Abstract
We aimed to determine the timing of neodymium:yttrium–aluminum–garnet (Nd:YAG) laser capsulotomy on corrected-distance visual acuity (CDVA), intraocular pressure (IOP), and spherical equivalent (SE) in patients with posterior capsular opacification (PCO). There were 59 patients with unilateral PCO and a history of Nd:YAG laser capsulotomy enrolled and further divided into the early Nd:YAG group (timing < 12 months, n = 25) and late Nd:YAG group (timing > 12 months, n = 34) depending on the elapsed months from phacoemulsification to Nd:YAG laser capsulotomy. The primary outcomes were CDVA, IOP, and SE before (immediately before Nd:YAG laser capsulotomy) and after (weeks one and four after the laser treatment). The independent t test was applied to analyze the difference in CDVA, IOP, and SE between the two groups, while the generalized estimating equation with Bonferroni adjustment was conducted to evaluate the effect of all the parameters on the change in SE with adjusted odds ratio (aOR) and 95% confidence interval (CI). The CDVA showed significant improvement in both the early Nd:YAG group (p = 0.005) and the late Nd:YAG group (p = 0.001), and hyperopic change occurred in both the early Nd:YAG group (p = 0.003) and the late Nd:YAG group (p = 0.017). The early Nd:YAG group revealed more significant hyperopic change compared with the late Nd:YAG group four weeks after Nd:YAG treatment (p < 0.001), which was still significant after multivariable analysis (aOR: 0.899, 95% CI: 0.868–0.930, p = 0.011). In addition, a deeper ACD (aOR: 0.764, 95% CI: 0.671–0.869, p = 0.019) was significantly correlated with hyperopic change. In conclusion, Nd:YAG laser capsulotomy performed within one year after cataract surgery may lead to significant hyperopic change, in which the ACD alteration affects the hyperopic shift significantly.
Highlights
Posterior capsule opacification (PCO) is the most common delayed complication of modern cataract surgery [1,2], occurring at the first to fifth years postoperatively in 1.2% to 13.2% of patients [3]
The generalized estimating equation (GEE) was applied to yield the adjusted odds ratio with 95% confidence interval (CI) of the early-Nd:YAG group compared with the late Nd:YAG group concerning hyperopic change after adjusting for the effects of time points, age, sex, laterality, energy, corrected-distance visual acuity (CDVA), intraocular pressure (IOP), K, anterior chamber depth (ACD), and axial length (AXL)
The energy of Nd:YAG laser capsulotomy was significantly higher in the early Nd:YAG group compared with the late Nd:YAG group (69.52 ± 15.96 versus 28.31 ± 16.90, p < 0.001)
Summary
Posterior capsule opacification (PCO) is the most common delayed complication of modern cataract surgery [1,2], occurring at the first to fifth years postoperatively in 1.2% to 13.2% of patients [3]. In spite of decreasing rates of PCO by using advanced IOL biomaterials and optic edge designs [6,7], PCO is gradually intolerable with the introduction of premium IOL [4] Once it occurs, PCO is routinely treated by the neodymium:yttrium– aluminum–garnet (Nd:YAG) laser capsulotomy with significant visual improvement in most cases [8,9]. The size and shape of Nd:YAG laser capsulotomy, the energy used in Nd:YAG laser capsulotomy, and the designs of IOL did not affect the post-laser refractive status according to previous research [19–21]. Still, it remains unclear whether the timing of laser capsulotomy plays a pivotal role in the refractive and visual prognosis of patients after Nd:YAG laser capsulotomy. Since the IOL would keep rotating for at least 6 months after cataract surgery [22], an early Nd:YAG laser capsulotomy may lead to instability of lens position and subsequent refraction change that would need evaluation
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