Anterior Capsulotomy Research Articles

Effective deep brain stimulation for obsessive-compulsive disorder after failed anterior capsulotomy: illustrative cases.

Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by recurrent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) performed to relieve distress related to the obsessions. For patients with severe illness refractory to first-line pharmacotherapy and psychotherapy, neurosurgical treatments such as deep brain stimulation (DBS) and stereotactic lesioning are an option. The choice between DBS and lesioning is often driven by patient preference, but these options are not mutually exclusive. Here, the authors highlight the success of one surgical therapy (DBS) after the failure of another (lesioning). Two patients with severe, treatment-refractory OCD underwent DBS lead implantation targeting the ventral capsule/ventral striatum after they did not attain any worthwhile benefit from a previous anterior capsulotomy. Both patients showed significant improvement (≥ 35% reduction in Yale-Brown Obsessive-Compulsive Scale [YBOCS] score) of their OCD symptoms at the long-term follow-up after DBS. One patient experienced a 37% reduction in symptom severity as measured by the YBOCS, and the other patient experienced a 47% reduction. DBS and lesioning procedures are both effective surgical options for patients with intractable OCD. In these cases, the authors demonstrate that DBS can be utilized even after a lesioning procedure in nominally the same target (ventral portion of the anterior limb of the internal capsule). https://thejns.org/doi/10.3171/CASE24289.

Prevention of Argentinian flag sign in intumescent cataracts using anterior chamber air bubble and cortical fluid release techniques

BackgroundTo investigate the efficiency of a new method for the prevention of argentinian flag sign during the process of continuous, circular, and centered anterior capsulotomy (CCC) on the anterior capsule in cortically liquefied intumescent cataracts. This study was registered in an appropriate registry and the registration number of registration was xyy11[2022]-XJSFX-087; The date of of registration was 2022-04-29.MethodsPreoperative examinations including slit-lamp examination, ocular A-scan ultrasonography, and Ultrasound Biomicroscopy (UBM) UBM were conducted on 61 patients with intumescent cataracts. Cases with cortically liquefied intumescent cataracts were selected and after staining with indocyanine green, the anterior chamber air bubble technique was used to compress the anterior capsule, and liquefied cortex was aspirated using a puncture needle. Corrected Distance Visual Acuity (CDVA) and intraocular pressure were recorded on postoperative days 1, 1 week, 1 month, and 6 months. Intraoperative and postoperative complications were documented and analyzed.ResultsFifty eyes were identified as having cortically liquefied intumescent cataracts. No cases of the Argentinian flag sign occurred, and standard capsulorrhexis was achieved, facilitating smooth phacoemulsification. All patients achieved satisfactory outcomes at follow-ups of 1 day, 1 week, 1 month, and 6 months postoperatively. Mild corneal edema was observed in three cases on the first postoperative day, with no other complications noted.ConclusionsThe anterior chamber air bubble technique combined with cortical fluid release technique can prevent the occurrence of the Argentinian flag sign in cortically liquefied intumescent cataracts, this method is simple, convenient and economic for the clinical promotion.

Bilateral Anterior Capsulotomy for Treatment-Resistant Obsessive-Compulsive Disorder

Introduction: Ablative surgery is an intervention of last resort for treatment-resistant obsessive-compulsive disorder (TROCD). Our center has been using bilateral anterior capsulotomy (BAC) for the past 20 years for patients eligible for limbic surgery. This report details our experience with BAC for TROCD. Method: Five patients with OCD met eligibility criteria for BAC. Entry protocols were complex and took around 6 months to complete. Stereotactic radiofrequency was used to produce the capsulotomies. Lesion length varied between 5.7 and 16.9 mm in the coronal plane. Patients were followed between 4 and 20 years. Results: All 5 patients (100%) were responders as defined by the widely accepted criteria of a reduction of ≥35% in Yale-Brown Obsessive Compulsive Scale (YBOCS) score at 18-month follow-up. Four patients remained responders at the 48 months. One patient was lost to follow-up. Responder status when viewed from the perspective of the YBOCS was sustained over the 4- to 20-year follow-up with one relapse 19 years postsurgery when medications were discontinued. Real-world psychiatric outcomes were different as other vulnerabilities surfaced illustrating the multifactorial determinants of mental health. No patient had any significant long-term neurocognitive or physical side effects. Conclusion: BAC should remain an option of last resort for patients with severe OCD who remain unresponsive to all other interventions.

