: 10.1186/s12886-022-02738-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Neodymium:yttrium aluminum garnet (Nd:YAG) laser capsulotomy is a well-accepted, safe, and effective measure in the treatment of posterior capsule opacification. However, iatrogenic intraocular lens damage is a relatively common side effect that happens due to inappropriate focusing during the procedure. This experimental study analyzes the impact of YAG-pits to obtain qualitative information. METHODS Acrylic, monofocal hydrophilic and hydrophobic intraocular lenses (IOLs) with 6.0 mm optic and the with the same power (21D) were studied. First, all measurements were done with unmodified IOLs. Damage was intentionally created, performing YAG-pits (n = 5) in the central area of the lens optic (3.0 mm) using a photodisruption laser with the same energy level of 1.8 mJ. To simulate the cruciate pattern, the 5 defects were created in a cross shape within the 3.0 mm optical zone. Afterwards, all laboratory measurements were repeated: These included the United States Air Force (USAF) resolution test chart to study the imaging performance of the IOL, light field measurements to show the course of the rays behind the IOL and the modulation transfer function (MTF) measurements were analyzed. RESULTS Evaluating USAF showed that unmodified lenses produced a sharper image. Damaged lenses led to a more blurred image and to the impression of a lower contrast with a kind of halo/glare effect. The light field measurement showed that YAG-pits led to a kind of dispersion and scattering effect, which was higher in hydrophobic IOLs. MTF showed a deterioration in damaged hydrophilic and hydrophobic IOLs, respectively. CONCLUSION Our experimental study confirms that YAG-pits can reduce imaging quality of intraocular lenses. These defects behave as a new Huygens source, distribute a spherical wave that additionally illuminate the background of the USAF target. It can be assumed that material properties of the IOL (water content, refractive index) play an important role and affect results. The impact level is strongly dependent on the number, size and position of YAG-pits within the optic. LIMITATION Only monofocal IOLs have been investigated so far, further tests with various IOL optics have to follow. In addition, simulating the circular pattern of YAG capsulotomy is necessary.
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Affiliation(s)
- A. F. Borkenstein
- Borkenstein & Borkenstein private practice, Privatklinik der Kreuzschwestern Graz, Kreuzgasse 35, 8010 Graz, Austria
| | - E. M. Borkenstein
- Borkenstein & Borkenstein private practice, Privatklinik der Kreuzschwestern Graz, Kreuzgasse 35, 8010 Graz, Austria
| | - P. Omidi
- grid.11749.3a0000 0001 2167 7588Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Saar 66424 Homburg, Deutschland
| | - A. Langenbucher
- grid.11749.3a0000 0001 2167 7588Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Saar 66424 Homburg, Deutschland
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Incidence of graft-versus-host-disease in Germany: evidence from health care claims data. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01736-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Belda JI, Placeres J, Elvira JC, Puig X, Pérez-Vives C, Zou M, Sun S, Yu J, O’Boyle D. Costs and Healthcare Resource Utilization Associated with Posterior Capsule Opacification After Cataract Surgery with Five Different Intraocular Lenses: An Economic Analysis for Spain. Clin Ophthalmol 2022; 16:993-1001. [PMID: 35386615 PMCID: PMC8979752 DOI: 10.2147/opth.s349003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Materials and Methods Results Conclusion
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Affiliation(s)
- José I Belda
- Hospital Universitario de Torrevieja, Torrevieja, Alicante, Spain
| | - Javier Placeres
- Hospital Universitario de Torrevieja, Torrevieja, Alicante, Spain
| | | | | | | | - Ming Zou
- IQVIA Real World Solutions, Basel, Switzerland
| | - Shaohui Sun
- IQVIA Real World Solutions, Basel, Switzerland
| | - Jing Yu
- IQVIA Real World Solutions, Basel, Switzerland
| | - Derek O’Boyle
- Alcon Laboratories Ireland Ltd., Cork, Ireland
- Correspondence: Derek O’Boyle, Alcon Laboratories Ireland Ltd., Cork, Ireland, Email
