Laser Posterior Capsulotomy Research Articles

Influence of models of hydrophobic acrylic intraocular lenses on the development of posterior lens capsule opacifications (preliminary results)

To compare the influence of three models of hydrophobic acrylic IOLs on the development of PCO within one year after phaco surgery. The study included 72 patients (91 eyes) who were followed up for 12 months after implantation of one of three models of posterior chamber hydrophobic acrylic IOLs: MIOL-2 (Reper-NN, Russia, 24 eyes, 1st group), SA60AT and US60MP (Alcon, USA, 41 and 26 eyes, 2nd and 3rd groups, respectively). Posterior capsule images were taken and then processed with the EPCO 2000 (Evaluation of Posterior Capsular Opacification) software. The area of posterior capsule adjacent to the center of IOL's optic of 4.0 mm in diameter was estimated. PCO score was calculated as the weighted sum of opacification areas multiplied by the degree (from 0 to 4). Within 1 year of the follow-up, mean visual acuity was at least 1.0 (20/20). Significant PCO progression was observed as early as 3 months after surgery. Despite that, opacification density in all three groups at every follow-up visit did not exceed grade 2; maximal PCO score (0.0315, median) was seen 12 month after surgery in the 1st group. At the same time, differences in PCO score between the groups were not significant. Nd:YAG laser posterior capsulotomy was performed only in one patient from the 1st group 12 month after surgery. Difference in the percentage of clear posterior capsules was significant only 12 month after surgery between the 1st and 3rd groups (p=0.024). All three models of hydrophobic acrylic IOLs showed comparably high vision outcomess during 12 months of the follow-up with somewhat better PCO score and percentage of clear posterior capsules in eyes with US60MP.

Intraocular lens tilt and decentration after Nd:YAG laser posterior capsulotomy: Femtosecond laser capsulorhexis versus manual capsulorhexis

To compare intraocular lens (IOL) tilt and decentration after Nd:YAG laser posterior capsulotomy in eyes that had femtosecond laser-assisted capsulotomy versus manual capsulorhexis. Ekol Eye Hospital, Izmir, Turkey. Retrospective case series. Intraocular lens decentration and angle of tilt were measured using a Scheimpflug camera before and 1month after Nd:YAG capsulotomy. Eighteen eyes had a femtosecond laser-assisted capsulotomy and 25 eyes a manual capsulorhexis. The mean age was 58.2years±10.2 (SD) (range 44 to 69years) and 60.6±8.3years (range 45 to 70years), respectively. Before capsulotomy, the angle of tilt and decentration at both meridians did not differ significantly between the 2 groups (P>.05). After capsulotomy, the angle of tilt was significantly decreased in both groups (femtosecond: vertical 1.5 degrees and horizontal 1.2 degrees; manual: vertical 1.1 degrees and horizontal) and decentration was significantly increased (femtosecond: vertical 0.085mm and horizontal 0.096mm; manual: vertical 0.2mm and horizontal 0.2mm) at both meridians (P<.05). After capsulotomy, all tilt and decentration parameters were significantly different between the 2 groups (P<.05) except decentration on the horizontal meridian (P=.669). Nd:YAG posterior capsulotomy performed after femtosecond laser-assisted capsulotomy resulted in better mechanical stability of the IOL. This suggests that a femtosecond laser-created capsulotomy better maintains a proper IOL position. Although the differences were statistically significant, the tilt and decentration values were small and might not be clinically significant.