Nd:YAG laser capsulotomy vs needle aspiration in intumescent cataracts: comparative study of complications and outcomes.

To compare the complications and postoperative outcomes of Nd:YAG laser anterior capsulotomy vs a needle aspiration approach for capsulorhexis in patients with intumescent cataracts. University of Health Sciences, Basaksehir Cam and Sakura City Hospital Department of Ophthalmology, Istanbul, Turkey. Retrospective, cross-sectional study. Patients with intumescent cataract were divided into 2 groups. Group 1 (37 eyes) underwent Nd:YAG laser capsulotomy preoperatively, which reduced lens pressure. In Group 2 (31 eyes), the capsulorhexis was completed by reducing the intralenticular pressure by needle aspiration and then gradually expanding the capsule. Demographics, pre/postoperative parameters, complications, and surgical times were analyzed. 68 eyes of 68 patients were evaluated. Age and sex exhibited no significant differences between groups. Group 2 had more complications than Group 1 ( P = .041). Specifically, no capsular tear extensions were seen in Group 1 while 4 patients in Group 2 had tears extending to the lens periphery. Group 1 showed a significant decrease in surgical maneuvers and time ( P = .028) while no significant difference was found in effective phacoemulsification time ( P = .076). Nd:YAG laser capsulotomy effectively prevented capsular extensions and reduced surgical time in intumescent cataracts. This technique provides a safe alternative to traditional methods, potentially reducing intraoperative risks and improving surgical efficiency. The findings support Nd:YAG laser anterior capsulotomy as a viable approach for capsulorhexis in intumescent cataracts, emphasizing its potential benefits in reducing complications and enhancing surgical outcomes.

Anterior capsulotomy combined with subthalamic nucleus deep brain stimulation for tardive dystonia

BackgroundDeep brain stimulation (DBS) has been reported as a therapy option for the motor dysfunction of severe tardive dystonia (TD). The major psychiatric diseases, however, are contraindications to DBS treatment in TD patients. MethodsSix severe, medically refractory TD patients undergoing bilateral anterior capsulotomy combined with bilateral subthalamic nucleus (STN)-DBS treatment were studied retrospectively at two time points: pre-operation, and 1–3 years post-operation. Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS) was used to assess the dystonia and disability. Depressive, anxiety, psychiatric symptoms, and Quality of Life (QoL) were evaluated using the 17-item Hamilton Depression Scale (HAMD-17), the 14-item Hamilton Anxiety Scale (HAMA-14), the Positive and Negative Syndrome Scale (PANSS), and 36-item Short-Form Health Survey (SF-36), respectively. ResultsAfter receiving the combination treatment for 25 ± 11.6 months (range, 12–41 months), significant clinical symptom improvements were reported in TD patients. BFMDRS motor and disability scores were ameliorated by 78.5 ± 32.0% (p = 0.031) and 76.5 ± 38.6% (p = 0.031), respectively. The HAMD-17 and HAMA-14 scores were reduced by 60.3 ± 27.9% (p = 0.007) and 60.0 ± 24.6% (p = 0.009), respectively. Furthermore, the PANSS scores of the comorbidity schizophrenia TD patients decreased by 58.1 ± 6.0% (p = 0.022), and the QoL improved by 59.7 ± 14.1% (SF-36, p = 0.0001). During the research, there were no notable adverse effects or problems. ConclusionBilateral anterior capsulotomy combined with bilateral STN-DBS may be an effective and relatively safe treatment option for severe TD comorbid with major psychiatric disorders.