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Bai H, Li H, Zheng S, Sun L, Wu X. Nd:YAG Capsulotomy Rates with Two Multifocal Intraocular Lenses. Int J Gen Med 2021; 14:8975-8980. [PMID: 34876835 PMCID: PMC8643175 DOI: 10.2147/ijgm.s342039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the incidence of Nd:YAG capsulotomy after implantation of two types of multifocal intraocular lenses (MIOLs). Methods This retrospective analysis included patients who had undergone cataract extraction and implanted diffractive MIOL (Acri. LISA tri 839M) or asymmetric refractive MIOL (SBL-3) from May 2016 to September 2018. They were followed up for at least 3 years. During the follow-up period, the relevant data of patients were kept by special person in the hospital. The rates of Nd:YAG capsulotomy and the Kaplan-Meier survival curve were used to analyze the two groups. Results The Asymmetric Refractive MIOL group was comprised of 98 patients (121 eyes), while the Diffractive MIOL group was comprised of 99 patients (120 eyes). There were no significant differences in age, sex, or IOL power between the two groups. The Nd:YAG rate of the asymmetric refractive MIOL group and the diffractive MIOL group was 3.3% and 7.5% respectively (P = 0.15) in the first year, 14.88% and 22.5% respectively (P = 0.129) in the second year, and 21.49% and 34.17% respectively (P = 0.028) in the third year. In the first 7 months of follow-up, the two groups showed the same performance in the Nd:YAG rate. After that, there was a difference between the two groups, and the difference gradually increased. Until the 27th month of follow-up, the difference was significant (P < 0.05). What is more, there were significant differences in survival (without Nd:YAG capsulotomy)/failure (with Nd:YAG capsulotomy) functions (P = 0.0035). Conclusion The incidence of Nd:YAG laser capsulotomy in patients with diffractive MIOLs was higher than that in patients with asymmetric refractive MIOLs.
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Affiliation(s)
- Huiran Bai
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, People's Republic of China
| | - Honglei Li
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, People's Republic of China
| | - Simeng Zheng
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, People's Republic of China
| | - Lihong Sun
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, People's Republic of China
| | - Xiaoming Wu
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People's Republic of China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, People's Republic of China
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Yu SS, Lu CZ, Guo YW, Zhao Y, Yuan XY. Anterior segment OCT application in quantifying posterior capsule opacification severity with varied intraocular lens designs. Int J Ophthalmol 2021; 14:1384-1391. [PMID: 34540614 DOI: 10.18240/ijo.2021.09.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/20/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the application of anterior segment-optical coherence tomography (AS-OCT) in posterior capsule opacification (PCO) severity assessment and analyse the relationship between PCO severity and intraocular lens (IOL) characters. METHODS PCO patients were prospectively recruited. Cross-sectional images of the anterior segment at horizontal and vertical meridians were acquired with AS-OCT. The area of the IOL-PC (posterior capsular) space and PCO severity (area, thickness, and density at 3 mm and 5 mm IOL optic regions) were measured. The relationship between PCO severity and visual acuity, comparisons of PCO severity and IOL-PC space using varied IOL designs were analysed. RESULTS One hundred PCO eyes were enrolled. IOL-PC space, PCO thickness and area were positively correlated with axial length. In addition, PCO area and thickness were positively correlated with visual acuity when it was ≤0.52 logMAR. The cut-off level of visual acuity should be 0.52 logMAR. With varied IOL designs, 3-piece C haptic IOL showed a smaller PCO area and thickness than the 1-piece 3 haptic IOL and 1-piece 4 haptic IOL. PCO area and thickness values for an IOL with a diameter ≤11.0 mm was greater than for an IOL with a diameter of 12.5 mm, and the differences were statistically significant. PCO area and thickness increased when IOL haptic angulation increased (from 0 to 12 degrees). CONCLUSION In PCO eyes, cut-off level of visual acuity is 0.52 logMAR. With more severe PCO, visual acuity maybe not enough to describe the visual function impairment. PCO severity and IOL-PC space are significantly correlated with axial length and IOL design and material.
