Nd: YAG capsulotomy for posterior capsule opacification after combined clear corneal phacoemulsification and vitrectomy

Study of Variation in Intraocular Pressure Spike (IOP) Following Nd- YAG Laser Capsulotomy

INTRODUCTION

Posterior Capsular Opacifications (PCO) is a frequent complication of cataract surgery following posterior chamber intraocular lens implantation. Nd -Yag laser capsulotomy is the treatment of choice for PCO and is known to be associated with complications like Raised Intraocular Pressure (IOP), Intraocular lens pitting, intraocular lens cracks, cystoid macular oedema, retinal detachment, corneal burns. Raised IOP is the most common complication and prescribing anti-glaucoma drugs post capsulotomy is a common practise. Our study helps us to anticipate the post procedural IOP rise in specific patients and treat only selected group of patients with anti- glaucoma medications.

AIM

To study and correlate the effect of energy used and number of shots with post procedural IOP spike following Nd-YAG laser capsulotomy cases.

MATERIALS AND METHODS

All patients with PCO presenting to Ophthalmology Out Patient Department at Sri Siddhartha Medical College between November 2014 to November 2015 were included. All the patients with glaucoma, uveitis and high myopia were excluded from the study. Data relevant to history, ocular examination and IOP were recorded.

RESULTS

Significant correlation of IOP spike with the number of Nd- YAG Laser shots delivered was found by One-way ANOVA Post-Hoc Tukeys Test. The p-value was significant for shots more than 40, provided the energy was restricted to 20 mJ and below. Correlation of energy with IOP spike was not significant as found by One-way ANOVA, Post-Hoc Tukey test. Predictability of 2 hours post-procedure IOP regarding persistent IOP rise was significant.

CONCLUSION

It was observed that all pseudophakic patients may not require anti-glaucoma medication pre, or post Nd YAG laser capsulotomy. Only patients who required more than 40 shots during the procedure would need a close observation and if persistent rise is documented, ocular hypotensives may be advised.

Which procedure has more effect on macular thickness: primary posterior continuous capsulorhexis (PPCC) combined with phacoemulsification or Nd:YAG laser capsulotomy?

To compare the effect of Nd:YAG laser capsulotomy and primary posterior continuous capsulorhexis (PPCC) combined with phacoemulsification on macular thickness using optical coherence tomography (OCT) in adults. This prospective comparative interventional study included 32 eyes of 30 patients who underwent Nd:YAG laser capsulotomy and 33 eyes of 33 patients who underwent cataract surgery with PPCC. Detailed ocular examinations, including macular thickness measurements by OCT, were performed in all patients preoperatively and postoperatively on the 1st day, 1st week, and 1st, 3rd and 6th months. No significant differences were found in macular thickness between the two groups in preoperative and postoperative follow-up. No cystoid changes were observed in OCT during the postoperative period in both groups. Nd:YAG laser capsulotomy and PPCC combined with cataract surgery are safe and effective procedures that are not associated with an increase in macular thickness.

Secondary cataract: an epidemiologic and clinical survey at the Yaounde Gynaeco-obstetric and Paediatric Hospital

Objective:

To determine the incidence and risk factors of secondary cataract.

Materials and methods:

A retrospective study involving a review of medical records in the ophthalmology unit of the Yaoundé Gynaeco-obstetric and Paediatric Hospital in Yaoundé, Cameroon, was carried out. All patients who had cataract surgery between January 2006 and September 2010 were included. Variables included age, sex, past medical history, morphology of primary cataract, type of surgery, intraocular lens implantation, site of implantation, intra- and postoperative complications, and the time lapse for the presentation of secondary cataract. Both univariate and bivariate analyses were carried out. The χ² test was used to compare proportions, and P-values <0.05 were considered statistically significant.

Results:

A total of 864 eyes of 718 patients had cataract surgery. Ninety-two eyes developed posterior capsule opacification, giving an incidence of 10.65%. The mean age of patients who developed secondary cataract was 52.3 ± 23.05 years, with a range of 4 years to 84 years. Secondary cataract was more frequent in the age group of 0–20 years. The time lapse for presentation of secondary cataract was 64.7 ± 9.53 days, with a range of 1 to 504 days. Risk factors for the development of secondary cataract were age (P = 0.000), sex (P = 0.011), cortical cataract (P = 0.000), and postoperative inflammation (P = 0.000).

Conclusion:

The incidence of secondary cataract, though high in this study, is lower than that reported in other studies.