Angle-closure glaucoma associated with vitreous prolapse after neodymium-doped yttrium-aluminum-garnet laser posterior capsulotomy

ABSTRACT Capsulotomy with neodymium-doped yttrium--aluminum-garnet (Nd:YAG) laser is an effective treatment for posterior capsule opacification following cataract surgery. A wide opening of the posterior capsule associated with the ruptured anterior hyaloid can cause anterior chamber vitreous prolapse. Two patients who developed angle-closure glaucoma associated with vitreous prolapse following Nd:YAG laser posterior capsulotomy were successfully treated with antiglaucoma medication and peripheral iridotomies. Patient identification for potential risk factors and a careful postoperative follow-up are essential to avoid these serious complications.

Intraocular lens-blocking technique for intraocular foreign body removal

The aim of this study was to describe a novel technique for intraocular foreign body (IOFB) removal. Phacoemulsification was performed in all patients, followed by a complete microincision vitrectomy to free all tissues surrounding the IOFB. A three?piece intraocular lens (IOL) was placed in the capsular bag, and an opening was made in the upper center of the capsule. The IOFB was removed and lifted to the anterior chamber through the capsular opening and IOL edge. The IOFB was confined to the anterior chamber by the IOL, and then easily extracted through the main corneal incision. The technique was adopted in six eyes of six patients. All IOFBs were removed successfully in all patients without intraoperative or postoperative complications. The IOL?blocking technique is a useful approach for IOFB removal.

Clinical analysis of combined microsurgery for nanophthalmic patients with uncontrolled intraocular pressure after peripheral iridectomy / 中华显微外科杂志

Objective:To evaluate the efficacy and safety of limited pars plana vitrectomy(LPPV), pressure-controlled phacoemulsification(PCP), intraocular lens implantation(IOL), and posterior capsulotomy (PC) in treatment of nanophthalmic glaucoma eyes which intraocular pressure(IOP) were still out of control after peripheral iridectomy.Methods:All 24 patients(29 eyes) with nanophthalmic glaucoma whose IOP failed to be reduced after peripheral iridectomy and needed LPPV plus PCP plus IOL plus PC were recruited from July 2017 to April 2021. The age of these patients was(44.6±11.0) years old. Preoperative and postoperative IOP, best corrected visual acuity(BCVA), anterior chamber depth(ACD) and number of glaucoma medications were recorded by chart review and compared by using paired t-test or Wilcoxon signed rank-sum test. P<0.05 was considered as statistical significant. IOP could be controlled in normal range(≥5 mmHg and≤21 mmHg), without both of disease progression and serious complications were regarded as the success criteria of the operation. Surgical success rate was evaluated. Surgery-associated complications were recorded. Results:The average follow-up time was(11.52±12.44) months. After the microsurgery, IOP decreased from(33.12±9.25) mmHg to(14.23±3.44) mmHg( P<0.01); The ACD increased from(1.23±0.46) mm to(2.86±0.62) mm, and the median number of glaucoma medications dropped from 3(3,4) to 3(0,3) at final follow-up visit( P<0.05). There were no significant differences in BCVA( P=0.196) and the degrees of angle closure(AC) ( P=0.478) before and after operation. The total surgical success rate was 86.2%(25/29) at the final follow-up visit. Two eyes suffered from local choroidal detachment which recovered within 2 weeks with medical treatment. Conclusion:LPPV plus PCP plus IOL plus PC is a safe and effective novel surgical procedure in the treatment of nanophthalmic glaucoma patients with uncontrolled IOP after peripheral iridectomy. It could significantly decrease IOP, increase the depth of ACD, reduce the number of glaucoma medications and maintain BCVA. It can be considered as a first choice for the surgical management for patients with a such condition.

Application of posterior capsulotomy in cataract surgery combined with silicone oil removal for diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical effect of posterior capsulotomy in diabetic retinopathy with silicone oil removal combined with cataract surgery.<p>METHODS: A retrospective analysis that collected clinical data of 83 cases(83 eyes)diagnosed as diabetic retinopathy and silicone oil filled eyes with cataract and treated in our hospitalfrom January 2019 to February 2020. They were randomly divided into two groups. The experimental group consisted 41 eyes received silicone oil removal and posterior capsulotomy combined with cataract surgery; The rest 42 eyes were in control group, who received silicone oil removal combined with cataract surgery. At 6mo after surgery, the best corrected visual acuity, posterior capsular opacification, and floaters were evaluated between the two groups to confirm the advantages of posterior capsulotomy in combined cataract surgery with silicone oil removal for diabetic retinopathy.<p>RESULTS: At 6mo after surgery, the best corrected visual acuity in experimental group was better than control group(<i>P</i><0.05); There were significant differences between the two groups in the posterior capsular opacification, and floaters,experimental group is lower than control group(<i>P</i><0.05). There was no significant difference in intraocular pressure compared to preoperative between the two groups, and no significant difference in retinal detachment, vitreous hemorrhage and intraocular lens deviationafter operation(<i>P</i>>0.05). <p>CONCLUSION: Posterior capsulotomy is safe and reliable in the application of silicone oil removal combined with cataract surgery for diabetic retinopathy, and can effectively avoid the occurrence of posterior capsular opacification.

