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Does a small central Nd:YAG posterior capsulotomy improve peripheral fundal visualisation for the Vitreoretinal surgeon?

DOI: 10.1186/1471-2415-4-8

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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.There was a significant improvement in fundal visualisation of the retinal periphery with scleral indentation following Nd:YAG capsulotomy (p = 0.001).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.Posterior capsular opacification (PCO) is the commonest complication of cataract surgery [1]. It has implications not only for the immediate visual function of the patient, but also for the ophthalmologists' diagnostic ability, as PCO may have a significant impact on the ability of the vitreoretinal surgeon to visualise the peripheral fundus. This may be particularly important for patients at risk of retinal detachment.After uneventful extracapsular cataract surgery, Nd:YAG capsulotomy has been shown to increase the risk of developing a retinal detachment [2-11]. Proposed mechanisms include liquefaction of the vitreous[12] and interruption of the anterior hyaloid face[13]. Whilst some authors consider the increased risk to be as a result of opening the capsule and not a specific complication of the laser procedure itself[10,12,14], minimising the energy used to create the capsulotomy is generally considered advisable to minimise the associated risk of retinal detachment[15]. It has been suggested that current practise should be wary of performing Nd:YAG capsulotomy on high risk patients, such as high myopes. However when making this decision, one must also consider that there may be an increased difficulty in fundal visuali

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