Analysis of visual outcome of Neodymium: Yttrium-Aluminum -Garnet (Nd: YAG) laser capsulotomy in patients with Posterior Capsule Opacification
Abstract
Objective: Posterior capsular opacification (PCO) is a postoperative complication causing decreased visual acuity. This study aims to study the efficacy of Nd: YAG laser capsulotomy in posterior capsular opacification following cataract surgery by analyzing the visual outcome.
Material and Methods: A prospective study included a sample size of 50 eyes of 37 patients with Posterior capsular opacification following uneventful cataract surgery with significantly decreased visual acuity. Detailed anterior and posterior segment examination was done, best-corrected visual acuity (BCVA) was recorded along with measurement of IOP. Posterior capsulotomy was performed using Nd: YAG laser (Neodymium: Yttrium-aluminum–garnet) and patients were followed up. Visual acuity was assessed and complications if any were recorded.
Results: It was noted that 74% of the patients at the end of 1st week and 78% of the patients at the end of 1st and 3rd month had significant visual improvement following Nd: YAG laser capsulotomy. There was a statistically significant difference in Post Nd: YAG laser BCVA on follow up with P-value <0.001. Complications encountered were the rise in IOP in 6% of the population at the end of 1 hour and 1st day of the procedure, iris bleeding was noted in 4% of the population, intraocular lens damage in 2 %, and cystoid macular edema in 2 % of the study population.
Conclusion: Thus Nd: YAG laser posterior capsulotomy serves as an excellent treatment modality in patients with postoperative PCO.
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References
Van Bree MC, van den Berg TJ, Zijlmans BL. Posterior capsule opacification severity, assessed with stray light measurement, as main indicator of early visual function deterioration. Ophthalmol. 2013;120(1):20-33. doi: 10.1016/j.ophtha.2012.07.050.
Werner L, Apple DJ, Pandey SK. Postoperative proliferation of anterior and equatorial lens epithelial cells: A comparison between various foldable IOL designs. In: References Buratto L, Osher R, Masket S, editors, Cataract Surgery in Complicated Cases. Thorofare, NJ, Slack Inc., 2000; pp: 399-417. doi: 10.1016/s0161-6420(01)00674-1.
Aaron-Rosa D, Aron JJ, Griesemann M, Thyze lR. Use of neodymium-Yag laser to open the posterior capsule after lens implant surgery: a preliminary report.J Am Intraocul Implant Soc.1980;6(4):352-354. doi: 10.1016/s0146-2776(80)80036-x.
Apple DJ, Solomon KD, Tetz MR, Assia EI, Holland EY,Legler UF, et al. Posterior capsule opacification. Surv Ophthalmol. 1992;37(2):73-116. doi: 10.1016/0039-6257(92)90073-3.
Baratz KH, Cook BE, Hodge DO. Probabality of Nd:Yag laser capsulotomy after cataract surgery in Olmsted County, Minnesota .Am J Ophthalmol. 2001;131(2):161-166. doi: 10.1016/s0002-9394(00)00795-9.
Jose RM, Bender LE, Boyce JF, Heatley C. Correlation between the measurement of posterior capsule opacification severity and visual function testing. J Cataract Refract Surg 2005;31(3):534-542. doi: 10.1016/j.jcrs.2004.07.022.
Pandey SK, Apple DJ, Werner L, Maloof AJ, Milverton EJ. Posterior Capsule Opacification: A Review of the Aetiopathogenesis, Experimental and Clinical Studies and Factors for Prevention Indian J Ophthalmol. 2004;52(2):99-112.
Gardner M, Straatsma R. Nd:YAG laser posterior capsulotomy-first 100 cases at UCLA J Ophthalmic Surge. 1985.
Datiles MB, LasaMS. Evaluation of visual function following ND:YAG laser posterior capsulotomy. J Ophthalmol. 1997:104(8);1287-1293. doi: 10.1016/s0161-6420(97)30146-8.
Thompson AM, Sachdev N, Wong T, Riley AF, Grupcheva CN, McGhee CN. The Auckland Cataract Study: 2-year postoperative assessment of aspects of clinical, visual, corneal topographic and satisfaction outcomes. Br. J. Ophthalmol. 2004;88(8):1042-1048. doi: 10.1136/bjo.2003.032581.
