The Effect of Nd: YAG Laser Capsulotomy for Posterior Capsular Opacity after PC-IOL Implantation in Children

PURPOSE: To evaluate the effect of Nd: YAG laser capsulotomy for posterior capsular opacification (PCO) after posterior chamber intraocular lens (PC-IOL) implantation in children. METHODS: Thirty eyes of 23 children underwent Nd: YAG laser capsulotomy for PCO after PC-IOL implantation. The frequency of laser capsulotomy, elapsed time between cataract surgery and capsulotomy, laser parameters, pre and postoperative visual acuity, complications and recurrence were reviewed. RESULTS: From 108 eyes with intact posterior capsule after lensectomy, 30 (27.8%) were treated with Nd: YAG laser capsulotomy. The mean age at Nd: YAG laser capsulotomy was 7 years, the mean follow-up was 27 months, and the time interval between cataract operation and Nd: YAG laser capsulotomy was 13 months. Visual acuities of 20/40 or better were attained in 73% of eyes and visual acuities of 20/60 or less in 10% of eyes. PCO recurred in 12 eyes (40%), 10 of which were treated by performing a second laser capsulotomy, but the other two required a third laser capsulotomy. There was no relationship between the recurrence and the delay to initial laser capsulotomy, the amount of energy used for laser capsulotomy, or the patient age. One eye (3%) had corneal erosion, a bleeding from the pupillary margin and increased IOP; however, all responded well to medical treatment. CONCLUSIONS: Nd: YAG laser capsulotomy for PCO after PCL implantation in children offers a noninvasive and safe capability to create a clear visual axis. Although considered effective, there is a high likelihood that Nd: YAG laser capsulotomy will require revision.

A Case of Isolated Posterior Capsule Rupture Caused by Blunt Ocular Trauma

Isolated rupture of the posterior capsule caused by blunt ocular trauma is rarely reported and is usually detected incidentally during surgery for the associated cataract. We report a case of isolated posterior capsule rupture detected during cataract surgery in a 33-year-old man who had traumatic cataract. In this case, the ruptured posterior capsule had relatively large defect in size(5x5 mm)with thickened and fibrosed edge and vitreous opacity existed. The surgical management of this case consisted of phacoemulsification with PC-IOL implantation and pars plana vitrectomy. During surgery, although the posterior capsule rupture was large, further rupture of the capsule was prevented by the fibrosed edge which tightened the margin ofthe ruptured capsule, and so PC-IOL implantation could be possible securely.

Retinal Detachment after Transscleral Fixation of Posterior Chamber Intraocular Lens

To determine clinical features and outcomes of retinal detachments[RDs] following trans-scleral fixation of posterior chamber intraocular lens[PC-IOL], we reviewed the medical records of 249 eyes[239 patients] which had undergone trans-scleral fixation of PC-IOL and had been followed 6 months or longer. Retinal detachment occurred in 8 out of 249 eyes[3.2%]. The incidences of RDs were as follows:in 2/19 eyes[10.5%] with PC-IOL exchange for PC-IOL tilt, in 1/16 eyes[6.3%] with posterior capsule rupture during ECCE, in 1/26 eyes[3.8%] with ICCE, in 2/78 eyes[2.6%] with posterior capsule rupture during phacoemusification, in 2/106 eyes[1.9%] with aphakia, and in 0/4 eyes[0%] with anterior IOL exchange with PC-IOL. The sites of retinal break corresponded with the directions of needle during fixation in 5/8 eyes[62.5%] and all retinal breaks were located anterior to the equator. The timing of RD was between 2 weeks and 4.8 years after fixation although it occured within 2 months in most cases. Pars plana vitrectomy and scleral buckling were performed in 7 eyes and scleral buckling only in one eye. Retinal reattachment was achieved in seven eyes including three eyes which required two surgical interventions. The vitrectomy should be performed with meticulous care to reduce vitreous traction as much as possible during trans-scleral fixation of PC-IOL and a close follow-up examination for RD is required during the first two months.

Clinical Study of Transscleral Suture Fixation of Posterior Chamber Intraocular Lens after Pars Plana Vitrectomy

We reviewed medical records of 24 eyes which had undergone transscleral suture fixation of PC IOL after removal of clear or cataractous lens combined with pars plana vitrectomy from May 1992 to December 1996. The follow u[ [eropds fpr tjos seroes ramged frp, 54 to 772 days(mean 253 days). The visual acuity of 21 eyes (87.5%) was improved and that of 1 eyes(4.2%) was not changed. Postoperative complications, such as IOL precipitates(9 eyes), anterior chamber fibrin exudation (2 eyes), elevation of intraocular pressure(2 eyes)intraocular bleeding(2 eyes), corneal edema (1 eye), tilting of IOL(1 eye), decentration of IOL(1 eye), and retinal detachment(1 eye), were developed. Based on these results, transscleral suture fixation of PC IOL may be a good operative technique in aphakic eyes undergone pars plana vitrectomy and removal of lens.