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Methods of assessment of patients for Nd:YAG laser capsulotomy that correlate with final visual improvement
Tariq M Aslam, Niall Patton
BMC Ophthalmology , 2004, DOI: 10.1186/1471-2415-4-13
Abstract: 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.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.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.Posterior capsular opacification (PCO) remains one of the most common post operative morbidities in modern day cataract surgery [1,2] and Nd:YAG posterior capsulotomy is one of the most commonly performed surgical procedures.However, the Nd: YAG capsulotomy procedure has been associated with complications such as damage to intraocular lenses [3], post operative intraocular pressure increases [4], cystoid macular oedema [4], disruption of the anterior vitreous face [5] and increased incidence of retinal detachment [6].Until recently Nd:YAG laser treatments have cost the U.S healthcare system up to $250 million annually [7]. Apart from exposing a patient to unnecessary risk, unqualified capsulotomies worsen this burden to the developed and developing world [8].PCO is an extremely common development in patients after cataract extraction and in many mild cases it may not be immediately obvious whether it is visually significant. Patients may have reduced vi
Pseudofaquia de cámara posterior en cataratas de diversas etiologías
Mokey Castellanos,Miguel O.; Hernández Luis,ángela;
Revista Cubana de Oftalmolog?-a , 1999,
Abstract: pseudophakia of posterior chamber in cataracts of various etiologies. the visual results and the complications found in 150 intraocular lens implantations in two different modles for posterior chamber haven been studied in cataracts of various etiologies. good visual outcome eas achieved in 78 % of cases as well as a vision higher than 0,5 without correction and vision equals to 1,0 with correction were reached in 60 % of patients. good tolerance to iol and slight damage in the neighbouring structures of all studied cataracts were observed. the most frequent complication was capsular opacity and the most serious ones eye: corneal decompensation in 2 eyes; macular cystoid edema in 3 eyes and retinal detachment in one case after yag-laser capsulotomy. the 724b monobloc model was the lens with best result. the spherical refraction was under 2 diptries to attain the best vision in most cases.
Perception of difficulties with vision-related activities of daily living among patients undergoing unilateral posterior capsulotomy
Senne, Firmani M. B. de;Temporini, Edméa R.;Arieta, Carlos E. L.;Pacheco, Karla D.;
Clinics , 2010, DOI: 10.1590/S1807-59322010000500002
Abstract: objectives: to assess the influence of nd:yag (neodymium: yttrium-aluminum- garnet) laser unilateral posterior capsulotomy on visual acuity and patients' perception of difficulties with vision-related activities of daily life. methods: we conducted an interventional survey that included 48 patients between 40 and 80 years of age with uni- or bilateral pseudophakia, posterior capsule opacification, and visual acuity <0.30 (logmar) in one eye who were seen at a brazilian university hospital. all patients underwent posterior capsulotomy using an nd:yag laser. before and after the intervention, patients were asked to complete a questionnaire that was developed in an exploratory study. results: before posterior capsulotomy, the median visual acuity (logmar) of the included patients was 0.52 (range 0.30-1.60). after posterior capsulotomy, the median visual acuity of the included patients improved to 0.10 (range 0.0-0.52). according to the subjects' perceptions, their ability to perform most of their daily life activities improved after the intervention (p<0.05). conclusions: after patients underwent posterior capsulotomy with an nd:yag laser, a significant improvement in the visual acuity of the treated eye was observed. additionally, subjects felt that they experienced less difficulty performing most of their vision-dependent activities of daily living.
