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Icoz M, Tarım B, Icoz SGG. The effect of Nd:YAG Laser applied in the posterior capsule opacification on retinal and choroidal structures. Photodiagnosis Photodyn Ther 2023; 43:103653. [PMID: 37295662 DOI: 10.1016/j.pdpdt.2023.103653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE To assess the effect of neodymium:yttrium-aluminum-garnet (Nd-YAG) laser procedure on the choroid and retina in patients who developed posterior capsular opacification (PCO) after cataract surgery. METHODS In this study, 32 eyes of 30 patients who underwent Nd:YAG laser treatment for PCO were evaluated. Visual acuity (VA), intraocular pressure (IOP), central macular thickness (CMT) with optical coherence tomography device (OCT), ganglion cell layer (GCL), inner plexiform layer (IPL), retinal nerve fiber layer (RNFL) and subfoveal choroidal thickness (SCT) were measured. Choroidal vascular index (CVI) was calculated from HD line images obtained by spectral domain OCT with the software Image J. RESULTS The mean age of the patients participating in the study was 60.1 ± 8.9 years. There was no significant difference in IOP, CMT, RNFL, GCL, IPL and SCT values in all comparisons before and after laser (p>0.05 for all values). While Nd:YAG laser pretreatment CVI was 63.2 ± 3.2%, it was 66.8 ± 2.9% at 1 week and 67.1 ± 2.6% at 1 month after laser treatment. A significant difference was detected in the comparison of pre-laser CVI and post-laser 1 week and 1 month CVI (p<0.05 for all values). DISCUSSION CVI was found to be significantly higher in the post-laser period in patients who underwent Nd:YAG laser. As far as the author knows, this study is the first research in the literature to evaluate this relationship. CVI can be used to evaluate choroidal vascular changes after Nd:YAG laser.
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Affiliation(s)
- Mehmet Icoz
- Department of Ophthalmology, Yozgat City Hospital, Erdoğan Akdağ Mah., Viyana Cad., 66100 Merkez, Yozgat, Turkey.
| | - Bilge Tarım
- Department of Ophthalmology, Ankara City Hospital, Ankara, Turkey
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Effect of Nd: YAG laser capsulotomy on the risk of retinal detachment after cataract surgery: A systematic review and meta-analysis. J Cataract Refract Surg 2021; 48:238-244. [PMID: 34538778 DOI: 10.1097/j.jcrs.0000000000000755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT We aimed to evaluate the impact of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy on the incidence of pseudophakic retinal detachment (RD). The PubMed and Embase databases were searched for meta-analysis. Subgroup analyses were conducted according to study location, number of cases, mean follow-up time, and cataract procedure. The final analysis included 11 studies with 309 cases of RD in 65,117 eyes undergoing cataract surgery. Among them, 8,232 eyes underwent Nd:YAG capsulotomy. Our analysis demonstrated an increased risk of RD with Nd:YAG laser capsulotomy (RR=1.57; 95%CI, 1.17-2.12; P=0.003; HR=1.64; 95%CI, 1.03-2.62; P=0.04). Subgroup analysis suggested somewhat stronger associations in Asian (RR=4.54; 95%CI, 2.20-9.38; P<0.0001) than in non-Asian populations (America, P=0.12; Europe and others, P=0.21), and with extracapsular cataract extraction (RR=2.97; 95%CI, 1.83-4.83; P<0.0001) than with phacoemulsification (P=0.95). To conclude, Nd:YAG laser capsulotomy may be associated with an increased risk of pseudophakic RD.
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Wesolosky JD, Tennant M, Rudnisky CJ. Rate of retinal tear and detachment after neodymium:YAG capsulotomy. J Cataract Refract Surg 2019; 43:923-928. [PMID: 28823439 DOI: 10.1016/j.jcrs.2017.03.046] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 03/22/2017] [Accepted: 03/28/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the rate of retinal tear and retinal detachment (RD) after neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO) after cataract surgery. SETTING Province-wide outpatient and hospital settings, Alberta, Canada. DESIGN Database study. METHODS Eleven years of billing records data were collected to assess the rate of retinal tear and/or RD after Nd:YAG laser capsulotomy. A period of 90 days from Nd:YAG was considered the at-risk period, although statistics for 10 years of data were included in the study. Risk was calculated as a rate (%) of retinal tear or RD after Nd:YAG laser capsulotomy. RESULTS The study comprised 92 654 discrete billing records yielding 73 586 ocular procedures for the analysis of the rate of retinal tear and/or RD after Nd:YAG laser capsulotomy. There were 67 287 Nd:YAG capsulotomies for PCO performed during the study. The 90-day risk for retinal tear after Nd:YAG was 0.21%; 720 retinal tears occurred in the study population at some point after the procedure. The rate of RD was 0.60%, with 2219 RDs occurring at some point after Nd:YAG capsulotomy. The cumulative risk for retinal tear or detachment at 3, 6, 9, and 12 months was 0.21%, 0.30%, 0.36%, and 0.43% and 0.60%, 0.96%, 1.19%, and 1.39%, respectively. The rates of retinal tear and detachment varied significantly between age categories. CONCLUSIONS There was an increased risk for RD in the first 5 months after Nd:YAG, with a return to a baseline plateau thereafter. As such, the rate of retinal tear after Nd:YAG capsulotomy at 5 months was 0.29%, whereas the rate of RD was 0.87%.
