Nd-YAG Laser Posterior Capsulotomy Research Articles

Intraocular Pressure Changes after Neodymium Doped: Yttrium-Aluminum-Garnet (Nd: Yag) Laser Capsulotomy

Purpose: To assess the difference in intraocular pressure before and after Nd-YAG laser posterior capsulotomy. Study Design: Quasi-experimental study. Place and Duration of Study: Layton Rahmatulla Benevolent Trust Eye Hospital, Karachi, from July 2021 to October 2021. Methods: Patients of both gender with posterior capsular opacification (PCO) after cataract surgery, were included. Age ranged between 40 and 60 years. Patients with less than 6 months of surgery were excluded. Patients with posterior segment pathology like glaucoma, uveitis, high myopia, diabetic retinopathy, macular pathology, and hereditary fundus dystrophies were excluded from the study. After detailed history, complete ocular examination was performed. After pupil dilatation, YAG laser capsulotomy was done.IOP was measured with Goldmann Applanation Tonometer after instilling a topical anesthetic agent. Post-YAG, IOP was again measured at 1 hour and on day 1. Data was analyzed using SPSS version 25. Paired T-tests were used to assess the significance of any change in IOP. Results: Ninety eyes of 90 patients were inducted into the study in which 51 (57%) were male and 39 (43%) were female. The age varied from 40 to 60 years (mean 52.3 ± 10.25 years). There was no statistically significant difference between pre-YAG and post-YAG IOP. Similarly, no difference in IOP was found depending upon the age of the patients. No significant change was observed after 1 hour and 1 day in both groups with P > 0.05. Conclusion: This showed no significant change in intraocular pressure at one hour and one day, after Nd-YAG laser posterior capsulotomy.

Prophylactic role of Timolol to prevent rise of intraocular pressure after Nd-YAG laser posterior capsulotomy

This study was conducted to know the effectiveness of topical 0.5% timolol maleate for the intraocular pressure rise after Nd-YAG laser posterior capsulotomy. Ninety-six eyes of 92 patients undergoing Nd-YAG laser posterior capsulotomy were randomly selected for pretreatment with topical 0.5% timolol maleate, 48 patients (Group A) or control 48 patients (Group B). The mean IOP of the group A was 14.8±3.0 mmHg before capsulotomy and 15.7±3.4 mmHg after capsulotomy (P >0.05), whereas 15.1±3.3 mmHg and 17.2±4.3 mmHg (P <0.05) of the group B. There was no statistically significant difference between the two groups with regard to mean IOP before capsulotomy (P >0.05), but statistically significant difference between two groups after capsulotomy (P <0.05). Pretreatment with topical 0.5% timolol maleate is effective in preventing IOP elevation after Nd-YAG laser posterior capsulotomy.

Rise Of Intraocular Pressure After Nd: YAG Laser Capsulotomy

Objective: Posterior capsule opacification (PCO) after cataract is a common complication of extra capsular cataract extraction with or without intraocular lens implantation. Aim of this study was to evaluate changes in intraocular pressure after Nd-Yag laser posterior capsulotomy for PCO.
 Methodology: This retrospective study using convenient sampling technique was done at Eye Department of Shaheed Mohtarma Benazir BhuttoMedical College Lyari, Sindh Government General Hospital, Karachi for six months (1st January 2020 to 30th June 2020. After ethical approval and informed permission from patients and guardian, data was collected and analyzed by SPSS version 20 and presented by calculating mean and standard deviation for quantitative data and frequency and percentages for qualitative data.
 Results: Total 50 patients (20 males and 30 females) were studied where 22 right and 28 left eyes. Mean age was 59.08 years. Mean pre-operative IOP was 13.28 and 13.12 mmHg of right and left eye respectively (Table I). At 2 hours mean IOP was 16.84±3.63 mmHg and after one week 12.48±2.0 mmHg. Base line pre-laser IOP was measured by Goldman Applanation Tonometer (GAT) and slit lamp examination. Pupils were dilated using 1% tropicamide eye drops. IOP was evaluated immediate post-procedure, two hours post–procedure and one week from date of laser.
 Conclusion: Nd –Yag laser capsulotomy is treatment of choice for PCO and associated with complications like Raised Intraocular Pressure (IOP), Intraocular lens pitting, cystoid macular oedema, retinal detachment. Raised IOP is most common complication and prescribing anti-glaucoma drugs in order to decrease intraocular pressure.