Effect of Neodymium-YAG Laser Posterior Capsulotomy on Intraocular Pressure

Background: Posterior capsule opacification (PCO) also known as Secondary cataract is the most common complication following cataract surgery. It can occur between few months and many years after implantation of intraocular lenses (IOLs), with incidence figures ranging from <5% to as high as 50%. Objective: The aim of this study was to determine the frequency of intraocular pressure elevation after Nd: YAG laser posterior capsulotomy for treatment of PCO. Patients and Methods: A prospective non-randomized study that was conducted at Al Zahraa University Hospital. The study included a total of 40 eyes of 31 patients. All patients underwent Nd: YAG laser posterior capsulotomy. Patients were followed up at 4 hours, 1 day, 1 week and 1 month after laser capsulotomy. Nine cases were bilateral, 15 were males (48%) and 16 were females (52%). Results: The majority of patients (90%) showed significant improvement in visual acuity after capsulotomy and about 87.5% of patients had final BCVA of 6/6-6/12, visual acuity after 24 hours was 6/9 in 20 eyes (50%) and 20 eyes (30%) had VA of 6/12. All the 40 patients had visual acuity improvement of 1 or more lines after capsulotomy. No one had further decline in visual acuity after capsulotomy. Conclusion: The present study depicts the Nd: YAG laser capsulotomy as a good, successful treatment of PCO, because it was found to be modern, non-invasive, effective mode of treatment of PCO with lesser complications and it does not require hospitalization.

Effect of YAG Laser Posterior Capsulotomy on Central Macular Thickness in Pseudophakic Patients

Background: posterior capsular opacification (PCO), also known as ‘secondary cataract’ or ‘after cataract’, develops a few months to a few years over the clear posterior capsule after an uncomplicated cataract surgery. Purpose: evaluation the impact of Neodymium-doped Yttrium Aluminum-Garnet (Nd: YAG) laser capsulotomy on central macular thickness (CMT) by optical coherence tomography (OCT). Patients and Methods: the present study examined 50 eyes (24 males, 26 females) with an average age of 63.58±7.7 which was pseudophakic and had PCO, preoperative evaluation included history taking, ophthalmological examination and OCT was done. All patients underwent YAG laser posterior capsulotomy and CMT assessed at 3 days, 1 week, 1 month and 3 months by OCT. Results: there was significant improvement of BCVA (LogMAR) post laser capsulotomy (P< 0.001), IOP statistically significant increased (P< 0.001) at the first postoperative 3 days, 1 week, 1 month with mean ±SD of 16.46±2.54 mmHg 17.50±2.67 mmHg ,15.50±2.39 mmHg respectively when compared to preoperative values 13.0±1.67 mmHg. At 3 months there was minimal change (P=0.02). As regard CMT values at 1 week post laser (mean ±SD of 270.92±24.88) was highly significant increased (P< 0.001) and values at 3 months (mean ±SD of 248.70±21.66) showed nonsignificant difference (P=0.285) when compared to pre laser values (mean ±SD of 245.58±23.30). Conclusion: typical treatment of the PCO is YAG laser capsulotomy, IOP elevation is the most prevalent complication so antiglaucoma drugs is recommended and IOP return to normal values in the follow up period.

Evaluation of Vitreoretinal Changes after Nd: YAG Laser Posterior Capsulotomy

Objective: To evaluate the vitreoretinal changes after Neodymium-Yttrium-Aluminum-Garnet (Nd: YAG) laser posterior capsulotomy in patients with posterior capsular opacification after cataract extraction. Patients and Methods: 60 pseudophakic eyes of 50 patients with opacified posterior capsule after uncomplicated cataract surgery treated by Nd: YAG laser posterior capsulotomy. Patients were divided according to the preoperative refractive state of the eye into three groups (Myopic, Hypermetropic, and Emmetropic). Vitreoretinal assessment was done pre and post YAG capsulotomy. Results: The mean best corrected visual acuity (BCVA) had improved after YAG laser posterior capsulotomy in all groups (p < 0.001). Although there was no significant correlation between the refractive state of the eye and changes in CMT measured by optical coherence tomography (OCT) (p < 0.096), however, there was a statistically significant increase in CMT before and one week after YAG posterior capsulotomy (p < 0.001) without any detectable clinical effect on the BCVA. Conclusion: Nd: YAG laser posterior capsulotomy is the standard treatment for posterior capsular opacification [PCO] and gives rise to rapid improvement in visual acuity relieving the symptoms of blurring, photophobia, and glare.