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Affiliation(s)
- Jason D Wesolosky
- From the Department of Ophthalmology (Wesolosky), University of Saskatchewan, Saskatoon, Saskatchewan, and the Department of Ophthalmology (Tennant, Rudnisky), University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Tennant
- From the Department of Ophthalmology (Wesolosky), University of Saskatchewan, Saskatoon, Saskatchewan, and the Department of Ophthalmology (Tennant, Rudnisky), University of Alberta, Edmonton, Alberta, Canada
| | - Christopher J Rudnisky
- From the Department of Ophthalmology (Wesolosky), University of Saskatchewan, Saskatoon, Saskatchewan, and the Department of Ophthalmology (Tennant, Rudnisky), University of Alberta, Edmonton, Alberta, Canada.
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Jinagal J, Sahu S, Gupta G, Khurana S, Gupta R, Gupta PC, Ram J. Quantification of Inflammation Following Nd:YAG Laser Capsulotomy and Assessing the Anti-inflammatory Effects of Nepafenac 0.1% and Betamethasone 0.1. Ocul Immunol Inflamm 2019; 29:411-416. [PMID: 31638843 DOI: 10.1080/09273948.2019.1668025] [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: 10/25/2022]
Abstract
Purpose: To quantify the intraocular inflammation, measured using laser flare photometry (LFP), after Nd:YAG capsulotomy and compare the effects of different topical anti-inflammatory regimes.Methods: A single-center, prospective, randomized controlled study, which included 90 eyes of 90 patients with visually significant posterior capsular opacification. In all patients, Nd:YAG capsulotomy was done and was then randomized into three groups: (A) Topical betamethasone 0.1%; (B) Topical nepafenac 0.1%; and (C) Control group: did not receive any anti-inflammatory agent post capsulotomy.Results: There was a significant increase in the mean LFP values 2 h following laser capsulotomy (p < 0.001) and then declined gradually and came back to pre-laser values by 2 weeks in all three groups. The mean LFP values, central macular thickness, and best corrected visual acuity were comparable among groups. None developed central macular edema.Conclusion: Intraocular inflammation following Nd:YAG capsulotomies is minimal and transient. Routine use of prophylactic anti-inflammatory agents may be avoided.
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Affiliation(s)
- Jitender Jinagal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sabin Sahu
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surbhi Khurana
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rohit Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parul Chawla Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Parajuli A, Joshi P, Subedi P, Pradhan C. Effect of Nd:YAG laser posterior capsulotomy on intraocular pressure, refraction, anterior chamber depth, and macular thickness. Clin Ophthalmol 2019; 13:945-952. [PMID: 31239636 PMCID: PMC6559220 DOI: 10.2147/opth.s203677] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/15/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose: To see the effect of Nd:YAG laser capsulotomy on intraocular pressure (IOP), refraction, best-corrected visual acuity (BCVA), anterior chamber depth (ACD), and macular thickness. Methodology: The authors conducted a prospective, descriptive study on pseudophakic eyes with posterior capsule opacification who underwent Nd:YAG laser capsulotomy. BCVA, IOP, spherical equivalent (SE), macular thickness, and ACD were noted preoperatively, at 1 hr postoperatively and at 1-month follow-up. Patients were divided into two groups based on energy used (Group I ≤50 mJ, Group II >50 mJ). None of the patients received prophylactic antiglaucoma medications either before or after the procedure. Results: There were 96 eyes of 83 patients. Mean total energy levels were 26.64±12.92 mJ in Group I and 81.96±32.10 mJ in Group II. BCVA at 1 hr and 1 month postoperatively improved significantly in both the groups compared to preoperative BCVA (P<0.001). There was no significant change in SE compared to preoperative values in both the groups. The ACD continued to increase significantly in both the groups at both 1 hr and 1-month follow-up. In Group I, IOP increased at 1 hr postoperatively (P=0.023) and declined to preoperative levels at 1 month. In Group II, IOP increased at 1 hr postoperatively (P<0.001) and did not return to preoperative levels at 1-month follow-up (P=0.003). Likewise, macular thickness increased at 1 hr in both groups (P<0.001). In Group I, macular thickness decreased significantly to preoperative level at 1 month whereas in Group II, it remained significantly high at 1-month follow-up (P=0.006). There was no case with serious rise in IOP or cystoid macular edema. Conclusion: Statistically significant increment in IOP and macular thickness occurs after Nd:YAG laser capsulotomy which however may not necessitate the use of any medications.