English

BACKGROUND Posterior capsule opacification (PCO) is the most common delayed complication of cataract surgery. Nd:YAG (Neodymium yttrium aluminium garnet) laser posterior capsulotomy presents the advantages of a non-invasive, effective, relatively safe technique to manage intact posterior capsule that opacifies postoperatively. With this background we want to study the visual outcome and complications following Nd-YAG laser posterior capsulotomy in posterior capsular opacification following small incision cataract surgery (SICS). METHODS The study includes 64 patients attending outpatient department of a tertiary eye care hospital at Latur from June 2018 to May 2019 who have undergone SICS with PMMA PC IOL (polymethyl methacrylate posterior chamber intraocular lens) implantation and clinically diagnosed with posterior capsular opacification. 64 eyes with PCO were subjected to Nd:YAG laser posterior capsulotomy after detailed slit lamp bio microscopic examination pre- and post-capsulotomy. Follow-up was done at 1 hour, 1 week, 2 weeks and 4 weeks and patients were examined for visual outcome and any complications at each visit. RESULTS There were 16 males (25 %) and 48 females (75 %) with a mean age of 65 years. Posterior capsule opacification occurs within 3 years accounting for 46.9 % of the cases. Elschnig pearls type of PCO was more common when compared to fibrous type of PCO. Best corrected visual acuity (BCVA) before Nd:YAG laser capsulotomy was less than 6 / 60 in 35 patients (54.7 %) and within 6 / 60 to 6 / 24 in 23 patients (35. 9 %) with 6 patients (9.4 %) accounting for visual acuity between 6 / 24 to 6 / 18. After Nd - YAG Laser Capsulotomy, 46.9 % gained best corrected visual acuity of 6 / 18 or better, 39.1 % cases improved 6 / 12 and better and BCVA of 6 / 9, 6 / 6 was observed in 11 cases and 1 case respectively. Only 12 out of 64 patients had complications. Raised intraocular pressure (IOP) was found in 4 patients. Intraocular lens (IOL) pitting was found in 8 patients. CONCLUSIONS Nd:YAG laser capsulotomy is a safe, effective and a non-invasive procedure which avoids all the complications of surgical capsulotomy in patients of posterior capsule opacification. KEYWORDS Posterior capsule opacification (PCO), Nd:Yag Laser Capsulotomy, Best Corrected Visual Acuity (BCVA), Central Subfield Macular Thickness (CSMT)

Short-Term Anterior Segment Changes After Nd-YAG Laser Posterior Capsulotomy in Pseudophakic Eyes with Fuchs' Endothelial Dystrophy.