Alteração refracional após capsulotomia posterior com laser Nd: YAG / Change on refraction after Nd: YAG laser posterior capsulotomy

RESUMO Objetivo: Identificar se há mudança refracional significativa após realização de capsulotomia posterior com laser Nd:YAG em olhos pseudofácicos. Métodos: Estudo retrospectivo com análise de prontuários de pacientes atendidos em um hospital com diagnóstico de opacificação de cápsula posterior do cristalino tratada com capsulotomia posterior com laser Nd:YAG no período de outubro de 2019 a março de 2021. A comparação entre a refração antes e após o procedimento foi realizada calculando-se o equivalente esférico. Também foi avaliada a mudança da acuidade visual, aferida por LogMAR. Resultados: Foram analisados 90 prontuários, totalizando 140 olhos, de pacientes submetidos à capsulotomia posterior com laser Nd:YAG. O equivalente esférico médio pré-procedimento foi de -0,07±0,89D, mínimo de -3,0D e máximo de +2,5D, mediana (intervalo interquartil) de 0,0D (-0,50D a +0,375D). A média pós-procedimento foi de -0,18±0,86D, mínimo de -3,5D e máximo de +2,25D, mediana (intervalo interquartil) de -0,125D (-0,50D a 0,0D). com p<0,0082. Dos 140 olhos, 66 sofreram miopização e 37 hipermetropização. A média de alteração do equivalente esférico geral foi de -0,12±0,51D, mínimo de -2,50D e máximo de +1,25D, mediana (intervalo interquartil) de 0,0D (-0,375D a +0,125D). Ao se comparar a diferença entre o equivalente esférico antes e após o procedimento do grupo de olhos que sofreu miopização (n=66) ou hipermetropização (n=37), separadamente, ambos obtiveram p<0,0001. Ao se compararem todos os olhos que sofreram alguma alteração refracional (n=103), foi encontrado p=0,008. A acuidade visual média pré-procedimento foi de 0,23±0,32, mínimo de 0,0 e máximo de 2,3. Pós-procedimento, a média foi de 0,06±0,13, mínimo de -0,12 e máximo de 0,7, com p<0,0001. Conclusão: A capsulotomia posterior com laser Nd:YAG gerou melhora significativa da acuidade visual nos pacientes do estudo, porém também gerou alteração refracional significativa após o procedimento, tanto para miopização (a mais frequente), quanto para hipermetropização.

ABSTRACT Objective: To identify if there is a significant change on refraction after Nd:YAG laser posterior capsulotomy in pseudophakic eyes. Methods: A retrospective study with analysis of medical records of patients treated at a hospital, with diagnosis of opacification of posterior lens capsule treated with Nd:YAG laser posterior capsulotomy, from October 2019 to March 2021. The comparison of refraction before and after the procedure was performed by calculating the spherical equivalent. Changes in visual acuity (VA), measured by LogMAR, were also evaluated. Results: A total of 90 medical records (140 eyes) of patients submitted to Nd:YAG laser posterior capsulotomy were analysed. The mean pre-procedure spherical equivalent was -0.07±0.89D, minimum of -3.0D and maximum of +2.5D, median (interquartile range) of 0.0D (-0.50D to +0.375D). The post-procedure mean was -0.18±0.86D, minimum of -3.5D and maximum of +2.25D, median (interquartile range) of -0.125D (-0.50D to 0.0D), with p <0.0082. Of the 140 eyes, 66 underwent myopia and 37 hyperopia, the mean change in the general spherical equivalent was -0.12±0.51D, minimum -2.50D and maximum +1.25D, median (interquartile range) of 0.0D (-0.375D to +0.125D). When comparing the difference between the spherical equivalent before and after the procedure of the group of eyes that underwent myopia (n=66) or hyperopia (n=37), separately, both obtained p<0.0001. When comparing all eyes that suffered any change on refraction (n=103), the p value was 0.008. The mean pre-procedure visual acuity was 0.23±0.32, minimum of 0.0 and maximum of 2.3. After the procedure, the mean was 0.06±0.13, minimum of -0.12 and maximum of 0.7, p<0.0001. Conclusion: Nd:YAG laser posterior capsulotomy significantly improved visual acuity of patients in this study; however, it also led to a significant change on refraction after the procedure, both for myopization, which was more frequent, and for hyperopization.

Objective evaluation of vision quality in pseudophakic patients with posterior capsular opacification using double-pass retinal imaging / Avaliação objetiva da qualidade da visão em pacientes pseudofácicos com opacificação capsular posterior pelo método de dupla passagem de luz