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Affiliation(s)
| | | | - Prabha Subedi
- Cataract and Refractive Surgery, Mechi Eye Hospital, Jhapa, Nepal
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Srinivasan S, Koshy Z. Pars plana posterior capsulectomy with a 27-gauge microincision vitrectomy system for dense posterior capsule opacification. J Cataract Refract Surg 2017; 43:719-723. [PMID: 28732603 DOI: 10.1016/j.jcrs.2017.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/24/2017] [Accepted: 01/29/2017] [Indexed: 10/19/2022]
Abstract
We describe a surgical technique of pars plana posterior capsulectomy using a transconjunctival sutureless 2-port 27-gauge microincision vitrectomy system to deal with dense posterior capsule opacification (PCO). The technique was used successfully in 5 eyes of 5 patients with dense PCO that had been unsuccessfully treated by neodymium:YAG laser photodisruption.
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Affiliation(s)
- Sathish Srinivasan
- From the Department of Ophthalmology (Srinivasan, Koshy), University Hospital Ayr, Ayr, and the Faculty of Medicine (Srinivasan), University of Glasgow, Glasgow, Scotland, United Kingdom.
| | - Zachariah Koshy
- From the Department of Ophthalmology (Srinivasan, Koshy), University Hospital Ayr, Ayr, and the Faculty of Medicine (Srinivasan), University of Glasgow, Glasgow, Scotland, United Kingdom
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Pekel G, Yağcı R, Acer S, Özdemir S, Sayin N. Evaluation of the impact of Nd:YAG laser posterior capsulotomy on ocular pulse amplitude and anterior segment morphology. Lasers Surg Med 2014; 46:553-7. [DOI: 10.1002/lsm.22273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Gökhan Pekel
- Ophthalmology Department; Pamukkale University; Denizli Turkey
| | - Ramazan Yağcı
- Ophthalmology Department; Pamukkale University; Denizli Turkey
| | - Semra Acer
- Ophthalmology Department; Pamukkale University; Denizli Turkey
| | | | - Nihat Sayin
- Eye Clinic; Kanuni Sultan Suleyman Research & Training Hospital; Istanbul Turkey
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Min JK, An JH, Yim JH. A new technique for Nd:YAG laser posterior capsulotomy. Int J Ophthalmol 2014; 7:345-9. [PMID: 24790883 DOI: 10.3980/j.issn.2222-3959.2014.02.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 12/06/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To investigate the effects of a new opening pattern in neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy on visual function. METHODS This technique was conducted along a circular pattern. The energy ranged between 0.8 and 1.2 mJ/pulse was consumed and mean total energy levels were 74±21 mJ (mean±standard deviation: SD, from 40 to 167) and laser shots aimed at 150 µm away behind a datum point and went along an imaginary line which extends 0.5 mm inside from optic margin and into the circular en bloc pattern. Vitreous stands were attached with fragment and then they were cut off by the laser after circular application. The circular fragment was completely separated from vitreous, and then this fragment was quickly sunk in intravitreal space. RESULTS The follow-up period ranges from at least a week to 40mo, making 15.8mo on average. The procedural outcome showed 96% (74 eyes out of the 77 eyes) enhancement in patients' visual acuity. Cystoid macular edema or retinal detachment was not observed in any of the patients during follow-up periods. CONCLUSION This new technique is expected to improve the weaknesses that the conventional procedures have by adding the process to cut off vitreous stands attached with the fragment by the laser to the circular application.