PurposeTo describe the changes in the central corneal thickness (CCT), endothelial cell count (ECC), intraocular lens (IOL) position, and refractive error 1 and 3 months after Nd-YAG laser posterior capsulotomy (YAG-PC) for posterior capsular opacification (PCO) in pseudophakic eyes with Fuchs’ endothelial cell dystrophy (FECD).DesignProspective case-control.ParticipantsFifty pseudophakic eyes of 50 patients with visually significant PCO (25 with healthy corneas, and 25 with FECD grade 1 and 2).MethodsFECD was clinically graded, and only patients without clinically evident corneal edema were included in the study (grade 1 and 2). All patients received YAG-PC and were followed up after 1 and 3 months. Best-corrected visual acuity, refractive errors, ACD, CCT, and ECC were assessed and compared between the pre-laser values and that of the 2 follow-up visits.ResultsIn both groups, BCVA showed significant improvement (P<0.05). Compared to healthy controls, a significant hyperopic shift was observed in the FECD eyes at the 2 follow-up visits (P=0.027, and 0.019). A significant backward movement of the IOL was observed in the FECD eyes in the 2 follow-up visits (P=0.043, and 0.02). There was a significant correlation between the hyperopic shift in the FECD eyes and the ACD deepening during the 1st month (R= −0.6, P=0.001) and 3rd month (R= −0.4, P=0.04). Significant drop in the ECC was noted in both groups but without significant increase in the CCT.ConclusionCompared to controls, a hyperopic shift and backward movement of the IOL were observed in the FECD eyes after YAG-PC. No significant corneal thickening was found in both groups despite the significant drop in the ECC. Future studies are required to confirm our results and monitor the long-term changes after YAG-PC in FECD.

An Evaluation of Best Corrected Visual Outcome (BCVA) after Nd-YAG Laser Posterior Capsulotomy in Patients of Posterior Capsular Opacification (PCO): A Prospective, Single Centre, Observational Study

An Evaluation of Best Corrected Visual Outcome (BCVA) after Nd-YAG Laser Posterior Capsulotomy in Patients of Posterior Capsular Opacification (PCO): A Prospective, Single Centre, Observational Study

PATTERN OF IOP CHANGES FOLLOWING Nd-YAG LASER CAPSULOTOMY FOR PCO

PURPOSE: To study the pattern of IOP changes following Nd-YAG capsulotomy for PCO and to calculate the percentage of patients requiring antiglaucoma medication following YAG laser capsulotomy. Study Design: Prospective study Material and Methods: The study was conducted in the department of ophthalmology in GMC Jammu. Patients who complained of diminution of vision due to posterior capsule opacification were enrolled. 50 patients who underwent Nd-YAG laser posterior capsulotomy were taken. After Nd: YAG, IOP was recorded after 1hr, 4hrs, weekly till 1 month to look for any pressure spike. Cases were followed upto 3 months to look for cystoid macular oedema, IOP rise, persistent iritis, vitritis, pitting of IOL and retinal detachment. Result: It was observed that intraocular pressure starts rising immediately after Nd-YAG, reaching a peak at 3-4 hours. It remains elevated at 24 hrs and returns to baseline in 1-week duration in most cases. Immediate IOP rise occurred in 21(42%) cases. At the end of 1 week, 6(12%) patients still had raised IOP. At 2 weeks, 3 cases showed high IOP among whom 2 returned to prelaser values at 1 month. Only 1 case had high IOP after 1-month duration. Only 1(2%) patient developed IOP elevation of >5 mm hg from prelaser values which did not return to baseline even after 1 month of laser and hence required antiglaucoma medication. Hence, according to this study 2% of cases require antiglaucoma medication to counter IOP rise following Nd-YAG. CONCLUSION: - IOP elevation associated with Nd: YAG laser is often transient without long-term damage and is typically observed within 2 to 4 hours after treatment. However, sometimes, IOP may rise high, requiring additional intervention. Hence it is important to monitor IOP post-YAG-Laser and do appropriate intervention to prevent unwanted consequences from raised IOP.