Trans-scleral posterior capsulorhexis in combined lens extraction and silicone oil removal

The aim of this study was to study the safety and efficacy of posterior capsulorhexis in vitrectomized eyes undergoing combined phacoemulsification or irrigation/aspiration and silicone oil removal. This prospective non-randomized interventional study involved 115 silicone-filled eyes of 115 previously vitrectomized patients. All patients underwent combined phacoemulsification or underwent irrigation/aspiration and silicone oil removal, followed by foldable intraocular lens implantation combined with primary posterior trans-scleral capsulorhexis. A 23-gauge trans-scleral vitrectomy probe was used to form the posterior capsulorhexis (vitrectorhexis). Patients were followed for 6 months. Intraocular lenses maintained good centration in the capsular bag during and after trans-scleral posterior capsulorhexis. No complications were observed in the postoperative period regarding lens centration or size of the posterior capsulorhexis. No included eyes needed YAG laser posterior capsulotomy and no recurrent retinal detachment was reported during follow-up. Performing primary trans-scleral capsulorhexis in patients undergoing combined phacoemulsification, or irrigation/aspiration and silicone oil removal, enabled achievement of an early postoperative clear visual axis and prevented the onset of dense postoperative posterior capsular opacification in previously silicone-filled eyes. This technique is reproducible and may facilitate additional intra-operative procedures and uncomplicated postoperative follow-up of retinal detachment patients without requiring YAG laser capsulotomy.

Influence of yttrium aluminum garnet laser posterior capsulotomy opening size on intraocular pressure and central macular thickness

Purpose This study aimed to show the effect of yttrium aluminum garnet (YAG) laser posterior capsulotomy opening size on intraocular pressure (IOP) and central macular thickness (CMT). Patients and methods Two hundred eyes having posterior capsule opacification were included in this study. These eyes were classified into two groups: the first group (100 eyes) had undergone small YAG laser posterior capsulotomy, whereas the second group (100 eyes) had undergone large YAG laser posterior capsulotomy. Eyes in both groups were carefully examined preoperatively and at 1 day, 3 days, 1 week, 1 month, 3 months, and 6 months postoperatively. In each visit, IOP and CMT were recorded in all eyes, and the results were compared between both groups. Results Patients in the second group with large YAG laser posterior capsulotomy opening size showed significantly higher IOP and higher CMT. Conclusion Neodymium : YAG laser posterior capsulotomy is a safe technique even with the presence of some possible complications like increased IOP, which is controlled rapidly after the first postoperative day, and macular edema, which improved rapidly with no long-lasting effect on vision.

FREQUENCY OF ACUTE RISE OF INTRAOCULAR PRESSURE FOLLOWING YAG LASER POSTERIOR CAPSULOTOMY

Background: Posterior capsular opacification (PCO) is the most frequent complication of cataract surgery. The objective of this study was to determine the frequency of acute rise of intraocular pressure (IOP) following Neodymium-Yttrium Aluminum Garnet (Nd:Yag) laser posterior capsulotomy. Materials &amp; Methods: This cross-sectional study was conducted in the Department of Ophthalmology, HMC, Peshawar, Pakistan, from July-December 2016. Sample size was 325 selected by consecutive sampling technique. Inclusion criteria were all patients having significant PCO after uneventful cataract surgery with intra ocular lens implant. Demographic variables were sex, age groups and age in years. Research variable was presence of acute rise of IOP following Yag laser capsulotomy. Pre-laser assessment included slit lamp examination and recording of IOP with Goldmann applanation tonometer by a single ophthalmologist. IOP was measured 3 hours after Nd: Yag laser capsulotomy. Rise in IOP was labeled when IOP was ≥5 mmhg from baseline. Mean ±SD was used to express quantitative variables like age. Categorical variables were analyzed as frequency and percentage. Goodness-of-fit was applied to compare the frequency of acute rise in IOP between sample and population. SPSS-20 was used for data entry and its analysis. Results: Out of 325 patients, 170(52.3%) were men and 155(47.7%) were women. The mean age of the sample was 44.92 ±23.843 years. A total of 107(32.9%) patients were 20-39 years old whereas 218(67.1%) were 40-70 years. IOP was raised in 61 (18.8%) patients while in 264(81.2%) patients it was not raised. The frequency of acute rise in IOP after Yag laser capsulotomy was significantly different in sample compared to population. Conclusion: Men were more than women, especially of old age. The frequency of acute rise in IOP after Yag laser capsulotomy was significantly different in sample compared to population.