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Affiliation(s)
- Jung Kee Min
- Department of Ophthalmology, Ulsan University Hospital, Ulsan University College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, Republic of Korea
| | - Jae Hwan An
- Department of Ophthalmology, Ulsan University Hospital, Ulsan University College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, Republic of Korea
| | - Jin Ho Yim
- Samsung Eye Clinic, Cheongju 361-270, Republic of Korea
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Kara N, Evcimen Y, Kirik F, Agachan A, Yigit FU. Comparison of Two Laser Capsulotomy Techniques: Cruciate Versus Circular. Semin Ophthalmol 2014; 29:151-5. [DOI: 10.3109/08820538.2013.874467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Interleukin-6 in the pathogenesis of posterior capsule opacification and the potential role for interleukin-6 inhibition in the future of cataract surgery. Med Hypotheses 2013; 80:466-74. [DOI: 10.1016/j.mehy.2012.12.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 07/18/2012] [Accepted: 12/29/2012] [Indexed: 12/14/2022]
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Kim Y, Park J. The Effect of Two Different Opening Patterns of Neodymium:YAG Laser Posterior Capsulotomy on Visual Function. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.3.390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Youngkook Kim
- Department of Ophthalmology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Jongseok Park
- Department of Ophthalmology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
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Kim IT, Roh YJ. A Case of Macular Hole After Nd:YAG Laser Capsulotomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.4.691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- In Tae Kim
- Department of Ophthalmology & Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Jung Roh
- Department of Ophthalmology & Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Chew J, Werner L, Stevens S, Hunter B, Mamalis N. Evaluation of the effects of hydrodissection with antimitotics using a rabbit model of Soemmering's ring formation. Clin Exp Ophthalmol 2006; 34:449-56. [PMID: 16872342 DOI: 10.1111/j.1442-9071.2006.01247.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Regeneration/proliferation of lens material within the capsular bag still is the most frequent complication after cataract surgery. We aimed to evaluate the effects of hydrodissection with low doses of antimitotics on the overall regeneration/proliferation of lens material in rabbit eyes, using a model allowing the lens material to be confined to the equatorial region of the capsular bag, facilitating its quantification. METHODS Twelve albino rabbits underwent bilateral phacoemulsification. Their eyes were randomized to receive 0.4 cc of balanced salt solution, 5-fluorouracil (12.5 mg/mL) or mitomycin C (0.1 mg/mL) during hydrodissection. They were left aphakic, so the capsulorhexis would fuse with the posterior capsule postoperatively. After 4 weeks, killing/enucleation was performed. Regeneration/proliferation of lens material within the equatorial capsular bag (Soemmering's ring) was graded from the Miyake-Apple view (0-4). Its area was also calculated (microm(2)) from direct measurements performed on histological sections. RESULTS The capsulorhexis margin fused with the peripheral posterior capsule, so the central posterior capsule remained clear. There was no significant difference among the groups (Kruskal-Wallis test) regarding Soemmering's ring gross grading (P = 0.511), number of lens epithelial cell layers lining the inner surface of the capsular bag (P = 0.310) and Soemmering's ring microscopic cross-sectional area (P = 0.638). CONCLUSIONS The effect of different solutions on after-cataract should be assessed in terms of overall regeneration/proliferation of lens material within the capsular bag, in addition to posterior capsule opacification. When administered in low doses during hydrodissection, 5-fluorouracil and mitomycin C did not show a significant inhibitory effect on after-cataract formation in rabbit eyes.
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Affiliation(s)
- Jesse Chew
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA
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Yeom HY, Lee JH, Hong YJ, Seong GJ. Brimonidine 0.2% Versus Brimonidine Purite 0.15%: Prophylactic Effect on IOP Elevation After Nd:YAG Laser Posterior Capsulotomy. J Ocul Pharmacol Ther 2006; 22:176-81. [PMID: 16808678 DOI: 10.1089/jop.2006.22.176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS The aim of this study was to compare the prophylactic effect of brimonidine 0.2% versus brimonidine Purite 0.15% on intraocular pressure (IOP) increase after Nd:YAG laser posterior capsulotomy. METHODS In this prospective, double-masked, randomized, controlled study, 106 patients (106 eyes) who underwent Nd:YAG laser posterior capsulotomy were allocated to a brimonidine 0.2% group (35 eyes), a brimonidine Purite 0.15% group (36 eyes), or a vehicle group (35 eyes). One (1) drop of brimonidine 0.2%, brimonidine Purite 0.15%, or vehicle was instilled 1 h preoperatively and 1 drop immediately after Nd:YAG laser posterior capsulotomy. IOPs were measured preoperatively and at 1, 2, 3, and 24 h postoperatively. RESULTS Decreases in IOP from baseline ranged from 2.3 to 2.7 mmHg in the brimonidine 0.2% group and 2.2-2.5 mmHg in the brimonidine Purite 0.15% group (P < 0.05), whereas the vehicle group exhibited a rise in IOP. IOP elevations of less than 5 mmHg occurred in 22.9% of patients in the brimonidine 0.2% group, 27.8% in the brimonidine Purite 0.15% group, and 48.6% in the vehicle group. Spikes of IOP greater than 10 mmHg occurred in 2.9% of patients in the brimonidine 0.2% group, 2.8% in the brimonidine Purite 0.15% group, and 8.6% in the vehicle group. The incidence of IOP elevation was not statistically significant between the brimonidine 0.2% and the brimonidine Purite 0.15% groups (P < 0.05). CONCLUSIONS Brimonidine 0.2% and brimonidine Purite 0.15% have similar efficacy in the prevention of IOP elevation after Nd:YAG laser posterior capsulotomy.