ABSTRACT Purpose: The purpose of this study was to objectively assess the optical vision quality of patients before and after Nd:YAG capsulotomy for posterior capsular opacification using a double-pass retinal imaging system. Methods: We retrospectively analyzed the data from 26 pseudophakic eyes with posterior capsular opacification that underwent Nd:YAG capsulotomy. The objective scatter indices, modulation transfer function cutoff frequencies, Strehl ratios, and logMAR corrected distance visual acuities were assessed before and after YAG capsulotomy with a double-pass retinal imaging system (OQAS II, Visiometrics, Spain). We also analyzed data from a subgroup of 10 patients with pre-YAG corrected distance visual acuity of 0.10 logMAR (20/25) or better. Results: Vision quality indices improved in all 26 eyes, resulting in a statistically significant improvement in the corrected distance visual acuity (p=0.007), objective scatter index (p=0.001), modulation transfer function cutoff frequency (p=0.001), and Strehl ratio (p=0.020). The overall mean improvements included 0.12 ± 0.04 logMAR for corrected distance visual acuity, 2.84 ± 0.76 for objective scatter index, 12.29 ± 2.77 for modulation transfer function cutoff frequency, and 0.06 ± 0.03 for Strehl ratio. Our sub-analysis of 10 eyes with 0.10 logMAR (20/25) corrected distance visual acuity or better also showed a statistically significant improvement in the mean objective scatter index (0.76 ± 16; p=0.001), resulting in approximately 35% decrease in intraocular light scatter. Conclusions: The objective vision quality measurements as assessed by the double-pass retinal imaging system showed a significant improvement after YAG capsulotomy. This suggests that the objective scatter index improves after YAG capsulotomy, even in eyes with pre-YAG 0.10 logMAR (Snellen 20/25) corrected distance visual acuity or better.

RESUMO Objetivo: Avaliar objetivamente a qualidade da visão óptica antes e depois da capsulotomia com Nd: YAG, obtida por imagem pelo metodo de dupla passagem de luz em pacientes com opacificação capsular posterior. Método: Análise retrospectiva de 26 olhos pseudofácicos com opacificação capsular posterior visualmente significativa, que foram submetidos à capsulotomia de Nd: YAG. O índice de dispersão objetiva, a função de transferência de modulação, a relação de Strehl e a acuidade visual à distância corrigida foram avaliados antes e após a capsulotomia com YAG usando o dupla passagem de luz (OQAS II, Visiometrics, Espanha). Também foi analisado um subgrupo de pacientes com acuidade visual à distância corrigida pré-YAG de 0,10 logMAR (20/25) ou melhor. Resultados: Os índices de qualidade da visão melhoraram em todos os 26 olhos, resultando em uma melhora estatisticamente significativa na acuidade visual à distância corrigida (p=0,007), índice de dispersão objetiva (p=0,001), função de transferência de modulação (p=0,001) e relação de Strehl (p=0,020). A melhora média na acuidade visual à distância corrigida foi de 0,12 ± 0,04 logMAR, no índice de dispersão objetiva foi de 2,84 ± 0,76, no função de transferência de modulação foi de 12,29 ± 2,77 e na razão de Strehl foi de 0,06 ± 0,03 em todos os olhos. Sub-análise de 10 olhos com 0.10 logMAR (20/25) acuidade visual à distância corrigida ou melhor também mostrou uma melhora estatisticamente significativa no índice de dispersão objetiva (p=0,001). A melhora média no OSI foi de 0,76 ± 16, uma diminuição de 35% na dispersão da luz intraocular. Conclusões: A qualidade da visão avaliada pelo dupla passagem de luz mostra uma melhora significativa nas medidas objetivas da qualidade da visão após a capsulotomia do YAG. O índice de dispersão objetiva melhora após a capsulotomia YAG, mesmo em olhos com acuidade visual à distância corrigida pré-YAG de 0,10 logMAR (Snellen 20/25) ou melhor.

Comparison of the Neodymium-doped Yttrium Aluminum Garnet Capsulotomy Rate with Viscoimplantation and the Hydroimplantation Intraocular Lens Technique

PURPOSE: To investigate the rate of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy in the hydroimplantation intraocular lens (IOL) technique. METHODS: This retrospective study was comprised of 6,192 eyes in 3,790 patients who underwent surgery from January 2013 to September 2017 and then were followed up for at least 1 year. The eyes of these patients were divided into two groups: either viscoimplantation or hydroimplantation. The follow-up examinations were carried out on the 1st day, 4th day, 1st month, and 3 months to 1 year postoperatively. The Nd:YAG capsulotomy rates were evaluated by the different IOL implantation techniques and IOL materials. RESULTS: The mean follow-up duration of the patients was in the viscoimplantation group 14.85 ± 2.43 and 15.05 ± 1.93 months in the hydroimplantation group. The Nd:YAG capsulotomy rate was significantly lower in the hydroimplantation group compared with the viscoimplantation group for the entire hydrophilic IOL model (p < 0.001). In addition, the Nd:YAG rate was lower in the hydroimplantation group that used a hydrophilic IOL than it was in the viscoimplantation group, which used a hydrophobic IOL. CONCLUSIONS: The hydroimplantation technique reduced the Nd:YAG capsulotomy rate.

