Yttrium Aluminum Garnet Laser Capsulotomy Research Articles

The Role of Early Nd:YAG Laser Capsulotomy in Improving Visual Performance in Mild to Moderately Symptomatic Trifocal Patients.

To determine the effect of early Nd:YAG (neodymium:yttrium-aluminum-garnet) laser capsulotomy on objective and subjective visual quality in symptomatic trifocal intraocular lens (IOL) patients. A single-center, prospective study examined symptomatic patients after bilateral cataract extraction with trifocal IOL implantation. A ten-question survey was conducted one month after surgery. Study endpoints included the assessment of monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), contrast sensitivity (CS), and subjective visual quality before and after Nd:YAG capsulotomy prior to 4 months after cataract surgery. A total of 38 eyes from 21 patients were included with a TFAT00 (n = 23) or TFAT30-60 (n = 15). Overall satisfaction with the IOL was 8.55 ± 1.77 (range 5-10). A Nd:YAG capsulotomy was performed at 55 ± 26 days. Monocular UDVA and UNVA > 20/25 before Nd:YAG were 53.0% and 42.0%, which improved post-Nd:YAG to 63.0% and 66.0%, respectively (P = 0.41, P = 0.051). Binocular UDVA and UNVA >20/25 before Nd:YAG were 82.0% and 63.0%, which increased to 97% and 97%, respectively (P < 0.05, P < 0.001). CS increased in all post-Nd:YAG capsulotomies (P < 0.01). The presence of glare was documented at 74% pre-Nd:YAG, which decreased to 41% post-Nd:YAG (P < 0.01). Glare which limited activities was documented at 24%, which decreased to 5% post-Nd:YAG (P = 0.21). Early treatment of posterior capsule opacities in mild to moderately dissatisfied trifocal IOL patients may be beneficial in improving CS, visual quality, and reducing the presence and severity of dysphotopsias.

Incidence of Nd:YAG laser capsulotomy following cataract surgery: a population-based nation-wide study – FreYAG1 study

RationaleNd:YAG (neodymium:yttrium-aluminum-garnet) capsulotomy (Nd:YAG-caps) is the gold standard for the treatment of PCO (Posterior Capsule Opacification). There is a lack of real-world data about Nd:YAG-caps use.PurposeThis study’s objectives were to estimate Nd:YAG-caps incidence in France, to describe the patient characteristics, and to analyze the time between surgeries and capsulotomies. Setting: The study was based on data extracted from the EGB database, a 1/97th sample representative of the French population. Design: observational, retrospective, cohort study using national claims data.MethodsFrench adult patients who underwent Nd:YAG-caps between 2014 and 2017 were selected. Main outcomes were the number of patients and procedures performed and the risk factors associated with early Nd:YAG-caps. Results: During the study period, Nd:YAG-caps were performed in 8,425 patients accounting for 10,774 procedures. The extrapolation to the French population led to estimate that 253.103 patients had Nd:YAG-caps, representing 312.103 procedures in 2017. The mean age at Nd:YAG-caps was 75.1 (± 10.2) years. About 36% of patients presented at least one ocular comorbidity. Nd:YAG-caps was performed within 2 years after surgery in 33.0% of patients and within one year in 9.8% of patients. Patients with Nd:YAG-caps within the first year (OR CI95 0.721 [0.673–0.772]) or in the first two years (OR CI95 0.721 [0.673–0.772]) were younger than patients with later Nd:YAG-caps and had a more frequent history of treated ocular diseases (OR 1.516 and 1.178, respectively).ConclusionsThis study brought new real-world and large-scale data regarding Nd:YAG-caps use and gave an updated insight into the patients’ characteristics.