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Affiliation(s)
- Ho Yeop Yeom
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Werblin TP, Krider D. Another view of neodymium:YAG capsulotomy. J Cataract Refract Surg 2006; 32:373-4; author reply 374. [PMID: 16631028 DOI: 10.1016/j.jcrs.2005.12.132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Indexed: 10/24/2022]
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Nanavaty MA, Vasavada AR, Zetterström C. Phakic IOL implantation versus clear lens extraction in highly myopic eyes. J Cataract Refract Surg 2005; 31:2041. [PMID: 16412901 DOI: 10.1016/j.jcrs.2005.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Fernandez V, Fragoso MA, Billotte C, Lamar P, Orozco MA, Dubovy S, Willcox M, Parel JM. Efficacy of various drugs in the prevention of posterior capsule opacification: experimental study of rabbit eyes. J Cataract Refract Surg 2005; 30:2598-605. [PMID: 15617931 DOI: 10.1016/j.jcrs.2004.05.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the efficacy of various drugs in the prevention of posterior capsule opacification (PCO) in a closed capsular bag technique. SETTING Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA. METHODS Lens material was removed using phacoaspiration or phacoemulsification through a microcapsulorhexis according to the hardness of the crystalline lens correlated with the weight and age of the rabbits. A mixture of an ophthalmic viscosurgical device (sodium hyaluronate 1.4% [SHA]) and a drug was injected into the empty capsular bag, allowed to remain inside for 3 minutes, and removed. The capsular bag was rinsed with balanced salt solution (BSS) and refilled with SHA. In a group of rabbits, the capsulorhexis was sealed with a minicapsulorhexis valve (MCV). Rabbits were treated with 1 of the following: SHA (control), BSS, mitomycin-C (MMC, 0.2 mg/mL), ethylenediaminetetraacetic acid (EDTA) (10 mM and 15 mM), 5-fluorouracil (5-FU, 33 mg/mL), acetic acid (3%, 0.3%, and 0.003%), and distilled water. RESULTS Upon completion of the study, the control and treated eyes had PCO and new lens material (not residual). Anterior capsule proliferation was observed in eyes treated with 5-FU. The order of PCO appearance (earliest to latest) was as follows: 15 mM EDTA, SHA, MMC, acetic acid 0.3%, acetic acid 3%, BSS, distilled water (small animals; no MCV), acetic acid 0.003%, 5-FU, 10 mM EDTA, and distilled water (large animals; MCV). The earliest appearance was day 1 postoperatively and the latest, day 47. CONCLUSIONS Distilled water and 10 mM EDTA treatments were the most efficient in retarding the appearance of PCO.
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Affiliation(s)
- Viviana Fernandez
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, Miami, Florida, USA
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Aslam TM, Patton N. Methods of assessment of patients for Nd:YAG laser capsulotomy that correlate with final visual improvement. BMC Ophthalmol 2004; 4:13. [PMID: 15387889 PMCID: PMC521490 DOI: 10.1186/1471-2415-4-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2004] [Accepted: 09/23/2004] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This paper attempts to clarify the usefulness of various simple pre-operative measures in estimating the potential for a visually successful capsulotomy. METHODS 24 patients attending for capsulotomy had pre-operative measures of glare with BAT tester, visibility of posterior pole and grading of posterior capsular pearls and fibrosis seen at slit lamp. Visual function was measured before and after standardised capsulotomy. Correlations of the various preoperative measures with eventual visual function improvements were calculated. RESULTS Pearls at slit lamp and poor posterior pole visualisation were all correlated with improvements in visual acuity and contrast sensitivity after capsulotomy. Amount of fibrosis visible at slit lamp and glare assessment were not correlated with vision improvements after laser. CONCLUSION Of the various measures that are taken prior to Nd : YAG capsulotomy, some correlate with eventual visual improvement but for others no clinical utility was found. Practitioners should note these findings as they are especially of use in more questionable or high-risk cases to help determine whether referral for PCO treatment by Nd: YAG capsulotomy is likely to benefit the patient.