Biomechanical evaluation of porcine lens capsule with and without nucleus after capsulotomy – Finite element analysis

Previous studies have shown that the nucleus could offer structural support to the lens capsule. This study investigated the biomechanical performance of porcine lens with and without nucleus for 4 mm, 4.5 mm, 5 mm, 5.5 mm and 6 mm capsulotomy and its potential impact on the stretch ratio of capsular bag when the anterior capsulotomy edge was stretched. Our simulation results showed higher strain for the capsular bag with nucleus, which is crucial for the porcine lens to tolerate more stretch without failure. This simulation could support future study on the optimization of capsulotomy based on patient specific condition, that is, the geometry of lens.

Histopathological findings of anterior lens capsule in pediatric cataract.

To investigate the histopathological findings of the anterior lens capsule in pediatric patients who had surgery for cataracts. This study is a prospective interventional study. Anterior capsule tissue samples that were obtained by the anterior capsulotomy method during phacoemulsification surgery were fixed and examined under a transmission electron microscope. Twenty-two eyes of 19 patients who were diagnosed with congenital and juvenile cataracts were included in this study. Five patients had associated systemic diseases, including hydrocephalus, cerebral palsy, prematurity, juvenile myelomonocytic leukemia, and Down's syndrome. Electron microscopic evaluation demonstrated single-layered epithelium under the capsule, degenerated organelles with round-oval and prismatic-oval nuclei, and degenerated mitochondria and heterochromatin-rich nuclei. In the case with cerebral palsy, collagen fibrils of the connective tissue and fibroblast-like cells were observed replacing the epithelium that should be underneath the capsule in both eyes, and there was a disorganized distribution of collagen fibrils and vacuole structures in the cytoplasm of fibroblast-like cells. Similar histopathological findings were found in pediatric cataracts with or without systemic disease except in one cerebral palsy case. The absence of lens epithelium may have been a result of degeneration in this patient, and this can be attributed to the presence of systemic inflammation and gliosis in cerebral palsy. The absence of lens epithelium can play a role in the development of dense subcapsular fibrosis and cataract formation.

Impact of Coracohumeral Ligament Release on Treatment Outcomes in Patients with Idiopathic Adhesive Capsulitis

Background. The coracohumeral ligament restricts external rotation of the shoulder joint and, along with the upper, middle, and lower glenohumeral ligaments, participates in stabilizing the shoulder joint. There is ongoing debate regarding the division of this anatomical structure in patients with limited external rotation. Objective: to compare the treatment outcomes of patients with idiopathic adhesive capsulitis who underwent coracohumeral ligament release along with selective capsulotomy to those who underwent only partial coracohumeral ligament release. Material and Methods. We treated 85 patients with idiopathic adhesive capsulitis, who were divided into two groups: group 1 underwent selective anterior capsulotomy of the shoulder joint with the division of the middle and lower glenohumeral ligaments, biceps long head tenotomy, subacromial decompression, and partial coracohumeral ligament release; group 2 underwent a similar surgical procedure with complete coracohumeral ligament excision. The average age of the patients was 47.9±19.1 years. The function of the shoulder joint was assessed using the Constant Shoulder Score and VAS scales before surgery and at 3 and 6 months postoperatively. Results. At 3 months postoperatively, group 2 showed a slightly better functional outcome according to the Constant Shoulder Score (12.2±6.9 points) compared to group 1 (18.1±6.4 points, p=0.038). At 6 months postoperatively, group 1 had a mean Constant Shoulder Score of 15.1±7 points, while group 2 had a score of 10.1±6.3 points (p=0.02). Conclusions. Excision of the coracohumeral ligament in patients with idiopathic adhesive capsulitis allows for better functional outcomes according to the Constant Shoulder Score and VAS at both 3 and 6 months postoperatively.

Benefits of stereotactic radiosurgical anterior capsulotomy for obsessive-compulsive disorder: a meta-analysis.