ND: YAG LASER

Objectives: To find out the visual acuity outcome after Nd: YAG laser capsulotomy in posterior capsular opacification in pseudophakic patients after cataract surgery. Study Design: Analytical study. Setting: Department of Ophthalmology Khyber Medical University Institute of Medical Sciences / K.D.A Teaching Hospital Kohat. Period: January 2016 to June 2017. Materials and methods: Special proforma was designed for record of patients. PreNd:YAG laser posterior capsulotomy best corrected visual acuity was checked and noted. Anterior and posterior segments examination was done with slit lamp and indirect slit lamp bimicroscopy. Pupils were dilated with tropicamide eye drops. Nd:YAG laser capsulotomy was done. All these procedure were conducted as out door. Patients were put on topical steroid and antiglaucoma drops for ten days to control inflammation and rise in IOP. Post laser best corrected visual acuity was recorded after one month of laser. Results: Total 92 patients were selected with age range from 21 to 83 years. Out of these patients 43(46.74%) were male and 49(53.26%) were female. Post surgical laser period was from 7 months to 13 years. Prelaser best corrected visual acuity of 6/24-6/36 was present in 59(64.13%) patients, 6/60 in 24(26.08%) patients while 9(9.78%) patients had visual acuity of counting finger (CF). Post laser best corrected visual acuity after one month of 6/6-6/9 was recorded in 43(46.39%) patients ,6/12-6/18 in 27(29.34%), 6/24-6/36 in 13(14.13%)and 6/60 &amp; below in 9(9.71%) patients. Conclusion: Post laser best corrected visual acuity is highly improved with Nd:YAG laser capsulotomy in posterior capsular opacification.

This issue of Acta

This issue of Acta

Magnesium Deficiency Effect on the Severity of Autonomic Dysfunction in Mitral Valve Prolapse Patients with Emotional Tension

To compare intraocular lens (IOL) tilt and decentration after Nd:YAG laser posterior capsulotomy in eyes that had femtosecond laser–assisted capsulotomy versus manual capsulorhexis.Ekol Eye Hospital, Izmir, Turkey.Retrospective case series.Intraocular lens decentration and angle of tilt were measured using a Scheimpflug camera before and 1 month after Nd:YAG capsulotomy.Eighteen eyes had a femtosecond laser–assisted capsulotomy and 25 eyes a manual capsulorhexis. The mean age was 58.2 years ± 10.2 (SD) (range 44 to 69 years) and 60.6 ± 8.3 years (range 45 to 70 years), respectively. Before capsulotomy, the angle of tilt and decentration at both meridians did not differ significantly between the 2 groups (P > .05). After capsulotomy, the angle of tilt was significantly decreased in both groups (femtosecond: vertical 1.5 degrees and horizontal 1.2 degrees; manual: vertical 1.1 degrees and horizontal) and decentration was significantly increased (femtosecond: vertical 0.085 mm and horizontal 0.096 mm; manual: vertical 0.2 mm and horizontal 0.2 mm) at both meridians (P < .05). After capsulotomy, all tilt and decentration parameters were significantly different between the 2 groups (P < .05) except decentration on the horizontal meridian (P = .669).Nd:YAG posterior capsulotomy performed after femtosecond laser–assisted capsulotomy resulted in better mechanical stability of the IOL. This suggests that a femtosecond laser–created capsulotomy better maintains a proper IOL position. Although the differences were statistically significant, the tilt and decentration values were small and might not be clinically significant.

Long-Term Outcome of Nd:YAG Laser Posterior Capsulotomy in Children: Procedural Strategies and Visual Outcome