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Patton N, Aslam TM, Bennett HG, Dhillon B. Does a small central Nd:YAG posterior capsulotomy improve peripheral fundal visualisation for the vitreoretinal surgeon? BMC Ophthalmol 2004; 4:8. [PMID: 15228627 PMCID: PMC449714 DOI: 10.1186/1471-2415-4-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Accepted: 06/30/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the effect of Nd:YAG capsulotomy for posterior capsular opacification (PCO) on visualisation of the peripheral fundus with scleral indentation. METHODS Patients undergoing Nd:YAG capsulotomy for PCO were examined pre- and four weeks post- Nd:YAG capsulotomy. In order to give a quantitative measure of visualisation of the peripheral retina, a novel scalar measurement was developed. Changes in the degree of visualisation following Nd:YAG capsulotomy were calculated. RESULTS There was a significant improvement in fundal visualisation of the retinal periphery with scleral indentation following Nd:YAG capsulotomy (p = 0.001). CONCLUSION Peripheral fundal visualisation with scleral indentation improves following a small central Nd:YAG capsulotomy. This finding is important in relation to the detection of peripheral pseudophakic retinal breaks, particularly in those patients deemed at high risk following Nd:YAG capsulotomy.
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Affiliation(s)
- Niall Patton
- Department of Ophthalmology, Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh. EH9 3HA
| | - Tariq M Aslam
- Department of Ophthalmology, Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh. EH9 3HA
| | - Harry G Bennett
- Department of Ophthalmology, Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh. EH9 3HA
| | - Baljean Dhillon
- Department of Ophthalmology, Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh. EH9 3HA
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Aslam TM, Patton N, Dhillon B. Pseudophakic retinal detachment after Nd:YAG capsulotomy. J Cataract Refract Surg 2004; 30:5; author reply 6. [PMID: 14967249 DOI: 10.1016/j.jcrs.2003.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dietlein TS, Lüke C, Jacobi PC, Kirchhof B, Krieglstein GK. Neodymium:YAG laser capsulotomy in vitrectomized pseudophakic eyes with persistent endotamponade. J Cataract Refract Surg 2004; 29:2385-9. [PMID: 14709301 DOI: 10.1016/s0886-3350(03)00248-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the feasibility and limits of neodymium:YAG (Nd:YAG) laser capsulotomy in eyes with persistent endotamponade. SETTING Department of Ophthalmology, University Cologne, Cologne, Germany. METHODS In this consecutive series, an Nd:YAG laser capsulotomy was performed by 1 surgeon in 6 eyes with posterior capsule opacification (PCO) and persistent endotamponade caused by proliferative vitreoretinopathy. The endotamponade was with silicone oil (5000 centistokes) in 5 eyes and with perfluorohexyloctane (F(6)H(8)) in 1 eye. Also evaluated were 6 vitrectomized eyes without endotamponade that had an Nd:YAG laser capsulotomy for PCO by the same surgeon. All 12 eyes were pseudophakic. The mean follow-up after capsulotomy was approximately 6 months (range 2 to 12 months). Follow-up examinations included visual acuity, intraocular pressure measurement, and IOL centration and capsule reopacification evaluation. RESULTS The total energy required was higher in eyes with persistent endotamponade. In 3 of these eyes, the laser capsulotomy could not be successfully completed and was surgically enhanced. The laser capsulotomy in eyes without endotamponade was successful in all cases. Complete reopacification occurred in 2 eyes with persistent endotamponade within 2 months and in no eye without endotamponade. Improvement in visual acuity was limited in all eyes because of retinal pathology. CONCLUSIONS Neodymium:YAG laser capsulotomy in pseudophakic eyes with persistent endotamponade was successful but had a relatively high reintervention rate. The visual prognosis was limited in all cases because of retinal pathology.