Anterior capsulotomy (AC) is a therapeutic option for patients with severe, treatment-resistant obsessive-compulsive disorder (OCD). The procedure can be performed via multiple techniques, with stereotactic radiosurgery (SRS) gaining popularity because of its minimally invasive nature. The risk-benefit profile of AC performed specifically with SRS has not been well characterized. Therefore, the primary objective of this study was to characterize outcomes following stereotactic radiosurgical AC in OCD patients. Studies assessing mean Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores before and after stereotactic radiosurgical AC for OCD were included in this analysis. Inverse-variance fixed-effect modeling was used for pooling, and random-effects estimate of the ratio of means and standard mean differences were calculated at 6 months, 12 months, and the last follow-up for Y-BOCS scores, as well as the last follow-up for the Beck Depression Inventory (BDI)/BDI-II scores. A generalized linear mixed model was used to generate fixed- and random-effects models for categorical outcomes. Univariate random-effects meta-regression was used to evaluate associations between postoperative Y-BOCS scores and study covariates. Adverse events were summed across studies. Publication bias was assessed with Begg's test. Eleven studies with 180 patients were eligible for inclusion. The mean Y-BOCS score decreased from 33.28 to 17.45 at the last-follow up (p < 0.001). Sixty percent of patients were classified as responders and 10% as partial responders, 18% experienced remission, and 4% had worsened Y-BOCS scores. The degree of improvement in the Y-BOCS score correlated with time since surgery (p = 0.046). In the random-effects model, the mean BDI at the last follow-up was not significantly different from that preoperatively. However, in an analysis performed with available paired pre- and postoperative BDI/BDI-II scores, there was significant improvement in the BDI/BDI-II scores postoperatively. Adverse events numbered 235, with headaches, weight change, mood changes, worsened depression/anxiety, and apathy occurring most commonly. Stereotactic radiosurgical AC is an effective technique for treating OCD. Its efficacy is similar to that of AC performed via other lesioning techniques.

Evaluation of Methods for Detection and Semantic Segmentation of the Anterior Capsulotomy in Cataract Surgery Video.

The capsulorhexis is one of the most important and challenging maneuvers in cataract surgery. Automated analysis of the anterior capsulotomy could aid surgical training through the provision of objective feedback and guidance to trainees. To develop and evaluate a deep learning-based system for the automated identification and semantic segmentation of the anterior capsulotomy in cataract surgery video. In this study, we established a BigCat-Capsulotomy dataset comprising 1556 video frames extracted from 190 recorded cataract surgery videos for developing and validating the capsulotomy recognition system. The proposed system involves three primary stages: video preprocessing, capsulotomy video frame classification, and capsulotomy segmentation. To thoroughly evaluate its efficacy, we examined the performance of a total of eight deep learning-based classification models and eleven segmentation models, assessing both accuracy and time consumption. Furthermore, we delved into the factors influencing system performance by deploying it across various surgical phases. The ResNet-152 model employed in the classification step of the proposed capsulotomy recognition system attained strong performance with an overall Dice coefficient of 92.21%. Similarly, the UNet model with the DenseNet-169 backbone emerged as the most effective segmentation model among those investigated, achieving an overall Dice coefficient of 92.12%. Moreover, the time consumption of the system was low at 103.37 milliseconds per frame, facilitating its application in real-time scenarios. Phase-wise analysis indicated that the Phacoemulsification phase (nuclear disassembly) was the most challenging to segment (Dice coefficient of 86.02%). The experimental results showed that the proposed system is highly effective in intraoperative capsulotomy recognition during cataract surgery and demonstrates both high accuracy and real-time capabilities. This system holds significant potential for applications in surgical performance analysis, education, and intraoperative guidance systems.

Late spontaneous posterior capsule rupture with single-piece hydrophobic acrylic intraocular lens dislocation

In this study, we described and discussed the late onset spontaneous posterior capsule rupture with intraocular lens (IOL) dislocation years after uncomplicated cataract surgery and implantation of hydrophobic acrylic IOLs. Eight patients presented with spontaneous posterior capsule rupture and IOL dislocation 5–20 years after uncomplicated phacoemulsification and IOL (AcrySof, Alcon, US) implantation. None of the patients had undergone posterior capsulotomy in the past. Four of the patients admitted habitual eye rubbing. An intact and well-centered continuous curvilinear capsulotomy edge was observed in all cases. IOLs were dislocated or displaced behind the anterior capsulotomy with a significant decrease in vision. A large rupture with a curled edge of the broken posterior capsule was visible. Dislocated IOLs were removed, and a three-piece IOL was inserted in the sulcus in six cases and suture fixated to the sclera in two cases. Improved vision was achieved in all cases. Although the mechanism underlying this late complication is unclear, habitual eye rubbing or IOL design may play a role. Further investigation is needed to prevent this complication in the future.

