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"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
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
Nd:YAG Laser Posterior Capsulotomy and Visual Outcome  [cached]
Khaleda Nazneen Bari
Delta Medical College Journal , 2013, DOI: http://dx.doi.org/10.3329/dmcj.v1i1.14971
Abstract: Background: Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy is a relatively noninvasive procedure that is used in the treatment of posterior capsular opacification (PCO). PCO is caused by proliferation of lens epithelial cells which causes fibrotic changes and wrinkling of the posterior capsule and results in decreased vision, glare, and other symptoms similar to that of the original cataract.Objective: To find out the visual outcome after performing Nd:YAG laser capsulotomy for PCO.Materials and method: A prospective clinical trial was carried out in National Institute of Ophthalmology (NIO), Dhaka, Bangladesh from January 2010 to June 2011 on purposively selected 70 adult subjects of both sexes who developed PCO within 2 months to more than 2 years after extracapsular cataract extraction with posterior chamber intra ocular lens implant. After thorough pre laser assessment Nd:YAG laser capsulotomy was carried out with Zeis VISULAS YAG II through Zeiss slit lamp under topical anesthesia. Data were recorded and expressed as proportion.Results: Out of the 70 subjects 40 were male and 30 were female. The average time interval of cataract surgery and Nd: YAG laser capsulotomy was 23 months. Capsular fibrosis (57.04%) was the predominant type of PCO. The pre laser visual acuity (VA) of more than 61.06% of eyes was 6/36 or below while 41.12% had VA hand movements to finger count. After Nd:YAG laser capsulotomy VA of 6/18 or better was achieved in 63.9% of eyes while 9.94% recovered to 6/9 and 11.36% achieved 6/6. None of these eyes showed further deterioration in VA.Conclusion: Nd:YAG laser capsulotomy for PCO is safe, effective and a rewarding procedure for improvement of vision.
Posterior capsule opacification and neovascularization treated with intravitreal bevacizumab and Nd:YAG capsulotomy  [cached]
Grimelda Yuriana Sánchez-Castro,Alejandra Hitos-Fájer,Erick Mendoza-Schuster,Raul Velez-Montoya
Clinical Ophthalmology , 2008,
Abstract: Grimelda Yuriana Sánchez-Castro1, Alejandra Hitos-Fájer1, Erick Mendoza-Schuster1, Raul Velez-Montoya2, Cecilio Francisco Velasco-Barona11Asociación para Evitar la Ceguera en México. Hospital “Dr. Luis Sánchez Bulnes”, México, D.F. Ophthalmology Department – Anterior Segment; 2Asociación para Evitar la Ceguera en México. Hospital “Dr. Luis Sánchez Bulnes”, México, D.F. Ophthalmology Department – Retina departmentAbstract: We reported a 75-year-old diabetic man, who developed opacification and neovascularization of the posterior capsule after extracapsular cataract extraction and posterior chamber intraocular lens implantation. The patient was treated with two injections of 2.5 mg of intravitreal bevacizumab. The treatment produced an important regression of the posterior capsular new vessels, allowing us to perform a successful Nd:YAG capsulotomy, clearing the visual axis and improving the visualization of the posterior pole. Even though, best corrected visual acuity was 20/200 due to diabetic macular edema.Keywords: posterior capsule opacification, posterior capsule neovascularization, cataract surgery, postoperative complications, intravitreal bevacizumab
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
THE STUDY OF COMPLICATIONS OF ND: YAG LASER CAPSULOTOMY  [cached]
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.
Imaging late capsular bag distension syndrome: an anterior segment optical coherence tomography study  [cached]
Tan YL,Mohanram LS,Ti SE,Aung T
Clinical Ophthalmology , 2012,
Abstract: Yar Li Tan,1,2 Lakshmanasamudram S Mohanram,1 Seng Ei Ti,1,2 Tin Aung,1–3 Shamira Perera1,21Singapore National Eye Centre, 2Singapore Eye Research Institute, 3National University of Singapore, Yong Loo Lin School of Medicine, Buona Vista, SingaporeBackground: Anterior segment optical coherence tomography (ASOCT) was used to categorize and provide insights into the etiology of capsular bag distension syndrome (CBDS).Methods: A prospective review was undertaken of 10 cases who presented with signs of late CBDS 5–11 years after uneventful phacoemulsification with in-the-bag posterior chamber intraocular lens implantation.Results: All 10 patients presented with a milky collection within the distended capsular bag without raised intraocular pressure or a shallow anterior chamber. ASOCT was used to confirm the diagnosis in all cases, and a hyperintense signal was seen in the space between the posterior chamber intraocular lens and the posteriorly bowed posterior capsule. The continuous curvilinear capsulorhexis was measured to be between 3.18 mm and 4.70 mm. Three cases had uncorrected visual acuity better than 6/12. Uncomplicated Neodymium-doped Yttrium Aluminium Garnet (Nd:YAG) posterior capsulotomy was performed in eight patients, with no resulting change in the intraocular lens position (measured by ASOCT) or subjective refraction.Conclusion: Our study showed that ASOCT is a useful modality to differentiate this condition clearly from posterior chamber intraocular lens opacification and to investigate its causation. Nd:YAG posterior capsulotomy proved to be a safe and successful treatment for late CBDS with no change in biometric or refractive parameters.Keywords: anterior segment optical coherence tomography, capsular bag distension syndrome, YAG capsulotomy
Nd: YAG capsulotomy for posterior capsule opacification after combined clear corneal phacoemulsification and vitrectomy