Nd-YAG laser posterior capsulotomy and visual outcome

Introduction: Posterior capsular opacification is the most common delayed complication of cataract surgery with IOL implantation. This results due to proliferation and migration of reminant epithelial cells that form clump and fibrosis on the posterior lens capsule leading to posterior capsular opacification(PCO). Method: The cases for Nd-Yag laser posterior capsulotomy were collected from amongst those attending the ophthalmology OPD of Nehru chikitsalay, Gorakhpur in period of one year (May 2015 to June 2016). Patients were selected on the basis of inclusion criteria according to study requirement and observations were made for outcomes. Observations: The observations made on the basis of our study are as follows: - Maximum eyes (52%) were in the age group 50-60 years. - Male (61.7%) outnumbered female(38.3%) in ratio of 3:2. - Maximum number of cases need YAG laser capsulotomy between the period of 36 months -60 months. - Thick white opacification type of PCO required maximum energy and maximum shots. - Post-YAG Laser capsulotomy visual improvement is 87.3% in 6/12 to 6/6. - 5.1% cases shows no change. - Most frequent complications is rise of intra ocular pressure. Conclusion: - Depending upon the thickness/density of PCO three types of PCO’s were encountered. - Most frequent complication is rise of IOP, which is mainly seen in eyes exposed to total laser energy level of >40mJ or above, this rise of IOP respond well to timolol 0.5%. - When the energy levels are raise, the complications also raises, thus to minimize this number of settings should be increased. - It is safe and readily acceptable to patients

Evaluation of the impact of Nd:YAG laser posterior capsulotomy on ocular pulse amplitude and anterior segment morphology

Posterior capsular opacification (PCO) is the most frequent complication after cataract surgery. The most used method in order to disrupt the opacified posterior capsule is Nd-YAG laser posterior capsulotomy. Our aim was to evaluate the impact of Nd-YAG laser posterior capsulotomy on ocular pulse amplitude (OPA), central corneal thickness (CCT), corneal volume (CV), iridocorneal angle (ICA), and anterior chamber depth (ACD). Thirty-three eyes of 30 pseudophakic patients who underwent Nd-YAG capsulotomy due to posterior capsule opacification, were included in this prospective cross-sectional consecutive case series. The OPA was measured with the Pascal dynamic contour tonometer. The CCT, CV, ICA, and ACD measurements were taken with the Scheimpflug imaging system (Pentacam HR). The examinations were performed preoperatively, and repeated at the postoperative first hour, week, and month. The mean OPA, ICA, and ACD values did not change statistically significantly after the posterior capsulotomy (P > 0.05). The mean CCT increased markedly and the mean CV increased slightly after one hour from the capsulotomy (P = 0.001 and P = 0.02, respectively), and then returned to the baseline values at the first week and first month visits (P > 0.05). Nd:YAG capsulotomy does not significantly alter OPA, ICA, and ACD; but it causes temporary increase of CCT and CV in the short term.

A Prospective Study to Analyse the efficacy of Apraclonidine in Preventing Intraocular Pressure Rise After Neodymium: YAG (Nd-YAG) Laser Posterior Capsulotomy

Objective: To analyse the efficacy of (0.5%) apraclonidine in preventing the acute rise of intraocular pressure following Nd-YAG Laser posterior capsulotomy. Material and method: A prospective case controlled randomised study was performed in the department of ophthalmology of SIMS in collaboration of department of pharmacology. Result: A total 52 patients were divided in two groups. Half of the patients were given 0.5% topical apraclonidine 15 minutes before the procedure and immediately after the procedure and after 1 hr, 2hr, and 4hrs respectively. The other half were not given any IOP lowering drug.IOP was measured by tonometry. There was significant fall in IOP in test group patients. IOP in two groups 1hr after procedure was 13.08% rise in control and 6.40% fall in test group. Conclusion: Apraclonidine, a highly selective alpha2 adrenoceptor agonist effectively and safely lowers IOP spikes after laser treatment without causing significant side effects like bradycardia or hypotension.

Correlation between eye aperture diameter and complications in the posterior eye segment after Nd-YAG capsulotomy.