To evaluate the long-term outcome of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy after cataract surgery in children. Retrospective case series. Electronic medical records of pediatric patients who underwent Nd:YAG laser posterior capsulotomy between January 1, 2008, and October 31, 2012, and followed up for more than 5 years were reviewed. Thirty-one eyes of 25 patients were included. Only compliant patients assessed during slit-lamp examination and anterior segment photography underwent laser treatment. The mean age at the time of initial laser treatment was 9.04 ± 3.51 years (minimum 56months), and the mean interval between cataract surgery and initial laser treatment was 28.1 ± 22.1months. Posterior capsular openings were successfully made in 26 (83.9%) eyes with a single attempt and in 3 (9.7%) eyes with a second attempt. Overall success rate was 93.5%. The logMAR best-corrected visual acuity was significantly improved from 0.61 ± 0.36 to 0.19 ± 0.25 at 1month posttreatment (P < .0001) and well maintained, at least for 5 years of follow-up, without serious complications. The recurrence of posterior capsular opacity was observed in 7 (24.1%) eyes, which was successfully managed by repeated laser procedure or surgical capsulectomy. By selecting compliant patients and repeated attempts, Nd:YAG laser posterior capsulotomy can be successfully performed in a pediatric population without serious complications. Laser treatment is also a good option for managing recurred posterior capsular opacity. Restored visual acuity can be maintained for at least 5 years.

Uncommon complication following uneventful Nd:YAG capsulotomy

This article reports the development of low grade endophthalmitis following Nd:YAG laser posterior capsulotomy. The patient previously underwent uncomplicated extracapsular cataract extraction with intraocular lens (IOL) insertion and was free of inflammation prior to laser capsulotomy. Anterior vitrectomy with partial capsular bag removal and anterior chamber washout were performed. Samples for cultures were taken and intravitreal antibiotics injected. The patient was managed with topical and systemic antibiotics and steroids. Complete resolution of the inflammation with return of vision to 20/25 was achieved without removal of the intraocular lens or lenticular remnants. The endophthalmitis was responsive to a minimally invasive intervention as well as medicinal therapy including antibiotic agents, and it resolved without any invasive surgical intervention, such as total capsulectomy, IOL exchange or removal and posterior vitrectomy.

The impact of Nd: YAG laser posterior capsulotomy by the use of "the circular pattern with vitreous strand cut" technique on anterior chamber parameters.

The purpose of this study is to identify the effect of Nd: YAG laser posterior capsulotomy using an anterior chamber morphology. This study included 42 eyes of 33 pseudophakic patients with visually significant PCO after uncomplicated cataract surgery. Exclusion criteria were complications related to cataract surgery, corneal pathology, pseudoexfoliation, glaucoma, uveitis, previous ocular surgery or trauma, and posterior segment pathology. All patients underwent routine ophthalmic examinations. The AS-OCT measurements were performed using NIDEK RS-3000 Lite retinal scan with anterior segment module. The anterior chamber depth (ACD) was measured by Monitor A&B Scan biometer. Nd: YAG laser posterior capsulotomy was done in a single session by the circular pattern with rupture of vitreous strands. Anterior chamber depth (ACD), central corneal thickness (CCT), and intraocular pressure (IOP) were measured. Anterior chamber angle (ACA), angle opening distances (AOD) at 500mm (AOD500), AOD at 750mm (AOD750), trabecular-iris space area at 500 (TISA 500), and TISA at 750 (TISA 750) were measured both nasally and temporally. The mean patient age was 55.56 ± 6.33years. There were non-significant changes in IOP, ACD, and CCT with P values 0.395, 0.153, and 0.541, respectively. ACA, AOD500, AOD750, TISA 500, and TISA 750 highly significantly increased with P value < 0.001 for all. Nd: YAG laser posterior capsulotomy with the circular pattern with vitreous strand cut technique is a safe technique for laser posterior capsulotomy.

Haptic Reposition with Laser Posterior Capsulotomy in Eyes with Capsular Contraction without Anterior Capsular Phimosis

Haptic Reposition with Laser Posterior Capsulotomy in Eyes with Capsular Contraction without Anterior Capsular Phimosis

Induction of oxidative stress in human aqueous and vitreous humors by Nd:YAG laser posterior capsulotomy.