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Affiliation(s)
- Sha-Sha Yu
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Nankai University Eye Hospital, Tianjin 300020, China
| | - Cheng-Zhe Lu
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Nankai University Eye Hospital, Tianjin 300020, China
| | - Ya-Wen Guo
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Nankai University Eye Hospital, Tianjin 300020, China
| | - Yun Zhao
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Nankai University Eye Hospital, Tianjin 300020, China
| | - Xiao-Yong Yuan
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Nankai University Eye Hospital, Tianjin 300020, China
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Sewerin P, Borchert K, Meise D, Schneider M, Mahlich J. Real-World Treatment Persistence with Biologic Disease-Modifying Antirheumatic Drugs Among German Patients with Psoriatic Arthritis-A Retrospective Database Study. Rheumatol Ther 2021; 8:483-497. [PMID: 33611778 PMCID: PMC7991063 DOI: 10.1007/s40744-021-00286-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/29/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION To investigate drug survival for biologic disease-modifying antirheumatic drugs (bDMARDs) in a real-world cohort of German adult biologic-naïve patients with psoriatic arthritis (PsA). METHODS Claims data for patients with a diagnosis of PsA, a bDMARD claims record (index date) between 1 January 2014 and 31 December 2017, and no bDMARD prescription for 365 days before the index date were retrospectively analyzed. The primary outcomes were the overall and individual bDMARD persistence rates over 12 months. Nonpersistence was defined as a treatment gap exceeding the days of supply plus 60 days or switching to a bDMARD other than the index therapy. Sensitivity analysis was performed, wherein the treatment gap was found to vary depending on the bDMARD regimen. Kaplan-Meier curves were plotted to determine persistence; the log-rank test was used to evaluate differences in the persistence rate. Factors associated with treatment discontinuation were evaluated using Cox regression analysis. RESULTS Among 10,954 patients with a PsA diagnosis, 348 were eligible. The overall bDMARD persistence rate was 57.5%; individual bDMARD persistence rates were 81.3% for ustekinumab, 66.7% for infliximab, and 60.0% for golimumab. The mean (SD) overall persistence with bDMARDs was 289 (103) days; the mean persistence was 334 (72) days for ustekinumab, 309 (82) days for golimumab, and 305 (92) days for infliximab. The main reasons for nonpersistence were switching to another bDMARD (15.8%) and treatment discontinuation (26.7%). Male gender was significantly associated with a lower risk of treatment discontinuation (hazard ratio 0.54, 95% confidence interval 0.39-0.77; P < 0.001). The sensitivity analysis yielded similar results. CONCLUSION The one-year persistence rate for bDMARDs in German PsA patients is modest, although the persistence rate depends on the bDMARD considered.
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Affiliation(s)
- Philipp Sewerin
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany.
| | | | | | - Matthias Schneider
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany
| | - Jörg Mahlich
- Health Economics and Outcomes Research, Janssen, Pharmaceutical Companies of Johnson & Johnson, Neuss, Germany
- Düsseldorf Institute of Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany
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Toropygin SG, Mayorova EV, Maslov AN, Budzinskaya MV. [Influence of models of hydrophobic acrylic intraocular lenses on the development of posterior lens capsule opacifications (preliminary results)]. Vestn Oftalmol 2020; 136:133-141. [PMID: 33371641 DOI: 10.17116/oftalma2020136062133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The search for optimal design and material of the intraocular lens (IOL) that would prevent posterior capsule opacification (PCO) is still a relevant problem. PURPOSE To compare the influence of three models of hydrophobic acrylic IOLs on the development of PCO within one year after phaco surgery. MATERIAL AND METHODS The study included 72 patients (91 eyes) who were followed up for 12 months after implantation of one of three models of posterior chamber hydrophobic acrylic IOLs: MIOL-2 (Reper-NN, Russia, 24 eyes, 1st group), SA60AT and US60MP (Alcon, USA, 41 and 26 eyes, 2nd and 3rd groups, respectively). Posterior capsule images were taken and then processed with the EPCO 2000 (Evaluation of Posterior Capsular Opacification) software. The area of posterior capsule adjacent to the center of IOL's optic of 4.0 mm in diameter was estimated. PCO score was calculated as the weighted sum of opacification areas multiplied by the degree (from 0 to 4). RESULTS Within 1 year of the follow-up, mean visual acuity was at least 1.0 (20/20). Significant PCO progression was observed as early as 3 months after surgery. Despite that, opacification density in all three groups at every follow-up visit did not exceed grade 2; maximal PCO score (0.0315, median) was seen 12 month after surgery in the 1st group. At the same time, differences in PCO score between the groups were not significant. Nd:YAG laser posterior capsulotomy was performed only in one patient from the 1st group 12 month after surgery. Difference in the percentage of clear posterior capsules was significant only 12 month after surgery between the 1st and 3rd groups (p=0.024). CONCLUSION All three models of hydrophobic acrylic IOLs showed comparably high vision outcomess during 12 months of the follow-up with somewhat better PCO score and percentage of clear posterior capsules in eyes with US60MP.