Comparison of different surgical approaches for pediatric cataracts: complications and rates of additional surgery during long-term follow-up

OBJECTIVES: To compare long-term postoperative complications of pediatric cataract surgery with primary intraocular lens (IOL) implantation associated with posterior capsulotomy (PC) and anterior vitrectomy (AV) between patients treated with a corneal or pars plicata/pars plana approach. METHODS: Children who underwent cataract surgery with in-the-bag primary IOL implantation were divided into two groups according to PC and AV surgical approach: a corneal approach (group 1) and a pars plicata/pars plana approach (group 2). Only patients with a follow-up duration of more than two years were included. Long-term surgical outcomes were retrospectively reported. RESULTS: The mean follow-up period was 10.00±3.13 years. No cases of glaucoma or retinal detachment were reported. The mean age at surgery was 34.57±22.66 months. Forty-six children were included (27 eyes in group 1 and 29 eyes in group 2). The most frequent postoperative complication was corectopia, followed by visual axis opacification. Both complications occurred more frequently in group 1 (p<0.001). After cataract surgery, the rate of additional surgeries in group 1 was 51.9%, while in group 2, the rate was 27.6% (p=0.1132). CONCLUSION: The pars plicata/pars plana approach with PC and vitrectomy with primary in-the-bag IOL implantation for pediatric cataracts is a safe procedure.

Comparison of visual quality following different methods of YAG laser posterior capsulotomy for posterior capsular opacification / 中华实验眼科杂志

Objective To evaluate and compare the subjective and objective visual quality of YAG laser posterior capsulotomy.Methods A series of case observation study was designed.Twenty-eight patients (38 eyes)underwent Nd:YAG laser posterior capsulotomy in the Eye Hospital of Wenzhou Medical University were retrospectively collected from 2015 to 2016.Patients were divided into circular capsulotomy group (20 patients 23 eyes) and cruciate capsulotomy group (12 patients 15 eyes) based on the capsulotomy technique (round incision of posterior capsule or cross incision of posterior capsule).The uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were examined before and 2 weeks after operation,the intraocular pressure was also measured before operation,1 hour after operation and 2 weeks after operation.The Strehl ratio (SR),modulation transfer function (MTF) cut-off,objective scatter index (OSI),OQAS values (OVs) were analyzed by Two-channel visual quality analysis system OQAS Ⅱ at 1 h and 2 weeks after operation.The changes of intraocular scattering and visual quality at 1 h and 2 weeks after operation with different posterior capsulotomy methods were compared and analyzed.Results At 2 weeks after operation,the UCVA was 0.18±0.15 and 0.16±0.14,and the BCVA was 0.10±0.10 and 0.10±0.11,respectively in the circular capsulotomy group and cruciate capsulotomy group,which was higher than those before operation (all at P＜0.05),but there was no significant difference in UCVA and BCVA between the two groups (all at P＞0.05).There was no significant difference in intraocular pressure between the two groups at 1 hour and 2 weeks after operation (both at P＞0.05).In the circular capsulotomy group,the incidence of black shadow drift was 39.1％ and 30.4％ respectively at 1 hour and 2 weeks after operation,which was higher than that in the cruciate capsulotomy group (6.7％ and 6.7 ％),with no significant differences between the two groups (P =0.065,0.177).No significant difference were found in the incidence of black shadow drift before eyes between the two groups (P＞0.05),and there was no significant differences in the OQAS parameters OSI,MTF,SR,OV100％,OV20％ and OV9％ between the two groups (all at P＞0.05).Conclusions After Nd:YAG laser capsulotomy,the incidence of black shadow drift in the cruciate capsulotomy group is lower than that in the circular capsulotomy group.There is no significant difference in the visual acuity,intraocular pressure,intraocular scattering and visual quality parameters between circular posterior capsulotomy and cross posterior capsulotomy.

The Changes of Anterior Chamber Depth and Refractive Errors after Phacovitrectomy with Posterior Capsulotomy

PURPOSE: To evaluate the changes in anterior chamber depth (ACD) and refractive error after combined phacovitrectomy with posterior capsulotomy using a vitrectomy probe. METHODS: In 20 eyes of 20 patients who underwent combined phacovitrectomy with posterior capsulotomy using a vitrectomy probe, the ACD was measured with Scheimpflug imaging (Pentacam®, OCULUS Optikgeräte GmbH, Wetzlar, Germany) preoperatively and postoperatively. We compared the preoperative desired refraction and postoperative refraction using an autokeratorefractometor. RESULTS: The preoperative ACD was 2.58 ± 0.248 mm; the ACD significantly increased in 1 month postoperatively to 3.65 ± 0.475 mm (p < 0.001), and it was maintained as 3.70 ± 0.452 mm (p = 0.213) at 3 months postoperatively. The preoperative target spherical equivalent was −0.60 ± 0.809 diopters (D). Myopic shifting was noticed at 1 month postoperatively as −1.45 ± 1.252 D, and it changed between 1 month and 3 months postoperatively (−1.48 ± 1.235 D at 3 months postoperatively was not statistically significant). There was no increased intraocular pressure or intraocular lens-related complication. CONCLUSIONS: Phacovitrectomy with posterior capsulotomy using a vitrectomy probe might be a useful way to stabilize the axial position of an intraocular lens without constriction of the capsular bag. However, using this procedure, the surgeon must consider the possibility of myopic shifting in the postoperative refractive error.