To evaluate whether the Q-switched Nd:YAG laser treatment applied in routine capsulotomy elicits oxidative stress in aqueous and vitreous humors. Thirty-six patients who had to undergo a 25 gauge pars plana vitrectomy due to vitreoretinal disorders were enrolled, 15 of them underwent a Q-switched Nd:YAG laser capsulotomy 7d before vitrectomy due to posterior capsule opacification (PCO) (Nd:YAG laser group) while the remaining 21 patients were not laser treated before vitrectomy (no Nd:YAG laser group). Samples of the aqueous and vitreous humors were collected during vitrectomy from all patients for the assessment of oxidative parameters which were compared between the Nd:YAG laser group and no Nd:YAG laser group. Thiobarbituric acid reactive substances (TBARS), a product of membrane lipid peroxidation, nitrite levels, the antioxidative activities of SOD and catalase, the 4-HNE-protein conjugate formation, indicating structural modifications in proteins due to lipoperoxidation, were assessed in aqueous and vitreous samples. In the human vitreous humor TBARS levels are significantly higher in the Nd:YAG laser group compared to the no Nd:YAG laser group and importantly, there is a significant correlation between the TBARS levels and the total energy of Nd:YAG laser used during capsulotomy. Moreover the anti-oxidative activities of SOD and catalase were significantly decreased by Nd:YAG laser treatment, both in aqueous and vitreous humors. In accordance with the TBARS data and anti-oxidative enzyme activities, significantly higher levels of proteins were conjugated with the lipoperoxidation product 4-HNE in the aqueous and vitreous humors in the Nd:YAG laser-treated group in comparison to no Nd:YAG laser group. These data, clearly suggest that any change that Q-switched Nd:YAG photo disruption may cause in the aqueous and vitreous compartments, resulting in a higher level of oxidative damage might be of considerable clinical significance particularly by accelerating the aging of the anterior and posterior segments of the eye and by worsening the intraocular pressure, the uveal, the retinal (especially macular) pathologies.

Comparative study of induced changes in effective lens position and refraction after Nd:YAG laser capsulotomy according to intraocular lens design.

PurposeTo evaluate and compare the changes in refraction and effective intraocular lens (IOL) position between a plate-haptic IOL and a c-loop single-piece IOL after neodymium-doped yttrium aluminium garnet (YAG) laser posterior capsulotomy.MethodsIn a prospective study, anterior chamber depth and subjective refraction were measured in 110 pseudophakic eyes from 110 patients, before and 1 month after YAG laser capsulotomy. Patients were divided into 2 groups according to the IOL design: group 1 (plate-haptic acrylic hydrophilic AT LISA tri 839MP®) and group 2 (c-loop acrylic hydrophobic single-piece AcrySof® SA60AT). Lens position was obtained through optical coherence biometry (Biograph WaveLight OB820®).ResultsYAG laser capsulotomy was performed 37.8±9.8 months after surgery in group 1 and 40.6±8.6 months in group 2 (p=0.125). Significant changes were found in the lens effective position after treatment in the 2 groups. The YAG posterior capsulotomy led to a change of anterior chamber depth in group 1 from 4.03±0.32 mm to 3.86±0.34 mm (p=0.02) and in group 2 from 4.03±0.37 mm to 4.14±0.45 mm (p=0.025). After YAG laser posterior capsulotomy, no significant changes were observed in mean spherical equivalent, sphere or cylinder for both groups (p>0.05).ConclusionYAG laser posterior capsulotomy can induce a significant change in the IOL position according to the IOL type; however, the refractive change after treatment is clinically insignificant.

Incidence of primary peripheral posterior capsular opacification after cataract surgery and posterior capsular opacification in the patients implanted with foldable intraocular lenses.

Preexisting posterior capsular opacification is commonly seen in the developing world due to late presentation of patients for cataract surgery. Patients are implanted with either hydrophilic or hydrophobic IOL. Effect of these IOLs on pre-existing posterior capsular opacification has not yet been reported. To determine the incidence of peripheral preexisting posterior capsular opacity (PPPCO) in patients undergoing cataract surgery and the rate of posterior capsular opacification (PCO) following implantation of hydrophilic and hydrophobic intraocular lens (IOLs). Prospective, observational case study Setting: Tertiary eye care center in central India. 1400 consecutive patients undergoing phacoemulsification of senile cataract between July 2009 and June 2010 discovered to have PPPCO were included in the analysis. Patients were either implanted with hydrophilic (n= 40) or hydrophobic IOL (n=40). Images of the posterior capsule immediately and 3-years postoperatively were compared. Patients were followed up for development of PCO, visual outcome at 3 years and neodymium: YAG laser posterior capsulotomy (NYLPC) rate. Eighty patients were found to have PPPCO (incidence of 5.7%). 47.5% of PPPCOs were from mature senile cataracts (n = 38), 36.2% were from posterior subcapsular cataracts (n = 29) and 16.2% were from posterior polar cataracts (n = 13). NYLPC was performed in 9 patients receiving hydrophilic (22.5%) and 3 patients receiving hydrophobic IOLs (7.5%; p = 0.12). Average time to NYLPC was 18 months in the hydrophilic and 30 months in the hydrophobic group (p = 0.002). Visual outcome was satisfactory at 3-years of follow-up. PPPCO is a frequent occurrence in mature cataract and there is a higher incidence of PCO in PPPCO patients implanted with hydrophilic IOL than with hydrophobic IOL. Therefore, hydrophobic IOL should be considered for patients discovered to have PPPCO during cataract removal.