Ventral targeted anterior capsulotomy for treatment-resistant depression and obsessive-compulsive disorder: A treatment method with cases

BackgroundAblative surgery using bilateral anterior capsulotomy (BAC) is an option for treatment resistant depression (TRD) and obsessive-compulsive disorder (TROCD). The location and extent of the lesion within anterior limb of the internal capsule (ALIC) remains uncertain. Accumulating evidence has suggested that the lesion should be located ventrally while limiting the dorsal extent. Our center is now targeting specific fiber tracts within the lower half of the ALIC. MethodPresurgical diffusion tensor Magnetic Resonance Imaging (MRI) was used to identify individual fibre tracts within the ventral aspect of the ALIC in the last two patients who underwent BAC at our center. One patient had TRD and the other had both TROCD and TRD. Radiofrequency-induced thermal lesions were created in the identified targets with lesion volumes between 20 and 229 mm3 (average 95 mm3). FindingsBoth patients were responders with neither experiencing significant side effects including compromised executive functions. LimitationsThe generalizability of our findings is limited because the outcome is based on two subjects. ConclusionThis work suggests that BAC can be individually tailored and more limited to the ventral aspect of the ALIC and is effective and safe for TRD and TROCD. Accumulating data also suggests that to be clinically effective the length of the capsulotomy should be about 10mm. BAC’s use may increase with the growing utilization and mastery of magnetic resonance guided focused ultrasound.

The first experience of using femtosecond laser in the treatment of anterior capsular contraction syndrome

The study was performed to develop a femtosecond laser-assisted technique for anterior capsulotomy in anterior capsular contraction syndrome and assess its preliminary results in preventing the progression of pathological changes in the capsular bag. The examination and femtosecond laser-assisted treatment without additional surgical intervention was performed in 6 patients (6 eyes) aged 69 to 73 years with anterior capsular contraction syndrome. Femtosecond laser-assisted anterior capsulotomy was performed using the VICTUS system (Technolas Perfect Vision, Germany). Capsulotomy diameter was 4.0-4.5 mm, laser radiation energy - 9000 nJ, laser exposure depth 900-1000 μm. The diameter of the anterior capsulotomy before treatment was 2.85 mm [2.75; 2.93]. After 1 month, the diameter of the anterior capsular opening was 2.88 mm [2.78; 2.96] (p>0.05). One year after femtosecond laser intervention, the anterior capsulotomy opening was almost the same shape and diameter - 2.84 mm [2.74; 2.94] (p>0.05). Femtosecond laser-assisted circular capsulotomy is an effective and safe method for preventing the progression of anterior capsular contraction syndrome in the absence of severe IOL decentration and for maintaining the diameter of the anterior capsular opening of at least 2.5-3.0 mm.