The aim of our research was to explore possible correlation between eye aperture diameter and occurrence of complications in the posterior eye segment after Nd-YAG capsulotomy. In the study, we analyzed 120 eyes of the patients who experienced opacities in the posterior capsule or developed secondary cataract after the surgery. All patients underwent Nd-YAG laser posterior capsulotomy. Thereafter, we monitored complications occurrence in the posterior eye segment in intervals of one hour, seven days, one month and six months following the surgery. The frequency of complications increased with time. Six months after Nd-YAG laser posterior capsulotomy we found changes in the posterior eye segment: hole in the anterior hyaloid membrane in case of 9 (7,50%) eyes, prolapse of the corpus vitrei in 2 (1,66%) cases, retinal hole in case of 5 (4,16%) eyes, macular hole in 3 (2,50%) eyes, retinal detachment in 3 (2,50%) eyes, cystoid macular edema in 2 (1,66%) eyes, (1,66%), and macular pack in case of 11 (9,16%) eyes. Aperture size in the posterior capsule directly correlates with the number of complications. We suggest that the aperture diameter should not exceed 4,0 mm.

Prophylactic use of timolol maleate to prevent intraocular pressure elevation after Nd-YAG laser posterior capsulotomy

To evaluate the effective prophylaxis of topical 0.5% timolol maleate for the intraocular pressure rise following Nd-YAG laser posterior capsulotomy. A total of 190 eyes of 184 patients who underwent Nd-YAG laser posterior capsulotomy were randomly assigned to pre-treatment with either topical application of 0.5% timolol maleate (treatment group) or nothing (control group). The mean intraocular pressure (IOP) of the treatment group was 14.8+/-3.0 mmHg before capsulotomy and 15.7+/-3.4 mmHg after capsulotomy (P>0.05), whereas IOP was 15.1+/-3.3 mmHg and 17. 2+/-4.3 mmHg (P<0.05) for the control group. There was no statistically significant difference between the two groups with regard to mean IOP before capsulotomy (P>0.05), but a statistically significant difference was seen between the two groups after capsulotomy (P<0.05). Six of 91 eyes (6.6%, two with aphakia) in the treatment group had an IOP elevation greater than 6 mmHg compared with 14 of 99 eyes (14.1%, eight with aphakia) in the control group (P<0.01). Pre-treatment with a topical application of 0.5% timolol maleate is effective in preventing IOP elevation after Nd-YAG laser posterior capsulotomy.

AXIAL MYOPIA IS AN EXTREMELY SIGNIFICANT RISK FACTOR FOR YOUNG-AGED PSEUDOPHAKIC RETINAL DETACHMENT IN TAIWAN

To investigate the possible risk factors of retinal detachment (RD) after cataract extraction and intraocular lens implantation in a geographic defined racially uniform population. Submitted claim records and charts of 9398 insurance beneficiaries who underwent cataract extraction and intraocular lens implantation between August 1999 and December 2001 were consecutively collected from the Bureau of National Health Insurance (BNHI). At the end of 2003, any ophthalmologic diagnosis and related treatment based on procedure and diagnosis codes listed in physician bills were evaluated. The cumulative risk of RD in our study group was 0.76% at the end of follow-up. The mean follow-up time was 36.92 +/- 8.89 months. Sex distribution had no significant effect on the occurrence of RD after cataract extraction, whereas age distribution showed significant influence on the risk of RD after cataract surgery (P = 0.0307), as did the history of RD (P < 0.0001) and Nd-YAG laser posterior capsulotomy (P = 0.0001). Axial length also had a significant effect on the risk of RD after cataract extraction (P < 0.0001). The longer the axial length, the more impact on the risk of RD carried by young age. The results showed that axial myopia is an extremely significant risk factor for young-aged pseudophakic RD in Taiwan.

In-vivo Imaging of IOL Damage After Nd:YAG Laser Treatment

Objective: The use of specular microscopy to photograph in-vivo intraocular lens defects produced as a result of Nd-YAG laser posterior capsulotomy. Patients: Thirty randomly selected patients following Nd-YAG laser posterior capsulotomy. IOL: Lathe cut PMMA planoconvex. Results: IOL damage was found in 28 (93%) of IOLs. The most common damage was a crater with melted margins, craters with irregular margins and inclusions are also seen. Stellate defects in the intraocular lens were found in two cases. Conclusion: Specular microscopy performed during and after Nd-YAG laser capsulotomy demonstrates various kinds of intraocular lens defect.

