Abstract
ABSTRACTAim The current treatment for posterior capsular opacification (PCO), neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy, may lead to increased intraocular pressure (IOP). Our aim was to survey routines in the management of IOP spikes and to identify the rate of IOP spikes following prophylactic apraclonidine treatment.Materials and methods A survey questionnaire among ophthalmologists and a retrospective registry review was used. Patients were administered apraclonidine 0.5% prior to capsulotomy. The IOP was measured before and 1 hour postprocedure.Results A total of 71% of responders (n = 45) routinely prescribe topical IOP-lowering medication and 82% routinely measure IOP before or after capsulotomy. The registry analysis included 87 eyes of 75 patients. Mean IOP decreased by 0.9 ± 3.3 mm Hg (p = 0.01, range: -6 to 10) following capsulotomy. No patient reached IOP values above 21 mm Hg following the procedure, with 3.4 and 1.1% of patients demonstrating an IOP elevation of more than 3 and 5 mm Hg respectively. No association was found between number of laser shots, mean laser power, or comorbid conditions, such as diabetes, hypertension, or glaucoma status with posttreatment IOP.Conclusion Most ophthalmologists surveyed routinely prescribe prophylactic IOP-lowering medication and measure IOP before or after capsulotomy. Mean IOP remained clinically stable following capsulotomy with prophylactic apraclonidine instillation, and no patient reached IOP values above 21 mm Hg. Differences in laser delivery or comorbid conditions were not associated with posttreatment IOP. Considering that no patient demonstrated a clinically significant IOP spike following prophylactic apraclonidine instillation, perhaps routine measurement of IOP following primary Nd:YAG laser may be reserved for high-risk patients only.Clinical significance In this work, we showed the prophylactic effect of apraclonidine 0.5% and suggest that measuring IOP after the procedure is necessary only in certain high-risk cases, possibly helping to reduce workload and patient waiting time and improving quality of service.How to cite this article Achiron A. Intraocular Pressure Spikes following Neodymium-doped Yttrium Aluminum Garnet Laser Capsulotomy: Current Prevalence and Management in Israel. J Curr Glaucoma Pract 2017;11(2):63-66.
Highlights
Posterior capsular opacification is the most common postoperative complication of cataract surgery with a cumulative 5-year incidence of 11.9%.1 The treatment of choice for posterior capsular opacification (PCO) is short pulsed neodymium-doped yttrium aluminum garnet (Nd):YAG laser applied to the posterior capsule in order to create an opening in the visual axis
No association was found between number of laser shots, mean laser power, or comorbid conditions, such as diabetes, hypertension, or glaucoma status with posttreatment intraocular pressure (IOP)
Differences in laser delivery or comorbid conditions were not associated with posttreatment IOP
Summary
Posterior capsular opacification is the most common postoperative complication of cataract surgery with a cumulative 5-year incidence of 11.9%.1 The treatment of choice for PCO is short pulsed Nd:YAG laser applied to the posterior capsule in order to create an opening in the visual axis. The treatment of choice for PCO is short pulsed Nd:YAG laser applied to the posterior capsule in order to create an opening in the visual axis. Considered safe, it may result in retinal detachment, lens subluxation, and lens pitting. The most common complication is a transient increase in IOP, which may occur in 15 to 36% of patients who receive no prophylactic treatment.[2,3,4,5,6] This IOP spike may lead to additional injury in eyes with advanced glaucomatous optic nerve damage.[2]. Apraclonidine 0.5% is a common choice as a prophylactic treatment prior to laser capsulotomy.[8,13] Reported rates of IOP spikes above 5 mm Hg following prophylactic apraclonidine 0.5% and capsulotomy vary between 2 and 8.5%.2,5,11,12
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