61 Increased Apathy Post-Laser Ablation for Refractory Obsessive-Compulsive Disorder

Objective:Severe OCD is often nonresponsive to pharmacological and behavioral therapies and thus surgical interventions are emerging. Surgical interventions have proven to be efficacious for treating refractory OCD, however limited publications suggest 22–40% of patients experience transient apathy and disinhibition post-surgery (McLaughlin et al., 2021). Apathy is highly associated with the same brain regions, the prefrontal cortex, striatum, and thalamus, which have also been implicated in OCD symptoms (Le Heron et al., 2018). Prior research noting post-surgical changes in apathy in OCD either used physician observations or less precise surgical methods (i.e., gamma knife or radiofrequency ablation). Apathy has also been highly associated with depression and executive dysfunction (Raffard et al, 2020) and often not co-assessed in prior studies. The newest intervention, cutting-edge MR-guided laser interstitial thermal therapy (LITT), limits damage outside the region of interest by precise control of thermal application in real-time. Thus, the current case series aims to investigate objective patient-reported change in apathy, disinhibition, depression, and executive dysfunction following anterior capsulotomy via this newest surgical approach for OCD.Participants and Methods:In this retrospective study, the responses of ten consecutive patients pre- and post-LITT on the following measures were examined: Frontal Systems Behavior Scale (FrSBe), Beck Depression Inventory-II (BDI-II), and Yale Brown Obsessive-Compulsive Scale (Y-BOCS). Reliable Change Index (RCI) was used to evaluate meaningful change in pre- and post-LITT self-reported levels of apathy, disinhibition, executive dysfunction, along with depressive symptoms. Per prior published guidelines, patient-reported Y-BOCS (range 0–40) scores were used to measure OCD symptoms with 24–34 % score reduction representing partial and 35% or greater score reduction representing full response (Pepper et al., 2019).Results:Seven patients (70%) were male, with a sample mean age of 38.4 (SD=13.6) and a mean of 14.6 (SD =2.27) years of education. Mean Y-BOCS score decreased from 32 (SD=5.3) before surgery to 18.8 (SD=11.1) after. Over 65% had partial or full response in OCD symptoms post-surgery. Six patients endorsed increased apathy, with others endorsing no change. Half of the non-responders reported this increase in apathy. The cohort remained relatively stable in disinhibition and executive dysfunction. Over half the cohort demonstrated a significant decrease in depressive symptoms. Interestingly, two of the non-responders and one responder endorsed increased apathy despite stable or improving depressive symptoms, disinhibition, and executive dysfunction.Conclusions:Surgical interventions for psychiatric disorders are emerging quickly and being refined daily. In this cohort, anterior capsulotomy via LITT provided full or partial OCD recovery for most patients. However, most patients reported significant increases in apathy, despite experiencing a decrease in depressive symptoms, with stable disinhibition and executive dysfunction. Despite these promising improvements in OCD symptomatology via LITT, impact of surgery on apathy levels is clearly warranted using objective, quantifiable methods. As apathy has consistently been related to functional impairment and poorer quality of life, understanding this outcome is imperative in larger trials. Better understanding of this finding and underlying circuity will allow patients to be fully informed regarding this promising surgical intervention.

Anterior Capsulotomy for Refractory Obsessive-Compulsive Disorder: A Tractography and Lesion Geometry study

Introduction: A bilateral anterior capsulotomy effectively treats refractory obsessive-compulsive disorder (OCD). We investigated the geometry of lesions and disruption of white matter pathways within the anterior limb of the internal capsule (ALIC) in patients with different outcomes. Methods: In this retrospective study, we analyzed data from 18 patients with refractory OCD who underwent capsulotomies. Patients were grouped into “responders” and “nonresponders” based on the percentage of decrease in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) after surgery. We investigated neurobehavioral adverse effects and analyzed the overlap between lesions and the ventromedial prefrontal (vmPFC) and dorsolateral prefrontal (dlPFC) pathways. Probabilistic maps were constructed to investigate the relationship between lesion location and clinical outcomes. Results: Of the 18 patients who underwent capsulotomies, 12 were responders (>35% improvement in YBOCS), and six were nonresponders. The vmPFC pathway was more involved than the dlPFC pathway in responders (p = 0.01), but no significant difference was observed in nonresponders (p = 0.10). The probabilistic voxel-wise efficacy map showed a relationship between ventral voxels within the ALIC with symptom improvement. Weight gains occurred in 11/18 (61%) patients and could be associated with medial voxels within the ALIC. Conclusion: The optimal outcome after capsulotomy in refractory OCD is linked to vmPFC disruption in the ALIC. Medial voxels within the ALIC could be associated with weight gains following capsulotomy.