Prophylactic use of acetazolamide to prevent intraocular pressure elevation following Nd-YAG laser posterior capsulotomy.

Fifty four eyes of 54 patients undergoing Nd-YAG laser posterior capsulotomy were randomly assigned to pretreatment with either 125 mg of oral acetazolamide (group A) or placebo (group B). During the first 3 hours following capsulotomy, an intraocular pressure (IOP) rise of at least 10 mm Hg was recorded in eight of the 26 eyes of group B (30.8%) and in none of the 28 eyes of group A (p < 0.01). A rise of at least 5 mm Hg was recorded in 16/26 (61.5%) and 4/28 (14.3%) eyes respectively (p < 0.001). Three eyes of group B developed an IOP greater than 35 mm Hg. We found that pretreatment with a low dose of acetazolamide is highly effective in preventing IOP elevation following Nd-YAG laser posterior capsulotomy.

Utilité du Laser Flare Cell Meter (LFCM, KOWA FC-1000) pour l'évalution de l'inflammation en chambre antérieure dans la pratique clinique

The Laser Flare Cell Meter (LFCM, Kowa FC-1000), an instrument measuring aqueous flare and cells in a quantitative, objective and non-invasive way, has been mainly used so far to measure inflammation in clinical and experimental research. In the light of some illustrative examples, its practical clinical usefulness is presented; the LFCM was found to be specially helpful in 3 types of situations. 1. In acute anterior uveitis (AAU) patients, precise LFCM monitoring of inflammation made it possible to avoid excessive corticosteroid therapy, mainly by more rapid and controlled tapering at the end of an inflammatory episode, so possibly minimizing steroid side effects in a group of patients prone to numerous uveitis recurrences. In a steroid-responder patient it allowed successful treatment of a flare-up of AAU with a combination of systemic and topical diclofenac (Voltaren), a potent nonsteroidal antiinflammatory drug. 2. LFCM monitoring of inflammation in patients undergoing laser treatments allowed optimal adjustment of antiinflammatory therapy. Diclofenac drops (Voltarene Ophta), were sufficient to treat inflammation in all patients, undergoing Nd-YAG laser posterior capsulotomy or Argon laser trabeculoplasty. 3. In patients with acyclovir treated herpes simplex or herpes zoster uveitis corticosteroid treatment should be avoided whenever possible, because of the tendency to develop steroid dependency. LFCM monitoring of this group of patients gave a precise evolutionary pattern of inflammation and permitted to avoid steroid treatment in many patients.

Prevention of IOP-rise following Nd-YAG laser capsulotomy with pre-operative timolol eye-drops and 1 tablet acetazolamide 250 mg systematically.

Short-term observation following Nd-YAG laser capsulotomy indicates that serious elevation of intra-ocular pressure may occur, unrelated to the amount of energy used. In this study the IOP in 3 groups of 10 pseudophakic patients undergoing Nd-YAG laser posterior capsulotomy was measured before capsulotomy and 2 and 4 hours afterwards, using the fellow-eye as control. The first group received no medication, the second received timolol 1/2% eyedrops preoperatively, the third group a combination of timolol 1/2% and 1 tablet of acetazolamide 250 mg systemically. Pretreatment with timolol 0.5% minimizes IOP-rise but does not give complete protection. The combination of timolol 0.5% with 1 tablet of acetazolamide 250 mg proves to be a safe procedure for the prevention of IOP-rise after YAG laser capsulotomy. To prevent other complications it is advisable to make a small capsulotomy of 2-3 mm diameter using as little energy as possible. Also a defocussing system in the laser is a great advantage. Indomethacin drops during a period of 6 weeks after Nd-YAG laser capsulotomy should prevent cystoid macular edema.