Ilias Georgalas,Petros Petrou,George Kalantzis,Dimitrios Papaconstantinou
Therapeutics and Clinical Risk Management , 2009,
Abstract: Ilias Georgalas1, Petros Petrou2, George Kalantzis2, Dimitrios Papaconstantinou2, Chrysanthi Koutsandrea2, Ioannis Ladas21Department of Ophthalmology, “G. Gennimatas” Hospital of Athens, NHS, Athens, Greece; 2Department of Ophthalmology, University of Athens, Athens, GreecePurpose: To evaluate the efficacy and safety of Neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO) following combined phacoemulsification and vitrectomy for the treatment of cataract in association with macular hole (MH) or epiretinal membrane (ERM).Methods: Retrospective clinical study of 34 eyes of 34 patients who underwent combined cataract surgery and vitrectomy, developed PCO, and subsequently underwent Nd:YAG laser capsulotomy. Follow-up examinations included visual acuity measurement, evaluation of intraocular lens (IOL) centration, intraocular pressure (IOP) measurement, and dilated fundus examination.Results: Nd:YAG laser capsulotomy was performed in all 34 eyes. The mean age of the patients was 65.08 years (range 45–87) and the mean follow up period was 11.05 months (range 4–23). The mean time elapsed between the last intraocular operation and the development of PCO was 10.00 months for patients with previous ERM and 15.33 for those with MH (P = 0.001, t-test for equality of means). None of our patients developed recurrence of MH, retinal detachment, IOL dislocation, or permanent IOP elevation.Conclusion: In our study, the most remarkable observation is that no complication occurred after the YAG capsulotomy, possibly because the eyes were vitrectomized and vitreous seems to play an important role in the occurrence of post-Nd:YAG complications. In addition we noted that PCO seems to occur earlier in the eyes undergoing combined surgery for cataract and ERM when compared with those where combined phacoemulsification and vitrectomy are performed for cataract and MH.Keywords: Nd:YAG capsulotomy, phacoemulsification, vitrectomy
Post-operative capsular opacification  [PDF]
SM Raj,AR Vasavada,SR Kaid Johar,VA Vasavada,VA Vasavada
Nepalese Journal of Ophthalmology , 2009, DOI: 10.3126/nepjoph.v1i1.3673
Abstract: Post-operative capsular opacification (PCO) is a multifactorial physiological consequence of cataract surgery. Opacification involving the central posterior capsule has a significant impact on high and low contrast acuity and low contrast sensitivity. The assessment of PCO on cadaver eyes, experimental studies and culture models and in clinical studies has provided an understanding of its pathogenesis. The proliferation, migration and abnormal differentiation of residual lens epithelial cells and fibers in the capsular bag have been implicated in the pathogenesis of PCO. The incidence and severity of PCO correlates to the use of surgical techniques, intraocular lens (IOL) optic edge designs and IOL materials. This article summarizes the clinical studies with recommendations for retarding the development of central PCO. It discusses experiments with pharmacological agents broadly categorized as anti-inflammatory, immuno-modulating, antiproliferative, antiadhering and antitransdifferentiating agents for the prevention of PCO. These studies will remain critical for future endeavors undertaken for the eradication of PCO. Key words: posterior capsular opacification; capsular opacification; cataract; crystalline lens; phacoemulsification DOI: 10.3126/nepjoph.v1i1.3673 Nep J Oph 2009;1(1):43-59
Effect of Hydrophobic Acrylic versus Hydrophilic Acrylic Intraocular Lens on Posterior Capsule Opacification: Meta-Analysis  [PDF]
Ying Li, Jiaxing Wang, Zhuo Chen, Xin Tang
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0077864
Abstract: Purpose This?meta-analysis aims to evaluate the differences in performance of posterior capsular opacification (PCO) between hydrophobic acrylic intraocular lens (IOLs) and hydrophilic acrylic IOLs. Setting Tianjin Medical University, Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China. Design Systematic review of randomized controlled trials (RCTs) or meta-analysis. Methods An electronic literature search was performed using the PubMed, EMBASE and Cochrane Library database before May in 2013 to identify prospective RCTs comparing hydrophobic acrylic IOLs and hydrophilic acrylic IOLs in patients after phacoemulsification with IOL implantation with a follow-up time of at least 1 year. Pertinent studies were selected by meeting predefined criteria and reviewed systematically by meta-analysis. The PCO scores and YAG capsulotomy rate, as indicator of PCO, were measured and discussed in a meta-analysis. Standardized mean differences (SMD), relative risk ratio (RR), and the pooled estimates were computed according to a random effect model or fixed effect model. Results Nine prospective RCTs involving 861 eyes were included in the current meta-analysis. The hydrophobic acrylic IOLs were favored and the pooled SMD of PCO severity was1.72 (95% confidence interval (CI), 0.20 to 1.23, P = 0.0002) and 1.79 (95% CI, 0.95 to 2.64, P<0.0001) with 1-year follow-up and 2-year follow-up respectively. The pooled RR of Nd:YAG laser capsulotomy rates at postoperative 2-year follow-up was 6.96 (95% CI, 3.69 to 13.11, P<0.00001) comparing hydrophilic acrylic IOLs with hydrophobic acrylic IOLs. Conclusions Compared with hydrophilic acrylic IOLs, the hydrophobic acrylic IOLs showed superior reduction in rates of PCO and laser capsulotomy in 2-year follow-up. More RCTs with standard methods for longer follow-up are needed to validate the association.
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