Unilateral anterior capsulotomy combined with deep brain stimulation for Parkinson's disease psychosis and motor dysfunctions

Psychosis is a frequent and debilitating non-motor symptom of Parkinson's disease (PD). This study aimed to evaluate the availability of unilateral anterior capsulotomy combined with subthalamic nucleus deep brain stimulation (STN-DBS) in managing advanced PD patients comorbid with psychosis. Five advanced PD patients with psychosis who had been treated with unilateral anterior capsulotomy combined with bilateral STN-DBS were assessed. The positive subscore of the Positive and Negative Syndrome Scale (PANSS) and the Unified Parkinson's Disease Rating Scale III (UPDRS-III) were used to assess the efficacy parameter of psychosis and the improved motor symptoms, respectively. The quality of life (QoL) was accessed by an 8-item Parkinson's disease Questionnaire (PDQ-8). Clinical outcome assessments were performed at baseline and follow-ups after one or two years. Significant improvement was observed in PD patients during follow-up after the combined treatment. The positive subscore of PANSS improved by 13.4 (5.7) (mean (SD), p = 0.006). Item P1 (delusions) and Item P3 (hallucinations) of the PANSS improved by 5.0 (0.71) (p < 0.0001) and 3.6 (0.89) (p = 0.0008), respectively. Furthermore, the motor symptoms improved by 32.4 (5.7) (UPDRS-III, p = 0.0002), and the QoL improved by 6.4 (3.8) (PDQ-8, p = 0.021). No significant side effects or complications occurred during the study. For advanced PD patients with refractory psychosis, unilateral anterior capsulotomy combined with bilateral STN-DBS improved PD psychosis and motor dysfunction, providing an effective therapeutic option for such patients.

Complete resolution of hyperopic shift in anterior capsular contraction syndrome after Nd:YAG laser capsulotomy: a case report

Link of Video Abstract: https://youtu.be/UfCbUNzPIRE Background: Anterior capsular contraction syndrome (ACCS) is a disorder in which the anterior capsulectomy opening shrinks excessively. One of the many factors that have been discovered to aggravate the problem is a lack of zonular support for the lens capsule. The prognosis for non-progression of contractions after Nd:YAG anterior capsulotomy is quite excellent. This study aims to present a complete resolution of the hyperopic shift in an anterior capsular contraction syndrome (ACCS), a rare complication of cataract surgery. Case Illustration: This case report presented a 63-year-old female who developed ACCS in the right eye two years after uncomplicated cataract surgery and intraocular lens implantation. A moderate hyperopic shift of +3.00 D was noted in the affected eye at the initial presentation. Slit-lamp examination revealed an anterior capsule opacification and anterior capsular contraction with fibrosis surrounding the capsulorhexis opening. Ocular and systemic past medical history was unremarkable, and no known risk factors associated with contraction syndrome were found. Nd:YAG laser capsulotomy with six relaxing incisions was performed to release the anterior capsular contraction. Two weeks following capsulotomy, the patient’s visual acuity remarkably improved to LogMAR 0.00 without correction. The hyperopia was completely resolved, and a decrease in anterior chamber depth compared to pre-capsulotomy measurement was noted. ACCS is a possible complication following capsulorrhexis performed in uneventful cataract surgery, which may occur in patients with no known ocular or systemic risk factors. ACCS is commonly asymptomatic, and hyperopic shift is a rare manifestation of ACCS. The backward shift of the intraocular lens (IOL) induces hyperopia due to the anterior capsule contraction. The preferred treatment for ACCS is relaxing incisions using Nd:YAG laser capsulotomy. Conclusion: Hyperopic shift in ACCS is a rare complication of cataract surgery. However, prompt treatment of contraction release with Nd:YAG laser capsulotomy effectively restored visual function.

Different strokes for anterior capsulorhexis in pediatric cataract.