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Affiliation(s)
| | | | - A N Maslov
- Tver State Medical University, Tver, Russia
| | - M V Budzinskaya
- Tver State Medical University, Tver, Russia.,Research Institute of Eye Diseases, Moscow, Russia
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Borkenstein AF, Borkenstein EM. Analysis of YAG Laser-Induced Damage in Intraocular Lenses: Characterization of Optical and Surface Properties of YAG Shots. Ophthalmic Res 2020; 64:417-431. [PMID: 33221803 DOI: 10.1159/000513203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/15/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To assess differences in neodymium:yttrium aluminum garnet (Nd:YAG)-induced defects in hydrophilic and hydrophobic intraocular lenses (IOLs) and describe optical and surface properties of YAG shots/pitting. Describing and measuring the iatrogenic produced defects should achieve higher awareness on this topic and change the mindset of such a trivial procedure to be proceeded with more caution and calmness in the future. MATERIALS Twelve IOLs from different manufacturers made of hydrophilic and hydrophobic materials were evaluated before and after treatment with the Nd:YAG laser. Microscopy and environmental scanning electron microscopic (ESEM) images were used to visually analyze the defects. Additionally, wavefront measurements were taken for power mapping and Raman spectroscopy was performed. Vertical and horizontal dimensions of the defects were analyzed and compared, and Raman line scans assessed the changes in the chemical structure in the defect area of the IOL. RESULTS Microscopically, pitting of the surface could be observed in both lens types. Defects in hydrophobic lenses appeared bigger and were visible with less magnification than in hydrophilic lenses. Similar results were obtained with ESEM images where the defects in hydrophobic IOLs seemed to be frayed while defects in hydrophilic IOLs were of circular shape. Raman spectroscopy revealed deeper defects in hydrophobic lenses. Vertical dimensions of the defects were statistically significant (p = 0.036) and greater in hydrophobic materials while horizontal dimensions did not reach significance (p = 0.056). The area of chemical changes was greater than the visible defect area and smaller in hydrophilic than that in hydrophobic materials. CONCLUSION Nd:YAG seems to have greater impact on hydrophobic IOL materials as that damage was greater and more frayed than that in hydrophilic materials. Moreover, there seems to be larger, distinctive damage area in IOLs (with chemical changes in the material) than that is visually recognizable. Therefore, a very cautious approach is recommended when performing capsulotomy, as defects in the surface structure can occur. This might come along with problems in quality of vision in monofocal and primarily premium IOLs (multifocal, enhanced depth of focus, and toric IOLs), dependent on the size, dimension, and position in the IOL. YAG capsulotomy should not be considered trivial but should be carried out with precision and without time pressure, just like surgery itself.
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Ling R, Borkenstein EM, Borkenstein AF. Evaluation of Nd:YAG Laser Capsulotomy Rates in a Real-Life Population. Clin Ophthalmol 2020; 14:3249-3257. [PMID: 33116375 PMCID: PMC7569058 DOI: 10.2147/opth.s276329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The objective of this study was to assess the rate of posterior capsule opacification (PCO), under “real-life” conditions, as measured by rates of Nd:YAG laser intervention, rather than from a controlled study from which patients with conditions predisposing to PCO have been excluded. Methods and Analysis This was a retrospective, multicenter study in an unselected consecutive cohort of patients undergoing surgery for senile cataract. Patients aged 18 years and older, previously implanted with the CT LUCIA 611P IOL, were contacted at 12, 18 and 24 months to ascertain if they had received Nd:YAG laser treatment. There was an additional assessment at 36 months at the Austrian centre. Results A total of 200 patients were recruited at two centers. Laser capsulotomy rates were 4.5% at 1 year and 10% by year 2 and 12% by year 3. Three Nd:YAG capsulotomies, carried out at other external centers, were performed for reasons other than PCO, including astigmatism, epiretinal membrane and ARMD. If these patients are excluded, the true rate of Nd:YAG carried out for PCO at 1 year was 3.5% and at 2 years was 8.5%. Conclusion It is critical to ensure that Nd:YAG capsulotomies are being performed only for the correct clinical reason. Carrying out unnecessary procedures places the patient at risk of adverse events, is a cost to the healthcare system, and is likely to have no direct visual benefit for the patient. In PCO studies, it should be a requirement to document the fibrosis grade to confirm that Nd:YAG capsulotomy was correctly indicated.