Effect of Nd:YAG Laser Capsulotomy on Anterior Segment Parameters in Patients with Posterior Capsular Opacification after Phacovitrectomy

PURPOSE: To compare changes in anterior segment parameters after Nd:YAG laser capsulotomy in eyes that underwent either combined phacovitrectomy or cataract surgery. METHODS: This retrospective study enrolled 37 eyes of 35 patients with posterior capsular opacification treated with combined phacovitrectomy (group A), and 35 eyes of 32 patients with posterior capsular opacification treated with cataract surgery (group B). Anterior segment parameters, including anterior chamber depth (ACD), anterior chamber angle, and anterior chamber volume, were measured by a Pentacam before Nd:YAG laser capsulotomy and 1 hour, 1 day, 1 week, 1 month, and 3 months after this treatment. RESULTS: In the cataract surgery group, the ACD was significantly lower 1 day (3.75 ± 0.74 mm), 1 week (3.73 ± 0.24 mm), and 3 months (3.74 ± 0.33 mm) after Nd:YAG laser capsulotomy compared with the pretreatment value (4.20 ± 0.62 mm, p = 0.002). By contrast, the ACD did not change significantly over time in the combined phacovitrectomy group. The ACD differed significantly between the two groups at 1 week, 1 month, and 3 months after capsulotomy. There were no significant changes in the anterior chamber volume, anterior chamber angle, central corneal thickness, or pupil size from before to after capsulotomy in either group. A non-significant trend toward myopic shift was observed in group A (p = 0.072) and B (p = 0.055). CONCLUSIONS: The results of the present study may help determine the power of the intraocular lens in patients who underwent combined surgery or cataract surgery and who will receive Nd:YAG laser capsulotomy.

Efficacy of plasma knife assisted posterior capsulotomy versus manual primary posterior capsulorhexis in preventing visual axis opacification in pediatric cataract surgery: A randomized controlled trial

Background: Posterior capsule opacification (PCO) is the commonest complication of extracapsular catraract surgery in pediatric patients with an incidence as high as 95%. But there is inadequate evidence on appropriate intervention to prevent PCO. Aim: To compare the efficacy of plasma knife assisted posterior capsulotomy versus manual primary posterior capsulorhexis in Pediatric Cataract surgery. Materials and methods: The current study was a randomized open labeled controlled study, conducted in the department of ophthalmology, All India Institute of Medical Sciences, New Delhi between July 2015 to June 2016. The study population included 32 children in each of < 2 years age, suffering from bilateral cataract and each eye was randomized to different intervention groups consisting of manual posterior capsulorhexis or and posterior capsulotomy using plasma knife. Anterior vitrectomy was performed in all the eyes. Visual acuity, axial length, Intra ocular pressure, and refraction etc. were measured using appropriate methods. The retro-illuminated clinical photograph was taken using NEW CARL ZEISS f340 CANON camera and was analyzed by EPCO software. Prakash S, Giridhar, Harshila Jain. Efficacy of plasma knife assisted posterior capsulotomy versus manual primary posterior capsulorhexis in preventing visual axis opacification in pediatric cataract surgery: A randomized controlled trial. IAIM, 2017; 4(9): 171-177. Page 172 Results: There was no statistically significant difference in any of the ocular parameters at baseline and at 6 months following surgery. The log MAR visual acuity was significantly higher in intervention 1 (0.465±0.143) as compare to intervention 2 (0.397 ± 0.108) at 1 year, which was statistically significant (P value 0.036). There were no statistically significant differences in the proportion of Visual Axis Opacification (VAO) between the intervention groups. Conclusion: Visual axis opacification after pediatric cataract surgery remains comparable in both techniques at one year (plasma knife assisted posterior capsulotomy and manual capsulorhexis). Hence it can be concluded that plasma knife assisted posterior capsulotomy does not have any added advantage over manual posterior capsulorhexis in preventing visual axis opacification.

Influence of posterior capsular opacity and its removal on retinal nerve fiber layer thickness measured with spectral domain optical coherence tomography / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate the influence of posterior capsular opacity(PCO)and its removal on retinal nerve fiber layer(RNFL)thickness measured with spectral domain optical coherence tomography(SD-OCT).<p>METHODS: Fifty patients underwent RNFL measurements using SD-OCT before and after Nd: YAG laser posterior capsulotomy. The patients were divided into groups according to the value of signal to noise ratio(SNR)measured by SD-OCT as group 1: SNR 3 and 4, group 2: SNR 5 and 6 and group 3: SNR 7 and 8. The other eye served as control(control group).<p>RESULTS: The mean BCVA, SNR and RNFL measurements significantly increased in eyes underwent Nd: YAG laser capsulotomy. The preoperative and postoperative mean BCVA, SNR and RNFL measurements were significantly different in group 1 and group 2. Although the preoperative and postoperative mean BCVA and SNR were significantly different, the preoperative and postoperative RNFL thickness weren't significantly different in group 3.<p>DISCUSSION: PCO has an influence on OCT image quality. SNR improved in all cases after removal of the PCO. However, RNFL thickness significantly improved after Nd:YAG laser capsulotomy in patients with preoperative SNR under 7.

