Possible Risk Factors Affecting Successful Femtosecond Laser-assisted Cataract Surgery

PURPOSE: To determine the risk factors of intraoperative complications in femtosecond laser-assisted cataract surgery. METHODS: This study included 598 eyes of 337 patients who underwent femtosecond laser-assisted cataract surgery (FLACS) between July, 2012 and January, 2017. All eyes had corneal incisions, anterior capsulotomy, nuclear fragmentation, and limbal relaxing incisions (if required). Intraoperative complications were analyzed by watching videos, and the related factors of each complication were retrospectively reviewed alongside the medical records. RESULTS: The mean age of the patients was 62.1 ± 11.9 years. Among the study group, 18 eyes required manual creation of corneal incisions; because the corneal incisions could not be made due to corneal central opacity, corneal peripheral degeneration, ptreygium, conjunctival chalasis, or idiopathic. The anterior capsulotomy was incomplete in 43 cases and manual capsulorrhexis was required for completion. These cases were associated with various conditions, including hypermature cataract, anterior polar or subcapsular cataract, corneal central opacity, pupillary abnormality, lens subluxation, poor pupil dilation, and idiopathic. Overall, 22 eyes had difficulties with nuclear fragmentation, with either mature cataract, lens subluxation, corneal central opacity, anterior polar or subcapsular cataract, or pupillary abnormality. Using the Laser SoftFit™ patient interface decreased the incidences of incomplete corneal incision (from 3.56% to 2.24%, p = 0.367), anterior capsulotomy (from 9.31% to 4.03%, p < 0.05), and nuclear fragmentation (from 5.20% to 1.34%, p < 0.05). The incidences of complications in the experienced group was statistically lower compared with the novice group (p < 0.05 for all comparisons). CONCLUSIONS: The femtosecond laser platform was effective and safe for cataract surgery. However, in the presence of related factors, use of this platform might need to be re-assessed and should be considered for intraoperative complications. Additionally, with the Laser SoftFit™ patient interface and improved surgeon experience, better intraoperative results can be expected for FLACS surgery.

Effects of femtosecond laser-assisted anterior capsulotomy versus manual continuous curvilinear capsulorhexis on intraocular lens centration / 眼科新进展

Objective To assess the effects of femtosecond laser-assisted anterior capsulotomy versus manual continuous curvilinear capsulorhexis on intraocular lens (IOL) centration by measuring and comparing shape,size and positional parameters.Methods Eighty cases (80 eyes) with age-related cataract from March 2015 to July 2016 in our hospital were collected.Forty patients (40 eyes) in the femtosecond group underwent femtosecond laser anterior capsulotomy and 40 patients (40 eyes) in the annular group were treated with annular continuous capsulorhexis.At postoperative 1 week,1 month,1 year,the slit lamp digital photography and Pentacam anterior segment analyzer were used to collect the anterior segment images,and the parameters include horizontal and vertical diameter,roundness,package and partial centre of IOL were analyzed by image analysis software image-pro-plus 6.0.Using repeated measurement of variance analysis,Fisher exact probability,and Generalized estimation equations (GEE),the differences between parameters of the groups and IOL decentration predictor were analyzed.Results The vertical diameter,roundness,maximum distance,minimum distance,package and horizontal deviation were statistically significant between the femtosecond group and the annular group at 1 week and 1 month after operation (all P ＜ 0.05),and there was no significant difference in horizontal diameter and vertical deviation between two groups (all P ＞ 0.05).At 1 year after operation,the maximum distance,minimum distance,package and horizontal deviation between two groups were statistically significant (all P ＜ 0.05).There was no significant difference in vertical and horizontal diameter,roundness,and vertical deviation between two groups (all P ＞ 0.05).There was no patient with horizontal shift ＞ 0.4 mm in the femtosecond group at 1 week,1 month and 1 year;The ratio of cases with horizontal shift ＞0.4 mm and ＜0.4 mm in the annular group at 1 week,1 month and 1 year were 2/38,4/36,8/32,respectively.There was significant difference in the horizontal shift ＞ 0.4 nun between the two groups after 1 year(P ＜ 0.05).In the univariate generalized estimating equation model,the capsulorhexis type was a significant predictor of horizontal shift.Of all the capsulorhexis parameters,the difference of inclusion degree was statistically significant (P =0.001).There was negative correlation between the horizontal shift and package at different time points in the femtosecond group at 1 week,1 month and 1 year (r =-0.89,P ＜ 0.05;r =-0.72,P ＜ 0.05;r =-0.58,P ＜ 0.05);There was negative correlation between the horizontal shift and package at different time points in the annular group at 1 week(r =-0.68,P ＜ 0.05),but no correlation at 1 month and 1 year (r=-0.41,P＞0.05;r=-0.33,P＞0.05).Conclusion The anterior capsule made by femtosecond laser anterior capsulotomy is more round,centered and accurate,pocket IOL position is more stabled and neutral.