Intraoperative performance and longterm outcome of phacoemulsification in age-related cataract.  [cached]
Dholakia Sheena,Vasavada Abhay
Indian Journal of Ophthalmology , 2004,
Abstract: PURPOSE: To evaluate intraoperative performance and longterm surgical outcome after phacoemulsification of age-related cataracts. METHODS: Prospective, observational, non-comparative study of 165 consecutive eyes undergoing phacoemulsification with nuclear sclerosis Grade I to III (Scale I to V). Preoperative evaluation included specular microscopy. Phacoemulsification was performed by a single surgeon using a standardised surgical technique under topical anaesthesia. Intraoperatively, effective phaco time (EPT), wound site thermal injury (WSTI), serious complications (eg. vitreous loss, posterior capsule rupture, zonulolysis) and intraoperative posterior capsule opacification (plaque) were evaluated. Postoperatively, posterior capsule opacification (PCO), Neodymium:YAG (Nd:YAG) laser posterior capsulotomy rate, corneal endothelial count, best corrected visual acuity and cystoid macular oedema were evaluated. Eyes were examined at 6 months and then yearly for 3 years. RESULTS: Mean ages of 78 males and 87 females were 59.12 +/- 8.56 and 58.34 +/- 7.45 years respectively. EPT was 36 +/- 19 seconds and WSTI occurred in 7 eyes (4.7%). No serious intraocular complications occurred. Intraoperative posterior capsule opacification (plaque) was present in 21 eyes (13.93%). Postoperatively, PCO occurred in 8 eyes (4.84%) and Nd:YAG laser posterior capsulotomy was performed in 3 eyes (1.8%). Endothelial cell loss was 7.1% at 3 years follow-up. At the end of 3 years follow-up, 146 eyes (88.89%) maintained a best corrected visual acuity of > or = 6/12. Cystoid macular oedema did not occur in any eye at 1 and 6 months′ follow-up. CONCLUSION: PCO rates and endothelial cell loss were acceptable. Consistent and reproducible outcome can be obtained after phacoemulsification of age related cataracts (grade I to III).
Efectividad del Nd- Yag láser en la capsulotomía posterior Effectiveness of Nd-Yag laser in posterior capsulotomy
Alina Pedroso Llanes,Katia Trujillo Fonseca,Reinaldo Ríos Caso
Revista Cubana de Oftalmolog?-a , 2004,
Abstract: Este trabajo se propuso determinar la efectividad del neodimio YAG láser (Nd-YAG láser) en la realización de capsulotomía posterior a 150 pacientes (ojos) operados de catarata senil o presenil en el centro de Microcirugía Ocular en Serie del Hospital Oftalmológico Docente "Ramón Pando Ferrer" en el período comprendido de febreroa diciembre de 1999. En este grupo se analizaron como variables la edad, sexo, raza, implante o no de lente intraocular, tipo de opacidad de cápsula posterior, agudeza visual con corrección pre y postratamiento, complicaciones encontradas, comportamiento de la presión intraocular, así como la energía empleada para realizar dicho proceder. Estos datos se analizaron a través de tablas de contingencias Chi cuadrado. Como resultado de esta investigación se encontró que el láser es altamente efectivo para el mejoramiento de la agudeza visual en los pacientes afectados de catarata secundaria (74,7 %). Se observó además aumento transitorio de la presión intraocular en las dos primeras horas posteriores al láser (60,7 %), y no se encontró ninguna complicación que afectara la visión de los ojos estudiados The aim of this paper was to determine the effectiveness of neodymium YAG laser (Nd-YAG laser) on performing the posterior capsulotomy in 150 patients (eyes) operated on of senile or presenile cataract at the Center of Serial Ocular Microsurgery (CSOM) of "Ramón Pando Ferrer" Ophthalmological Teaching Hospital from February to December 1999. Age, sex, race, implantation or not of the intraocular lens (IOL), type of opacity of the posterior capsule, visual acuity with pre- and posttreatment correction (Avcc), complications found, behavior of the intraocular pressure (IOP), as well as the energy used to carry out such procedure, were analyzed. The Chi square contingency tables were used to this end. As a result of this research, it was found that the laser is highly effective for improving visual acuity in patients affected with secondary cataract (74.7 %). It was also observed a transitory increase of the IOP during the first 2 hours after laser (60.7 %) It was not observed any complication affecting the vision of the studied eyes
"String of Pearls" following Nd:YAG laser posterior capsulotomy  [cached]
Chatterjee Samrat,Garg Prashant
Indian Journal of Ophthalmology , 2002,
Abstract: Posterior capsular re-opacification can occur following Nd-YAG capsulotomy. This necessitates multiple capsulotomies with its potential complications. We report one such case and discuss possible predisposing factors and preventive measures for this condition
Gore V.S.