Optic coherence tomography measurement of choroidal and retinal thicknesses after uncomplicated YAG laser capsulotomy / Medidas das espessuras de coroide e retina após capsulotomia por YAG laser não complicada

ABSTRACT Purpose: Optic coherence tomography (OCT) evaluation of the choroid, retina, and retinal nerve fiber layer after uncomplicated yttrium-aluminum-garnet (YAG) laser capsulotomy. Methods: OCT analysis of retinal and choroidal structures was performed in 28 eyes of 28 patients following routine examinations before and 24 h, 72 h, 2 weeks, 4 weeks, and 12 weeks after YAG laser capsulotomy. Data were analyzed using the SPSS software. Results: Data collected before YAG capsulotomy and at the above mentioned follow-up visits are summarized as follows. Mean central subfoveal choroidal thickness before YAG capsulotomy was 275.85 ± 74.78 µm; it was 278.46 ± 83.46 µm, 283.39 ± 82.84 µm, 280.00 ± 77.16 µm, 278.37 ± 76.95 µm, and 278.67 ± 76.20 µm after YAG capsulotomy, respectively. Central macular thickness was 272.14 ± 25.76 µm before YAG capsulotomy; it was 266.53 ± 26.47 µm, 269.14 ± 27.20 µm, 272.17 ± 26.97 µm, 270.91 ± 26.79 µm, and 273 ± 26.63 µm after YAG capsulotomy, respectively. Mean retinal nerve fiber layer thickness before YAG was 99.89 ± 7.61 µm; it was 98.50 ± 8.62 µm, 98.14 ± 8.69 µm, 99.60 ± 8.39 µm, 99.60 ± 8.39 µm, and 99.60 ± 8.35 µm after YAG capsulotomy, respectively. No observed change was statistically significant. No significant changes were observed with regard to mean intraocular pressure. Conclusions: After YAG laser capsulotomy, no statistically significant changes were found in choroidal, retinal, and optical nerve fiber layer thicknesses, although slight thickness changes in these structures were observed, particularly during the first days.

RESUMO Objetivo: Avaliação da coroide, retina e a camada de fibras nervosas da retina por meio de tomografia de coerência óptica (OCT) após capsulotomia por YAG laser não complicada. Método: Vinte e oito olhos de 28 pacientes foram incluídos neste estudo. Estruturas da retina e coroide foram analisados usando ACT nos exames de rotina antes da capsulotomia posterior por YAG laser e 24 horas, 72 horas, 2 semanas, 4 semanas e 12 semanas após YAG. Os resultados foram avaliados através do programa SPSS. Resultados: Os resultados deste estudo, pré YAG e às visitas de acompanhamento acima, podem ser resumidos da seguinte forma. A espessura média de coroide subfoveal central antes do YAG foi 275,85 ± 74,78 m; após YAG foi 278,46 ± 83,46 µm, 283,39 ± 82,84 µm, 280,00 ± 77,16 µm, 278,37 ± 76,95 µm, e 278,67 ± 76,20 µm, respectivamente. A espessura macular central foi 272,14 ± 25,76 mm antes YAG; e 266,53 ± 26,47 µm, 269,14 ± 27,20 µm, 272,17 ± 26,97 µm, 270,91 ± 26,79 µm, e 273 ± 26,63 µm, respectivamente. Espessura média da camada de fibras nervosas da retina antes do YAG foi 99,89 ± 7,61 mm; e 98,50 ± 8,62 µm, 98,14 ± 8,69 µm, 99,60 ± 8,39 µm, de 99,60 ± 8,39 µm, 99,60 ± 8,35 µm, respectivamente. Nenhuma das alterações observadas foram estatisticamente significativas. As médias da pressão intraocular, também não mostraram alterações significativas. Conclusões: Não houve mudanças significativas foram encontradas na coroide, camada de fibras nervosas da retina espessuras e ópticos, após a capsulotomia por YAG laser, embora houvesse, especialmente nos primeiros dias, discretas alterações de espessura nas estruturas mencionadas.

Long-Term Follow-Up of Adverse Consequences after Nd:YAG Laser Treatment for Posterior Capsular Opacification

PURPOSE: To evaluate the long-term follow-up of adverse effects after neodymium: yttrium-aluminum-garne (Nd:YAG) laser treatment for posterior capsular opacification (PCO). METHODS: In this study, 152 patients (184 eyes) diagnosed with PCO and who received Nd:YAG laser posterior capsulotomy with at least 5 years of follow-up were retrospectively analyzed to evaluate the clinical adverse consequences after Nd:YAG laser posterior capsulotomy. RESULTS: The mean age in the study group was 63.2 +/- 4.2 years and the mean follow-up period was 6.2 +/- 0.6 years. Vitreous floaters (8.1%) were the most common complication followed by reactive anterior uveitis (5.9%) and transient increase in intraocular pressure of more than 30 mm Hg (5.4%). Other complications included primary Nd:YAG laser failure (2.7%), recurrent lens epithelial remnant proliferation (1.6%), cystoid macular edema (1.1%), corneal edema (0.5%), retinal tear (0.5%), and rhegmatogenous retinal detachment (0.5%). CONCLUSIONS: Although Nd:YAG laser treatment is the most effective and safe method, surgeons should be aware of the occasional complications such as recurrent lens epithelial remnant proliferation, retinal tear, and rhegmatogenous retinal detachment through long-term follow-up.

Maximizing the visual outcome in traumatic cataract cases: The value of a primary posterior capsulotomy and anterior vitrectomy.