Improving eye care services with a lean approach.

Effective provision of eye care services in government-financed hospitals is essential to balance the discrepancy between growing demand and limited resources. We aimed to improve efficiency of the treatment protocol for Nd:YAG laser posterior capsulotomy. Predetermined quality targets were a patient-oriented and patient-safe approach and the development of a clinical care process with purposeful use of competences. We utilized a lean process improvement methodology to develop a streamlined Nd:YAG laser posterior capsulotomy treatment protocol. A total of 206 patient visits were evaluated, where the lean-oriented treatment protocol was utilized in 158 of the visits and the conventional (CONV) protocol was followed in 48 of the visits. All baseline variables were comparable between the study groups. Compared to the CONV protocol, implementation of new operational principles shortened the total reception time per patient from 55:36±30:23; 12-136min to 44:40±4:49; 37-54min (mean±SD; range, p=0.040). The per hour number of patients and eyes treated in the operation room improved from 4.7±1.6; 2.6-8.4 patients and 5.5±2.0; 3.5-11.3 eyes to 16.3±2.3; 14.3-19.4 patients (p<0.001) and 18.0±1.6; 16.8-20.4 eyes (p<0.001). The time spent by the operating physician reduced from 8:19±3:06; 3:57-14:30min to 3:01±1:00; 1:34-6:38min in unilateral procedure (p<0.001) and from 8:45±3:55; 5:52-14:10min to 4:40±2:03; 2:38-10:14min in bilateral procedure (p<0.006). Furthermore, the overall patient satisfaction grade improved from 17.3±1.04; 15-18 points to 17.8±0.61; 15-18 points (p=0.001). The lean approach improved the treatment protocol for Nd:YAG laser posterior capsulotomy with substantial reductions in lead times without compromising patient satisfaction.

Comparison of two Nd:YAG laser posterior capsulotomy: cruciate pattern vs circular pattern with vitreous strand cutting.

To investigate the effects and safety of neodymium: yttrium-aluminium-garnet (Nd:YAG) laser posterior capsulotomy with vitreous strand cutting. A total of 40 eyes of 37 patients with symptomatic posterior capsular opacity (PCO) were included in this prospective randomized study and were randomly subjected to either cruciate pattern or round pattern Nd:YAG posterior capsulotomy with vitreous strand cutting (modified round pattern). The best corrected visual acuity (BCVA), intraocular pressure (IOP), refractive error, endothelial cell count (ECC), anterior segment parameters, including anterior chamber depth (ACD) and anterior chamber angle (ACA) were measured before and 1mo after the laser posterior capsulotomy. In both groups, the BCVA improved significantly (P<0.001 for the modified round pattern group, P=0.001 for the cruciate pattern group); the IOP and ECC did not significantly change. The ACD significantly decreased (P<0.001 for both) and the ACA significantly increased (P=0.001 for the modified round pattern group and P=0.034 for the cruciate group). The extent of changes in these parameters was not significantly different between the groups. Modified round pattern Nd:YAG laser posterior capsulotomy is an effective and safe method for the treatment of PCO. This method significantly changes the ACD and ACA, but the change in refraction is not significant. Modified round pattern Nd:YAG laser posterior capsulotomy can be considered a good alternative procedure in patients with symptomatic PCO.