Steinert RF, Puliafito CA, Kumar SR, Dudak SD, Patel S. Cystoid macular edema, retinal detachment, and glaucoma after Nd:YAG laser posterior capsulotomy. Am J Ophthalmol. 1991;112(4):37380. doi: 10.1016/s0002-9394(14)76242-7.
Billotte C, Berdeaux G. Adverse clinical consequences of neodymium:YAG laser treatment of posterior capsule opacification. J Cataract Refract Surg. 2004;30(10):206471. doi: 10.1016/j.jcrs.2004.05.003.
Keates RH, Steinert RF, Puliafito CA, Maxwell SK. Long-term follow-up of Nd:YAG laser posterior capsulotomy. J Am Intraocul Implant Soc.1984;10(2):164-168. doi: 10.1016/s0146-2776(84)80101-9.
Richter CU, Arzeno G, Pappas HR, Steinert RF, Puliafito C, Epstein DL. Intraocular pressure elevation following Nd:YAG laser posterior capsulotomy. Ophthalmol. 1985;92(5):636-640. doi: 10.1016/s0161-6420(85)33991-x.
Yilmaz S, Ozdil MA, Bozkir N, Maden A. The effect of Nd: YAG laser capsulotomy size on refraction and visual acuity. J Refract Surg. 2006;22(7):719-721.
Küçüksümer Y, Bayraktar Ş, Şahin Ş, Yılmaz ÖF. Posterior capsule opacification 3 years after implantation of an AcrySof and a Memory Lens in fellow eyes. J Cataract Refract Surg. 2000;26(8):1176-1182. doi: 10.1016/s0886-3350(00)00583-6.
Hossain MI, Hossain MA, Hossain MJ. Visual outcome after Nd: YAG laser Capsulotomy. J Armed Forces Med College, Bangladesh. 2009;5(2):29-31. doi: 10.3329/jafmc.v5i2.4580.
Yazici AT, Bozkurt E, Kara N, Yildirim Y, Demirok A, Yilmaz OF. Long-term results of phacoemulsification combined with primary posterior curvilinear capsulorhexis in adults. Middle East Afr J Ophthalmol. 2012;19(1):115. doi: 10.4103/0974-9233.92126.
Pai HV, Pathan A, Kamath YS. A comparison of posterior capsular opacification after implantation of three different hydrophobic square edge intraocular lenses. Indian J Ophthalmol. 2019;67(9):1424. doi: 10.4103/ijo.IJO_219_19.
Patil M, Singh D, Vanathi M. Posterior Capsular Opacification: Mechanism, Prevention and Management. DOS TIMES, September-October 2016.
Barman SA, Hollick EJ, Boyce JF, Spalton DJ, Uyyanonvara B, Sanguinetti G, et al. Quantification of posterior capsular opacification in digital images after cataract surgery. Invest Ophthalmol Vis Sci. 2000;41(12):3882-3892.
Saika S, Miyamoto T, Ishida I, Tanaka T, Okada Y, Nagane Y, et al. Comparison of Scheimpflug images of posterior capsule opacification and histological findings in rabbits and humans. J. Cataract Refract Surg. 2001;27(7):1088. doi: 10.1016/s0886-3350(00)00860-9.
Tanaka Y, Kato S, Miyata K, Honbo M, Nejima R, Kitano S, et al. Limitation of Scheimpflug videophotography system in quantifying posterior capsule opacification after intraocular lens implantation. Am. J. Ophthalmol. 2004;137(4): 732. doi: 10.1016/j.ajo.2003.11.011.
Moreno-Montanes J, Alvarez A, Maldonado MJ. Objective quantification of posterior capsule opacification after cataract surgery, with optical coherence tomography. Invest Ophthalmol Vis Sci. 2005;46 (11): 3999. doi: 10.1167/iovs.04-1531.
Daniel WW. Determination of sample size for estimating proportions. Biostatistics A foundation for analysis Health Sci. 1999;8:189-190. doi: 10.1002/1097-0258(20010130)20:2<324::AID-SIM635>3.0.CO;2-O.
Prajna NV, Ellwein LB, Selvaraj S, Manjula K, Kupfer C. The madurai intra ocular lens study IV posterior capsular opacification. Am J Ophthalmol. 2000;130(3):304-309. doi: 10.1016/s0002-9394(00)00481-5.
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