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Ranta P, Tommila P, Kivelä T. Retinal breaks and detachment after neodymium:YAG laser posterior capsulotomy. J Cataract Refract Surg 2004; 30:58-66. [PMID: 14967269 DOI: 10.1016/s0886-3350(03)00558-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2003] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the 5-year incidence of retinal breaks and retinal detachment (RD) after neodymium:YAG (Nd:YAG) laser posterior capsulotomy and the prophylactic treatment of perioperative retinal breaks. SETTING Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. METHODS This study design was stage 2 of a prospective nonrandomized interventional case series. Of 341 patients (350 eyes) referred for a first Nd:YAG laser posterior capsulotomy between October 1994 and February 1996, 211 (220 eyes) were examined for retinal breaks before and after capsulotomy (stage 1 of study). Asymptomatic breaks were prophylactically photocoagulated. Of the 211 patients, 106 (113 eyes) were examined at stage 2 a median of 4.9 years after Nd:YAG capsulotomy. The charts of all 341 patients were reviewed for development of RD and retinal breaks. The proportion of patients developing RD was estimated by Kaplan-Meier survival analysis, and the risk for RD was modeled by Cox proportional hazard regression. RESULTS By 5 years, the overall cumulative proportion of RD in the 341 patients was 2.0% (95% confidence interval [CI], 1.0-4.0). Of the 211 eyes enrolled in stage 1, 2 (1.2%) developed an RD (95% CI, 0.3-4.7). Of 51 fellow eyes that had a capsulotomy and 120 eyes that had a capsulotomy but were not enrolled in stage 1 and were not prophylactically treated, RD occurred in 6 eyes (5.8%; 95% CI, 2.6-13). By univariate Cox regression, the axial length, whether modeled as a continuous variable (hazard ratio [HR] 1.51 for each millimeter increase) or categorized using 25.0 mm as a cutoff (HR 11.1), had the strongest association with RD after Nd:YAG posterior capsulotomy (P =.0002 and P =.0016, respectively). CONCLUSIONS In addition to the capsulotomy, other known risk factors predicted RD after Nd:YAG laser posterior capsulotomy. Close follow-up and prophylactic photocoagulation of preexisting retinal breaks are worth considering, especially in high-risk eyes.
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Affiliation(s)
- Päivi Ranta
- Vitreoretinal Service, Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.
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Abstract
Surgery for cataract removal has become successively refined such that posterior capsular opacification is the most common problem presenting after modern cataract extraction. Various techniques and treatments exist to manage patients with posterior capsular opacification using Nd:YAG capsulotomy. There are many possible variations in initial assessment, pre-laser treatments, laser techniques, and follow-up routines. The literature on the use of Nd:YAG laser for capsulotomy was reviewed and interpreted. This article presents the currently available knowledge in a format that allows the practitioner to tailor an evidence-based protocol for treating patients with symptomatic posterior capsule opacification.
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Abstract
Pseudophakic retinal detachment is a rare, but potentially serious, complication of cataract surgery. The incidence of pseudophakic retinal detachment following current surgical techniques of cataract extraction, including extracapsular cataract extraction by nuclear expression and phacoemulsification, is lower than that found after intracapsular cataract extraction. The risk of pseudophakic retinal detachment appears to be increased in myopic patients, in those patients in whom vitreous loss had occurred at the time of cataract surgery, and in patients undergoing Nd:YAG posterior capsulotomy. Most cases present to the clinician when the macula is already detached and the central vision is affected. When evaluating patients with pseudophakic retinal detachment, the fundal view is often impaired by anterior or posterior capsular opacification, reflections related to the intraocular lens, or poor mydriasis. Scleral buckling, pneumatic retinopexy, and primary pars plana vitrectomy, with or without combined scleral buckling, are the surgical techniques used to treat pseudophakic retinal detachment. Anatomical success rates are high after vitreo-retinal surgery for pseudophakic retinal detachment, although a smaller proportion of patients recover good vision following surgery.
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Affiliation(s)
- Noemi Lois
- Retina Service, Ophthalmology Department, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, UK
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Jahn CE, Richter J, Jahn AH, Kremer G, Kron M. Pseudophakic retinal detachment after uneventful phacoemulsification and subsequent neodymium: YAG capsulotomy for capsule opacification. J Cataract Refract Surg 2003; 29:925-9. [PMID: 12781277 DOI: 10.1016/s0886-3350(02)01820-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine the incidence of retinal detachment (RD) after neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO) and define the characteristics of this type of RD. SETTING A private practice, with statistical evaluation at a university department. METHODS Five hundred twenty-six consecutive eyes that had Nd:YAG capsulotomy because of visually disturbing PCO were followed prospectively for up to 52 months (median 21 months) to determine the incidence of RD. The median age of the 142 men and 320 women was 76 years and the median axial length, 23.3 mm (range 20.5 to 31.3 mm). Before the capsulotomy, all eyes had uneventful phacoemulsification with implantation of a posterior chamber intraocular lens (PC IOL). Eyes with additional surgical procedures or with panretinal laser photocoagulation were excluded. Eyes in which a retinal hole had been treated before Nd:YAG (n = 4) were included. The fundus was examined by binocular indirect ophthalmoscopy with a 2.2 diopter Volk lens in full mydriasis. If necessary, an examination with a 3-mirror lens was done. RESULTS The incidence of RD was 0% (0/483; 95% confidence interval [CI], 0.0%-0.8%) at 6 months, 0% (0/407; 95% CI, 0.0%-0.9%) at 12 months, and 0.5% (1/213; 95% CI, 0.0%-2.6%) at 24 months. Twenty-one months after Nd:YAG capsulotomy, 1 eye developed an RD that occurred as the result of a horseshoe tear that reopened. The tear, which formed 7 months after phacoemulsification and PC IOL implantation and 6 years before Nd:YAG capsulotomy, had been immediately treated with argon laser photocoagulation. Excluding the 4 eyes with preexisting tears, presumably sealed retinal holes, the incidence at 24 months was 0% (0/212; 95% CI, 0.0%-1.7%). No other eye developed RD over the follow-up. CONCLUSIONS Retinal detachment after Nd:YAG capsulotomy for PCO was rare in eyes that had previous uneventful phacoemulsification and PC IOL implantation. The exact relationship between the 2 events remains to be established.
