Abstract
We aimed to survey whether the timing of neodymium:yttrium–aluminum–garnet (Nd:YAG) laser capsulotomy would alter the corneal endothelial morphology and density. A retrospective cohort study was conducted, and 48 patients with unilateral posterior capsular opacity (PCO) and Nd:YAG laser capsulotomy performance were enrolled. The participants were divided into the early Nd:YAG group (timing ≤ 12 months, n = 20) and late Nd:YAG group (timing > 12 months, n= 28) depending on elapsed months between phacoemulsification and Nd:YAG laser capsulotomy. Endothelial cell density (ECD), coefficient of variant (CV), hexagonality (HEX), and central corneal thickness (CCT) between the two groups were collected. A generalized estimate equation was conducted to evaluate the corneal endothelial parameters between the two groups with an adjusted odds ratio (aOR) and 95% confidence interval (CI). The CDVA was improved after treatment in both groups (both p < 0.001). Chronically, ECD in the early group was significantly decreased one week after treatment (2221.50 ± 327.73/mm2 vs. 2441.55 ± 321.80/mm2, p < 0.001), which recovered to 2369.95 ± 76.37/mm2 four weeks after the treatment but was still lower than the preoperative status (p < 0.001). In addition, the HEX percentage showed a significant reduction at four weeks after treatment (p = 0.028). The ECD in the early group was significantly lower than that in the late group (aOR: 0.167, 95% CI: 0.079–0.356, p = 0.003) in both week 1 (p < 0.001) and week 4 (p = 0.004) after laser treatment. In conclusion, the early application of Nd:YAG laser capsulotomy within one year after cataract surgery may be the reason for postoperative ECD decrement without known etiology.
Highlights
Posterior capsule opacification (PCO) is a late complication frequently encountered after cataract surgery [1,2], with an incidence of 1.2% and 13.2% in the first and fifth years postoperatively [3]
The energy used in neodymium:yttrium– aluminum–garnet (Nd):YAG laser capsulotomy was significantly higher in the early Nd:YAG group (69.36 ± 17.45 vs. 29.24 ± 18.30, p < 0.001), and the elapsed time was longer in the late Nd:YAG group (9.65 ± 1.42 vs. 16.03 ± 1.90, p < 0.001)
The baseline corrected-distance visual acuity (CDVA) was 0.75 ± 0.23 in the early Nd:YAG group, which significantly improved to 0.28 ± 0.07 one week after treatment and was maintained at 0.27 ± 0.08 four weeks after treatment (p < 0.001), while the intraocular pressure (IOP) remained similar throughout the study period (p = 0.924)
Summary
Posterior capsule opacification (PCO) is a late complication frequently encountered after cataract surgery [1,2], with an incidence of 1.2% and 13.2% in the first and fifth years postoperatively [3]. The Nd:YAG laser capsulotomy is effective, it is not free from prominent complications such as hyphema, transient intraocular pressure (IOP) elevation, cystoid macular edema, uveitis, dislocation of IOL, change of IOL position, and rhegmatogenous retinal detachment, in the first few months [8,10,11,12]. Except for the above-mentioned complications, the Nd:YAG laser management could affect the corneal endothelium with only limited regenerative capacity, and corneal decompensation with reduced vision is a major concern occasionally [13]. The laser iridotomy causes significant endothelial cell loss but without prominent corneal decompensation [14,15,16]. Whether early or late arrangement of Nd:YAG laser capsulotomy exerts more harmful effects on the corneal endothelium was largely unknown. The previous study that surveyed the influence of Nd:YAG laser capsulotomy on corneal endothelium only evaluated the ECD, while the changes of coefficient of variant (CV), hexagonality (HEX), and central corneal thickness (CCT) after Nd:YAG laser capsulotomy remain inconclusive
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