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Affiliation(s)
- Roland Ling
- The Medical Eye Clinic, Royal Devon and Exeter Hospital, Exeter, UK
| | - Eva-Maria Borkenstein
- Privatklinik der Kreuzschwestern Graz, Private Practice Borkenstein & Borkenstein, Graz, Austria
| | - Andreas F Borkenstein
- Privatklinik der Kreuzschwestern Graz, Private Practice Borkenstein & Borkenstein, Graz, Austria
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PMMA Intraocular Lenses Changes after Treatment with Nd:Yag Laser: A Scanning Electron Microscopy and X-ray Spectrometry Study. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10186321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser may cause intraocular lenses (IOLs) damages. Therefore, the effects of Nd:YAG laser on IOLs were evaluated. Twenty-four IOLs (copolymer of 2-hydroxyethylmethacrylate and 2-ethoxyethylmethacrylate) were used. For scanning electron microscope (SEM), twelve IOLs were divided into three groups: Group 1, controls; Group 2, IOLs treated with two laser spots (YC-1800 Nidek Nd:YAG laser set at 1.2 mJ); and Group 3, IOLs treated with six laser spots. All IOLs were critical point dried in CO2 and viewed in a Zeiss EVO LS10 SEM. For Energy Dispersive X-ray spectrometry (EDX), four IOLs of each group were examined with a Jeol JMC-6000 SEM. With SEM, Group 1 IOLs showed well-preserved size, shape and surface. Group 2 IOLs exhibited normal shape and margins, a peripheral furrow with irregular blebs, straight clefts and holes on the wrinkled surface. Group 3 IOLs were swollen and broken into two or three parts. With SEM and EDX, Group 1 and the undamaged surfaces of Groups 2 and 3 showed evident carbon and oxygen peaks, while, in the damaged areas, both atoms were significantly reduced. Nd:YAG laser induced evident changes in IOLs morphology and organic alterations in their chemistry: great care during posterior capsule opacification treatment is required.
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Hecht I, Dubinsky‐Pertzov B, Karesvuo P, Achiron A, Tuuminen R. Association between intraocular lens diopter and posterior capsular opacification. Clin Exp Ophthalmol 2020; 48:889-894. [DOI: 10.1111/ceo.13821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/04/2020] [Accepted: 07/04/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Idan Hecht
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology, Shamir Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Biana Dubinsky‐Pertzov
- Department of Ophthalmology, Shamir Medical Center and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Petteri Karesvuo
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Asaf Achiron
- Department of Ophthalmology, Wolfson Medical Center, Holon and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Eye Centre Kymenlaakso Central Hospital Kotka Finland
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Anti-inflammatory Medication After Cataract Surgery and Posterior Capsular Opacification. Am J Ophthalmol 2020; 215:104-111. [PMID: 32061757 DOI: 10.1016/j.ajo.2020.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/01/2020] [Accepted: 02/05/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the role of anti-inflammatory medication following cataract surgery on the formation of posterior capsular opacification. DESIGN Cohort study. METHODS A retrospective registry analysis of 25,818 consecutive patients who underwent cataract surgery between the years 2014 and 2018 at Helsinki University Hospital in Finland. Nd:YAG laser capsulotomy rates were compared between patients treated postoperatively with topical steroids, nonsteroidal anti-inflammatory medications (NSAIDs), or their combination. Kaplan-Meier and Cox regression analyses were used. A single eye of each patient was included. Main outcomes were confirmed against a second independent dataset. RESULTS A total of 13,368 patients were included in the analysis, with a mean age of 73.2 ± 9.7 years; 61.7% were female. Pseudoexfoliation was noted in 10.1% of cases. The mean follow-up time was 22.8 ± 15.7 months. Patients were treated with steroid monotherapy (28.9% of cases), NSAID monotherapy (62.2%), or a combination of both (8.9%). Treatment with steroids resulted in significantly lower Nd:YAG capsulotomy rates compared to NSAIDs (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.62-0.93, P = .009). Treatment with combination therapy of steroids and NSAIDs showed no added benefit over steroid monotherapy (HR 1.11, 95% CI 0.68-1.80, P = .674). Cox regression analysis adjusted for patients' age, sex, pseudoexfoliation, and risk stratification remained significantly predictive for lower capsulotomy rates with steroid treatment over NSAIDs (HR 0.70, 95% CI 0.52-0.88, P = .001). CONCLUSIONS Postoperative treatment with steroids among patients undergoing uncomplicated cataract surgery was associated with lower rates of clinically significant posterior capsule opacification compared to treatment with NSAIDs alone. Combination therapy of steroids and NSAIDs had no added benefit over steroids alone.