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Affiliation(s)
- Claus E Jahn
- Augenpraxisklinik Dr. Jahn, Bodmanstrasse 8, 87435 Kempten, Germany
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Abstract
Removal of the crystalline lens increases the risk of rhegmatogenous retinal detachment (RD) by creating changes in the ocular environment that predispose to development of retinal breaks. The evolution of cataract surgery from intracapsular cataract extraction (ICCE) to extracapsular cataract extraction (ECCE) and phacoemulsification has reduced the incidence of RD, while advances in vitreoretinal surgery have resulted in improved outcomes when retinal detachment does occur. The incidence of RD varies between 0.4-3.6% for ICCE and between 0.55-1.65% for ECCE. In eyes having undergone phacoemulsification the incidence is similar to those of ECCE and ranges between 0.75-1.65%. In this article the authors review the incidence and risk factors associated with pseudophakic and aphakic RD. The risk factors discussed include pre-operative risk factors such as age, status of the fellow eye and myopia, and surgical risk factors such as vitreous loss, posterior capsular integrity and Nd : YAG capsulotomy.
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Affiliation(s)
- Meisy Ramos
- Massachusetts Eye & Ear Infirmary and Schepens Eye Research Institute Boston, MA, USA
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Ranta P, Kivelä T. Functional and anatomic outcome of retinal detachment surgery in pseudophakic eyes. Ophthalmology 2002; 109:1432-40. [PMID: 12153792 DOI: 10.1016/s0161-6420(02)01111-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the long-term anatomic and functional visual outcome of retinal detachment (RD) surgery in pseudophakic eyes after uncomplicated cataract surgery. DESIGN An interventional, retrospective noncomparative case series PARTICIPANTS One hundred thirty-eight consecutive patients who had undergone uncomplicated extracapsular cataract extraction and intraocular lens implantation followed by rhegmatogenous RD between 1990 and 1995. METHODS One hundred one eligible patients were examined (inclusion ratio, 73%) a median of 4.3 years after last RD surgery. The best-corrected visual acuity (BCVA), visual fields, retinal status, and patient-rated visual outcome were recorded, the latter by a questionnaire that included self-reported satisfaction, trouble with vision, a modified Cataract Symptom Score, and the VF-14 Visual Functioning Index. MAIN OUTCOME MEASURES BCVA, retinal attachment, diameter of visual field, modified Cataract Symptom Score, VF-14 score. RESULTS Baseline characteristics of enrolled and nonenrolled patients were comparable, except that nonenrolled patients were older. When RD developed, 55 eyes had an intact posterior capsule, and 46 had a laser posterior capsulotomy (LCT). The BCVAs before (median, logarithm of the minimum angle of resolution [-logMAR] 1.2 versus 1.1, Snellen equivalent 0.063 versus 0.08) and after retinal surgery (median, -logMAR 0.46 versus 0.4, Snellen equivalent 0.35 versus 0.4) were comparable for eyes with and without LCT (P = 0.86). The retina was reattached with one procedure in 75 eyes (74%), with two procedures in 98 eyes (97%), and with three to five procedures in all eyes. The retina remained attached long term in 92 eyes (91%). Redetachment rate (9% versus 9%, P = 1.0) and visual field diameters were comparable for eyes with and without LCT. Overall, 80% of patients were satisfied or very satisfied with their binocular vision, and 62% had no or only a little trouble with binocular vision. Visual performance was similar regardless of presence or absence of LCT (median Cataract Symptom Score, 3.0 versus 3.0, P = 0.76; and median VF-14 score, 87.5 versus 87.5, P = 0.81). CONCLUSIONS Nine in 10 pseudophakic retinal detachments remain attached long term, and 8 in 10 patients are satisfied with their binocular vision after surgery. Even though secondary cataract and posterior capsulotomy can cause problems for the retinal surgeon, the anatomic and functional outcomes of pseudophakic RD are not influenced by capsulotomy.
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Affiliation(s)
- Päivi Ranta
- Department of Ophthalmology, Helsinki University Central Hospital, Finland
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