Functional Neurosurgery for Psychiatric Disease / 대한정신약물학회지

Despite a long and controversial history, psychosurgery has persisted as a modern treatment option for some severe, medically intractable psychiatric disorders. The empirical basis of psychosurgery is weak because of the lack of well-designed investigations. Several carefully conducted studies in which independent evaluation has been made, however, show convincingly that highly selective stereotactic operations on the brain can benefit some carefully selected, chronically ill psychiatric patients with a low rate of unwanted side effects. The goal of this article is to review the current state of psychosurgery. In this review, the definition of psychosurgery, patient selection criteria, and anatomical and physiological rationales for anterior cingulotomy, subcaudate tractotomy, anterior capsulotomy, limbic leukotomy, vagus nerve stimulation and deep brain stimulation are discussed.

Postoperative Changes of Continuous Curvilinear Capsulorhexis

As a growing number of surgeons are perforining cataract extraction by phacoernulsification and the continuous curvilinear capsulorhexis [CCC] has rapidly increased in popularity as the anterior capsulotomy technique, its advantages have been reported recently. But its complications induced by capsular contraction after ccc have been noted, and so we have studied the change in anterior capsular opening area and refractive error after ccc. One surgeon performed cataract extraction using ccc and phacoernulsification, and implanted posterior chamber IOL [optic size 5. 5mm, Pharmacia 812A] in the bag in 48 eyes, and we measured the area of anterior capsular opening and refractive error [spherical equivalent] at I week and 3 months after operation. The average percentage of anterior capsular shrinkage rate at 3 months was 14.8% and showed statistically significant difference [P<0.05], but. had not correlation with initial ccc size. The average refractive change at 3 months was 0. 2D hyperopic shift but did not show statistically significant difference.

The Effect of Anterior Capsulotomy Size and Lens Epithelial cells Removal on the Posterior Capsular Opacification

The most common complication of cataract surgery, posterior capsular opacification is known to arise from the lentivular epithelial proliferation. The simple mechanical elimination of the lenticular epithelial cells by irrigation and asiration is most widely used now. Recently, the defenite size of continous curvilinear capsulorhexis(C.C.C.) and the effect of partial mechanical removal of lens epi thelial cells is under the discussion. We used 15 Neuzealand white rabbits(30 eyes) to examine the appropriate capsulotomy size and the effect of simple irrigation and aspiration on the posterior capsular opacification for 3 months after operation. The results from by using the slit lamp and the ophthalmoscope examination showed that the posterior capsular opacificaiton grade score was lower in the small(3~4mm) capsulotomy with irrigation and aspiration group(1.7) than in the small capsulotomy(3~4mm) group without irrigation and aspiration group(2.3) or the large capsulotomy (6~7mm) group without irrigation and aspiration(2.4). The optical power meter and posterior eye evaluation technique also presented the same results of posterior capsular opacification grade as those of slit lamp and ophthalmoscope examination which was done on the eneuc1eated eyes at postoperative 3 months.

Rabbit Corneal Endothelial Cell Damage by Q-switched Nd:YAG laser

Corneal endothelial damages following Nd: YAG laser application were evaluated rabbits. The first group underwent anterior capsulotomy, while the second group received laser applications at the corneal center and anterior capsule. The rabbits were evaluated with the intraocular pressure, the corneal endothelial cell number, the thickness of the corneal center, and the morphologic change of the cornea, before laser application and at postaplication 1 day, 7 day, and 14 day. But the endothelium was damaged when laser shots were applied at the cornea center and anterior caps ulotomy. In ophthalmologic procedure with Q-switched Nd:YAG laser, the minimal effective poser should be selected, the laser beam should be applicated on extremely fine focus and contact lens should be used to minimize the corneal endothelial injury.

The Effect of Indomethacin Pretreatment Before Nd:YAG Laser Anterior Capsulotomy on Intraoular Pressure of Rabbits

To evaluate the cause of intraocular pressure elevation and the effect of indomethacin after Nd:YAG laser anterior capsulotomy in rabbit authors measured the intraocular pressure, prostaglandin E2 and thromboxane B2 concentrations of aquous humor, and observed the morphological change of trabecular meshwork using scanning electron microscope in indomethacin pretreatment (group I) and non-treatment (group II) group. The intraocular pressure and the concentrations of prostaglanding E2 and thromboxane B2 in group II were higher than in group I. And the scanning electron microscopy showed inflammatory reaction in group II. These results support that the causes of intraocular pressure elevation are elevation of prostaglandin E2. thromboxane B2 concentrations in aqueous humor and intraocular inflammation secondary to it.

The Effect of Indomethacin Pretreatment Before Nd:YAG Laser Anterior Capsulotomy on Intraoular Pressure of Rabbits

To evaluate the cause of intraocular pressure elevation and the effect of indomethacin after Nd:YAG laser anterior capsulotomy in rabbit authors measured the intraocular pressure, prostaglandin E2 and thromboxane B2 concentrations of aquous humor, and observed the morphological change of trabecular meshwork using scanning electron microscope in indomethacin pretreatment (group I) and non-treatment (group II) group. The intraocular pressure and the concentrations of prostaglanding E2 and thromboxane B2 in group II were higher than in group I. And the scanning electron microscopy showed inflammatory reaction in group II. These results support that the causes of intraocular pressure elevation are elevation of prostaglandin E2. thromboxane B2 concentrations in aqueous humor and intraocular inflammation secondary to it.