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Raulinajtys-Grzybek M, Grabska-Liberek I, Opala A, Słomka M, Chrobot M. Budget impact analysis of lens material on the posterior capsule opacification (PCO) as a complication after the cataract surgery. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:19. [PMID: 32549794 PMCID: PMC7296914 DOI: 10.1186/s12962-020-00214-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Over 300,000 cataract operations are performed in Poland every year, and the most common, late complication of cataract removal surgery is posterior capsule opacification (PCO). The risk of PCO depends on the lens material. Hydrophobic acrylic lenses cause PCO less frequently as lymphatic endothelial cells show lower affinity for the surface of the lens made of silicone. The objective of this study is to assess the economic impact of using hydrophobic acrylic lenses compared to using hydrophilic acrylic lenses for cataract treatment in the Polish inpatient and outpatient settings. Methods A budget impact analysis (BIA) compared the economic outcomes associated with using hydrophobic acrylic lenses versus using hydrophilic lenses for patients undergoing cataract surgery. The BIA predicted annual expenses in the following scenarios: performing Nd:YAG to treat PCO within 2 and 3 years after implantation of hydrophobic or hydrophilic acrylic lenses for different lens structure. Data used to assess the frequency of PCO was determined in systematic literature review. Costs of current and predicted interventions were estimated based on average data from 19 Polish hospitals. Prices of health services were taken from official public tariff lists. Results The use of a hydrophobic lens significantly limits the number of complications after cataract surgery relative to a hydrophilic lens. As hydrophobic lenses have a higher unit price their use increases the cost of treatment which currently is not reflected by adequate difference in price of the service. Total annual National Health Fund (NHF) expenses for 3-year follow-up model range from 139.1 million EUR to 143.1 million EUR depending on the lens structure, due to the cost of complications. Conclusions BIA indicates the possibility of introducing surcharge for the use of hydrophobic lenses, which could increase the frequency of their use and reduce the number of complications after cataract surgery. It was estimated that total NHF expenses reach the minimum value for the surcharge at the level of 9 EUR. The surcharge of 14 EUR is the maximum value that does not increase the initial NHF expenses.
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Affiliation(s)
| | - Iwona Grabska-Liberek
- Department of Ophthalmology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Aleksandra Opala
- Department of Ophthalmology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marta Słomka
- Department of Neurochemistry, Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
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5 year incidence of YAG capsulotomy and PCO after cataract surgery with single-piece monofocal intraocular lenses: a real-world evidence study of 20,763 eyes. Eye (Lond) 2019; 34:960-968. [PMID: 31616057 PMCID: PMC7182577 DOI: 10.1038/s41433-019-0630-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/07/2019] [Accepted: 09/03/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To evaluate the 3- and 5-year incidence of posterior capsule opacification (PCO) and neodymium-doped yttrium aluminium garnet (Nd:YAG) capsulotomy in patients following cataract surgery, comparing results for different single-piece acrylic hydrophilic and hydrophobic monofocal intraocular lens (IOL) models and other patient factors. PATIENTS AND METHODS Electronic medical record data collected from seven United Kingdom (UK) National Health Service (NHS) ophthalmology clinics for routine, age-related (≥65 years) cataract surgeries that implanted single-piece acrylic monofocal IOLs during 2010-2013 were used to calculate 3- and 5-year incidence of Nd:YAG and PCO. IOL models of Alcon Acrysof, AMO Tecnis, Bausch & Lomb (B & L) Akreos, LenStec Softec, and Rayner Flex were analyzed. Pairwise comparisons were conducted between AcrySof IOLs and other IOLs using Bonferroni adjustment for multiplicity. Multivariate analyses were conducted adjusting for known confounders. RESULTS The incidence of Nd:YAG capsulotomy ranged between 2.4-12.6% at 3 years and 5.8-19.3% at 5 years post-cataract surgery. Similarly, the incidence of PCO ranged between 4.7-18.6% at 3 years and 7.1-22.6% at 5 years. When comparing all of the single-piece IOLs, AcrySof demonstrated the lowest incidence rates for both PCO and Nd:YAG (P < 0.001 for each comparison). From adjusted logistic regression analysis, AcrySof were associated with lower 3- and 5-year odds of Nd:YAG and PCO incidence. CONCLUSIONS Following cataract surgery with single-piece monofocal IOLs different incidence rates of PCO were observed with different IOLs. AcrySof IOLs were associated with significantly lower incidence of PCO requiring Nd:YAG treatment over periods of 3 and 5 years.
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