Objective: The objective was to provide evidence‑based care for patients with traumatic cataracts, we assessed whether a posterior capsulotomy and anterior vitrectomy, as part of the primary surgical procedure, could be a positive predictor of final visual outcome. Materials and Methods: This is a prospective randomized control trial. Patients presenting at our hospital between January 2010 and December 2012 having ocular trauma and traumatic cataracts were enrolled, according to the inclusion criteria. We enrolled two groups: Those with and without primary posterior capsulotomy and vitrectomy. Information regarding demographic and ocular trauma were collected using the World Eye Trauma Registry form at the first visit and follow‑up, and specific information was collected for both the group who underwent posterior capsulectomies and vitrectomies as a part of the primary procedure, and the control group. Data were analyzed to evaluate the predictive value of primary posterior capsulectomy and anterior vitrectomy. Results: We enrolled 120 cases, 60 in each group, comprising 31 females and 89 males. When all other variables were controlled for, the visual outcome (best corrected visual acuity) differed significantly (P < 0.001) between the groups. Conclusion: Performance of posterior capsulectomy and anterior vitrectomy as part of the primary procedure improves the final visual outcome.

The Influence of Vitrectomy of Nd:YAG Laser Posterior Capsulotomy

PURPOSE: This study aimed to investigate factors that cause after-cataract such as diabetes, intravitreal gas injection during vitrectomy, and other factors in relation to the vitrectomy. METHODS: The relationship between the vitrectomy and the frequency of Nd:YAG laser posterior capsulotomy was investigated in a sample of 947 monitored patients' eyes that underwent cataract surgery. The patients' eyes were classified into Group 1, which comprised 715 patients' eyes that underwent cataract surgery only, Group 2, which comprised 152 eyes that underwent both vitrectomy and cataract surgery at the same time, and Group 3, which comprised 80 eyes that underwent cataract surgery after vitrectomy. The age, gender, diabetes status, gases injected during the vitrectomy, and other factors were investigated. RESULTS: It was found that 50 eyes (6.99%) in Group 1 received the posterior capsulotomy, 28 eyes (18.4%) had the procedure in Group 2, and 16 eyes (20.00%) had the procedure in Group 3, respectively. In Group 1, 21 eyes (8.86%) that received the posterior capsulotomy were from diabetic patients, 20 eyes (19.8%) were diabetic in Group 2, and 10 eyes (21.73%) were diabetic in Group 3. In Group 1, 29 eyes (6.06%) were from non-diabetics that received posterior capsulotomy, 8 eyes (15.68%) were from non-diabetic patients in Group 2, and 6 eyes (17.64%) were from non-diabetic patients in Group 3. In the group that had vitrectomy with gas injection, 6 eyes (25%) received the posterior capsulotomy in Group 2, and 10 eyes (24.39%) had the procedure in Group 3, respectively, while those in the group that had vitrectomy without gas injection included 22 eyes (17.46%) in Group 2 and 6 eyes (15.38%) in Group 3. CONCLUSIONS: The Nd:YAG laser posterior capsulotomy was more frequently applied to patients who underwent vitrectomy, younger patients, diabetes patients, and patients who had vitrectomy with gas injection.

The Influence of Vitrectomy of Nd:YAG Laser Posterior Capsulotomy

PURPOSE: This study aimed to investigate factors that cause after-cataract such as diabetes, intravitreal gas injection during vitrectomy, and other factors in relation to the vitrectomy. METHODS: The relationship between the vitrectomy and the frequency of Nd:YAG laser posterior capsulotomy was investigated in a sample of 947 monitored patients' eyes that underwent cataract surgery. The patients' eyes were classified into Group 1, which comprised 715 patients' eyes that underwent cataract surgery only, Group 2, which comprised 152 eyes that underwent both vitrectomy and cataract surgery at the same time, and Group 3, which comprised 80 eyes that underwent cataract surgery after vitrectomy. The age, gender, diabetes status, gases injected during the vitrectomy, and other factors were investigated. RESULTS: It was found that 50 eyes (6.99%) in Group 1 received the posterior capsulotomy, 28 eyes (18.4%) had the procedure in Group 2, and 16 eyes (20.00%) had the procedure in Group 3, respectively. In Group 1, 21 eyes (8.86%) that received the posterior capsulotomy were from diabetic patients, 20 eyes (19.8%) were diabetic in Group 2, and 10 eyes (21.73%) were diabetic in Group 3. In Group 1, 29 eyes (6.06%) were from non-diabetics that received posterior capsulotomy, 8 eyes (15.68%) were from non-diabetic patients in Group 2, and 6 eyes (17.64%) were from non-diabetic patients in Group 3. In the group that had vitrectomy with gas injection, 6 eyes (25%) received the posterior capsulotomy in Group 2, and 10 eyes (24.39%) had the procedure in Group 3, respectively, while those in the group that had vitrectomy without gas injection included 22 eyes (17.46%) in Group 2 and 6 eyes (15.38%) in Group 3. CONCLUSIONS: The Nd:YAG laser posterior capsulotomy was more frequently applied to patients who underwent vitrectomy, younger patients, diabetes patients, and patients who had vitrectomy with gas injection.