A successful outcome in pediatric cataract surgery is determined by an intact, curvilinear anterior capsulotomy which is dependent on the type and density of cataract, the morphology of the anterior capsule, and associated anterior segment pathologies. This video highlights 10 different techniques which can be used for capsulorhexis in pediatric cataract. The choice of technique for capsulorhexis in pediatric cataract is on case basis, namely the gold standard manual capsulotomy aided by rhexis forceps (1. Standard capsulorhexis/2. Vitrector, Vitrectorhexis), with an assistance from capsular staining (3. Blue-rhexis), or by coaxial illumination (4. Coaxial-rhexis) or by just the sheen of capsule (5. Sheen-rhexis). The anterior chamber can be maintained using ophthalmic visco-elastic device (Visco-rhexis) or by irrigation fluid (6. Hydro-rhexis). A speed-breaker in the routine capsulotomy is the presence of plaque which is managed by rhexis forceps (7. Plaque-rhexis) or by a vitrector (vitrectorhexis) or a pair of micro-scissors (8. Scissor rhexis). Above all, the technology of femto-second-laser-assisted (9. Femto-rhexis) and zepto-pulse-precision capsulotomy (10. Zepto-rhexis) is also illustrated. This video highlights the 10 different techniques of capsulorhexis in pediatric cataract surgery. https://youtu.be/TgDrk5RYdbI.

Вариант использования лазерной фемтосекундной факофрагментации без лазерной капсулотомии в случае осложненной катаракты

Purpose. To evaluate the effectiveness of using femtosecond phacofragmentation without laser capsulotomy in cataract phacoemulsification with a relatively narrow pupil against the background of pseudoexfoliation syndrome in combination with grade I lens subluxation. Material and methods. The subject of the study was a case of complicated cataract in patient Ya., 74 years old, with complaints of decreased vision in the right eye. Standard preoperative and postoperative examinations were performed. The patient underwent surgery using a phacoemulsifier (CenturionVisionSystem, Alcon, USA) with preliminary laser femtosecond support (Catalys TM Precision Laser System-Johnson&amp;Johnson Vision). A three-part IOL AcrySof MA60AC (Alcon, USA) with an optical power of 22.0 diopters was implanted. The peculiarity of the operation was that at the stage of laser femtosecond support, only phacofragmentation was performed without capsulotomy. Result. In this case, only phacofragmentation was performed without the formation of capsulorhexis with laser femtosecond support of phacoemulsification against the background of a rigid, relatively narrow pupil, which made it possible to safely use the usual methods of mechanical pupil dilation followed by manual performance of capsulorhexis of the optimal diameter. On the 2nd day after the operation, visual acuity without correction was 0.5, with a correction of –0.75 diopters – 0.7. The result of surgical treatment in this case indicates that a separate use of femtosecond laser fragmentation of the lens without anterior capsulotomy is possible. In this case, it was applied taking into account the combined pathology: pseudoexfoliation syndrome, lens subluxation, relatively narrow pupil and the objective need to use the Malyugin ring, the planned method of fixing the IOL. The preserved anterior capsule made it possible to perform standard implantation of the Malyugin ring without any special features, followed by capsulorhexis of the optimal diameter. Conclusion. This example demonstrates the possibility of safely and effectively performing phacofragmentation without capsulorhexis at the stage of laser femtosecond support during cataract phacoemulsification, when the pupil diameter does not allow programming the optimal capsulorhexis size. Key words: ciliocapsular fixation, intraocular lens, pseudoexfoliation syndrome, femtosecond laser

Severe anterior capsular contraction with complete occlusion of capsulotomy after femtosecond laser-assisted cataract surgery

Anterior capsular contraction syndrome can cause a remarkable loss of sight in the postoperative period, requiring early laser or surgical treatment for visual rehabilitation. Despite several studies comparing the outcomes of femtolaser cataract surgery and conventional phacoemulsification, the incidence of anterior capsular contraction after laser cataract surgery is not known. We present a case of severe anterior capsular contraction with total occlusion of capsular opening in a patient after 7 weeks of uneventful femtolaser-assisted cataract surgery, who was treated with neodymium: yttrium aluminum garnet laser anterior capsulotomy. There is no other published report of complete occlusion of femtolaser capsulotomy by capsular contraction and fibrosis.