International Journal of Bioinformatics Research , 2012,
Abstract: Objective- To study the complications of ND:YAG Laser capsulotomy.Participants- Patients between age group of 08 to 80 who is having significant posterior capsular opacification leading to decreased visual acuity from early post operative days.Material and Method- 200 patients with PCO were studied for post ND:YAG laser complications. The patient who is not having any organic cause of decreased vision and who have completed at least three months after cataract surgery were selected. ND:YAG laser procedure was performed and their visual acuity improvement along with complications associated with this procedure were studied. Results- The procedure is absolutely safe if strict selection (inclusion/exclusion) criteria is followed. Most of complications are transient which can be managed by proper medication. Complications like retinal detachment or cystoid macular edema are multifactoral and can not always be only due to laser capsulotomy alone. Endophthalmitis is rare complication but highly unpredictable which can not be ruled out but be well treated with newer generation intravitreal drugs or vitrectomy surgery. Most of the patients 86% were significantly benifited by improved visual acuity.
Desprendimiento seroso de coroides y desprendimiento de retina posterior capsulotomía con YAG-LáSER Choroidal effusion and retinal detachment after capsulotomy with YAG-LASER
H.G. Cámara-Castillo,P. Navarro-López,J. Rivera-Sempértegui
Archivos de la Sociedad Espa?ola de Oftalmología , 2006,
Abstract: Caso Clínico: Mujer de 74 a os, que acudió por visión borrosa. Pseudofaca con lente intraocular de cámara anterior en ambos ojos, y opacidad de cápsula posterior de ojo izquierdo, se realizó capsulotomía con YAG-LASER. A los trece días presenta desprendimiento coroideo y desprendimiento de retina que requirió intervención quirúrgica. Discusión: El indicador para realizar una capsulotomía más usado es la disminución de la agudeza visual sin que exista una indicación precisa de cuando realizarla. Sin embargo; se deben de tener en cuenta las posibles complicaciones como son: desprendimiento de retina regmatógeno, dislocación del lente, uveítis recurrente, hipertensión ocular y complicaciones devastadoras como es el desprendimiento seroso de coroides y desprendimiento de retina. Case report: A 74-year-old woman presented complaining of blurred vision in her left eye. She had an anterior chamber lens in both eyes and an opaque posterior capsule in her left eye, for which a YAG-LASER capsulotomy was performed. Thirteen days later she re-presented with a choroidal effusion and a retinal detachment requiring surgery. Discussion: There is no consensus as to the exact time at which a capsulotomy should be done. Timing of the procedure requires evaluation as a whole and consideration of the potential complications of IOL dislocation, recurrent uveitis, ocular hypertension and the most devastating choroidal effusion and retinal detachment.
Does a small central Nd:YAG posterior capsulotomy improve peripheral fundal visualisation for the Vitreoretinal surgeon?
Niall Patton, Tariq M Aslam, Harry G Bennett, Baljean Dhillon
BMC Ophthalmology , 2004, DOI: 10.1186/1471-2415-4-8
Abstract: 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
Correlation of Total Energy, Pulse Energy and Pulse Number with intraocular pressure rise after YAG Laser Posterior Capsulotomy
Cumurcu,T.,Etikan, ?.
Erciyes Medical Journal , 2006,
Abstract: Subject: To evaluate the effect of number of pulses, energy per pulse and total energy on intraocular pressure (IOP) in patients with posterior capsule opasification who were treated with YAG laser posterior capsulotomy. Material and Methods: Thirty pseudophacic patients with posterior capsule opacification were treated with Nd: YAG laser capsulotomy. All the patients included in the study were treated with prophilactic %1 apraclonidine, administered one hour before the procedure. IOP was measured with Goldmann applanation tonometry one hr before and 30 min, 1 hr, 2 hr, 4 hr, 24 hr and 1 week after the process. Results: There was a positive relation between the number of pulses and rise in IOP at 30 min, one hr, 2 hr, 4 hr and 24 hr after the procedure but no significant relation was found in one week results. A positive and significant relation betwen pulse energy and rise in IOP was found at 30 min, one hr, 2 hr and 4 hr after the procedure. There was no significant relation in 24 hr and one week values after the procedure. In addition there was a positive relation between total energy and the rise in IOP at 30 min, one hr, 2 hr, 4 hr and 24 hr after the process. The rise in IOP one week after the process was not significant. Conclusion: This study indicates that pulse number, pulse energy and total energy which was applied during the operation increases the risk of a sudden rise in IOP. Therefore, in addition to using preoperative antiglaucomatous prophilaxy, during the operation minimum pulse energy and pulse number should be used.
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