Aplicación del Nd-YAG láser en pacientes con opacidad de cápsula posterior / Use of Nd-Yag laser in patients with posterior capsule opacification

Objetivo: determinar el resultado visual de la capsulotomía posterior en los pacientes con opacidad de cápsula posterior. Métodos: estudio descriptivo, transversal en el centro oftalmológico de Port Mourant en Guyana, en el período comprendido entre marzo de 2009 hasta julio de 2010. Con un universo de 54 pacientes, operados de catarata por la técnica de Blumenthal de más de 6 meses de evolución, con opacidad de la cápsula posterior. Las variables estudiadas fueron: edad, sexo, tipo de opacidad, complicaciones en el acto quirúrgico y agudeza visual corregida antes y después del láser. Los datos se recogieron de los informes operatorios y las historias clínicas. Resultados: existió un predominio del sexo femenino con más de 60 años. El 50 por ciento de los pacientes antes del tratamiento presentaban una agudeza visual corregida menor o igual a 20/60. El tipo de opacidad capsular más diagnosticada fue las perlas de Elschnig (68,5 por ciento). Solamente el 16,7 por ciento de los pacientes tuvieron complicaciones, entre ellas, la elevación transitoria de la presión intraocular fue la más frecuente. El 81,5 por ciento de los pacientes a los que se le realizó la capsulotomía posterior alcanzaron una visión corregida de 20/20. Conclusión: la capsulotomía posterior con Nd-YAG láser es un valioso procedimiento para los pacientes con opacidad de la cápsula posterior que mejora ostensiblemente su agudeza visual, con una incidencia mínima de complicaciones

Objective: to determine the visual outcome of the posterior capsulotomy in patients with posterior capsule opacification. Methods: a descriptive and cross-sectional study conducted in the National Ophthalmology Hospital of Port Mourant in Guyana, from March 2009 to July 2010. The universe of study was made up of 54 patients who had been operated on from cataract by Blumenthal technique six months earlier and presented with posterior capsule opacification. The variables were age, sex, opacity type, transoperative complications and the corrected visual acuity before and after the capsulotomy. The information was gathered from operative reports and medical histories. Results: prevalence of females with more than 60 years of age. Half of the patients had corrected visual lower than or equal to 20/60 before the treatment. The most diagnosed capsular opacity was Elsching pearls (68.5 percent). Just 16.7 percent of the patients suffered complications, being the transient rise of the intraocular pressure the most frequent. Of the sample, 81.5 percent of patients reached corrected vision of 20/20 after the posterior capsulotomyConclusion: posterior capsulotomy with Nd-Yag laser is a valuable procedure for the patients with posterior capsule opacification, since it remarkably improves visual acuity with minimum complications

Complicaciones de la capsulotomía posterior por láser de Nd-Yag en el Centro Oftalmológico "Enrique Cabrera" de La Habana / Complications of posterior capsulotomy due to Nd-Yag laser in "Enrique Cabrera" Ophthalmological Center from Havana

Introducción: La opacidad capsular posterior es la complicación más frecuente de la cirugía de catarata y, aunque la capsulotomía con láser de Nd-Yag es un procedimiento muy efectivo para solucionarla, no está exenta de complicaciones.Objetivo: Describir las complicaciones en pacientes expuestos a capsulotomía con láser de Nd-Yag.Métodos: Se realizó un estudio descriptivo y prospectivo de 104 pacientes con opacidad capsular posterior, atendidos en el Centro Oftalmológico "Enrique Cabrera" de la Habana, durante el 2010. Se analizaron las variables frecuencia y tipo de complicaciones, edad, sexo, antecedentes patológicos personales oculares y sistémicos, clasificación de la opacidad capsular, energía utilizada, así como agudeza visual antes y después del tratamiento.Resultados: En la casuística predominaron el aumento de la presión intraocular y el edema macular quístico como las complicaciones más comunes, los pacientes de 56-75 años, el sexo femenino, así como la opacidad capsular fibrótica y la capsulotomía con más de 8,0 MJ.Conclusiones: Más de la mitad de los afectados presentaron complicaciones de carácter transitorio y reversible, las cuales no estuvieron relacionadas con la cantidad de energía empleada; la mejoría visual después del proceder fue notable.

Introduction: The posterior capsular opacity is the most frequent complication in the cataract surgery and, although capsulotomy with Nd-Yag laser is a very effective procedure to solve it, it is not free of complications. Objective: To describe the complications in patients exposed to capsulotomy with Nd-Yag laser.Methods: A descriptive and prospective study of 104 patients with posterior capsular opacity, assisted in "Enrique Cabrera" Ophthalmological Center from Havana, was carried out during the 2010. Variables of frequency and type of complication, age, sex, pathological ocular and systemic medical history, classification of the capsular opacity, energy used, as well as visual acuity before and after the treatment were analyzed.Results: The increase of the intraocular pressure and the cystic macular edema as the most common complications, the 56-75 year-old patients, female sex, as well as the capsular fibrotic opacity and the capsulotomy with more than 8,0 MJ prevailed in the case material.Conclusions: More than half of the patients presented complications of transitory and reversible type, which were not related to the quantity of energy used; the visual improvement after the procedure was remarkable.