Outcome and safety of secondary pars plana capsulotomy in patients with posterior capsular opacity following extracapsular cataract extraction

Objectives: Posterior capsular opacity is a major delayed complication seen in patients following cataract extraction. Neodymium-doped Yttrium Aluminium Garnet laser capsulotomy is the standard procedure for capsulotomy; however, its high cost and unavailability in the developing countries makes it important for us to find an alternative, effective and safe method that will help reduce the burden of severe visual impairment and blindness in individuals who have had cataract extraction. The aim of the study was to showcase the effectiveness, outcome and safety of pars plana capsulotomy in reducing the burden of visual impairment and blindness occurring after cataract extraction due to posterior capsular opacity amongst patients. Materials and Methods: This is a hospital-based retrospective study, where the clinic, ward and theatre registers of patients who had secondary pars plana capsulotomy in the past 3 years (2019–2022) due to posterior capsular opacity were reviewed. Patient’s folders who had pars plana capsulotomy with incomplete records were excluded as well as patients who had diabetes, glaucoma, corneal opacity and age-related macular degenerations. The frequency, age distribution, duration from cataract extraction to presentation with posterior capsule opacification (PCO), the grading and morphology of PCO were all noted. The pre- and post-operative visual acuity (VA) was also recorded alongside the pre- and post-operative intraocular pressure (IOP). We also documented intra- and post-operative complications that were seen in these patients. Data were analysed using SPSS package version 23 (SPSS Inc. Illinois, Chicago), and values were expressed as simple frequencies and proportions. Paired t-test was used to test the statistical significance with P &lt; 0.05. Results: A total of 36 patients records were reviewed; capsulotomy was performed in all age groups with the majority done in individuals 60–69 years – 11 eyes (26.8%). A total of 41 eyes of 36 patients had undergone secondary pars plana capsulotomy. Five (13.9%) patients had bilateral pars plana capsulotomy on different occasions. The mean age was 45.3 ± 26.9 years. There were 22 (53.7%) females and 19 (46.3%) males. Female-to-male ratio was 1.2:1. About 75.6% presented between 1 and 5 years after cataract surgery; mean duration for presentation with posterior capsular opacity after cataract extraction was 2.0 years ± 1.6 months. The majority 31 (75.6%) had their pars plana capsulotomy done under topical anaesthesia. VA at presentation was found to be below 3/60 in 17 (41.5%) eyes. After pars plana capsulotomy, VA improvement was seen – 6/6–6/12 in 23 (56.1%) eyes. Grade of PCO revealed that 15 (36.6%) eyes had Grade 2 PCO and the Elschnig pearls were the most common morphological form seen in 30 (73.2%) eyes. Most eyes had normal IOP post-operatively 38 (92.7%); there was a transient increase in IOP in 3 (7.3%) eyes. There were no complications recorded in most eyes 27 (66%). The most common of the few complications seen was subconjunctival haemorrhages in 6 (14.6%) eyes which resolved within a week of follow-up. Conclusion: Pars plana capsulotomy is a safe, easy and effective alternative for posterior capsulotomy and will be useful in resource-poor settings.

Academy IRIS® Registry Analysis of Incidence of Laser Capsulotomy Due to Posterior Capsule Opacification After Intraocular Lens Implantation.

PurposeAcademy IRIS® (Intelligent Research in Sight) Registry was used to determine the incidence of postoperative neodymium-doped yttrium aluminum garnet laser capsulotomy (Nd:YAG) and time to posterior capsular opacification (PCO) diagnosis based on intraocular lens (IOL) type and brand.MethodsThis retrospective analysis included eyes implanted with 1 of 2 IOL brands, with ≥365 days of follow-up available in the IRIS Registry, and ≥2 visits within 180 days of surgery. Analyses included Nd:YAG incidence due to PCO within 1 year after surgery by IOL type and brand, mean time to PCO diagnosis, and mean time to Nd:YAG.ResultsOf 89,947 eyes after cataract surgery, 24,834 (28%) had PCO diagnosis within 365 days, and 9262 (10%) underwent Nd:YAG; 4.1% of 57,523 eyes with monofocal and 21.2% of 32,424 eyes with diffractive multifocal (MF) or diffractive extended depth of focus (EDOF) IOLs had Nd:YAG. Nd:YAG was 3.2 times more likely in eyes with diffractive MF or diffractive EDOF IOLs versus monofocal. For monofocal IOLs, 3.2% of eyes with AcrySof® and 8.1% of eyes with Tecnis® had Nd:YAG (P<0.0001). For diffractive MF or diffractive EDOF IOLs, 13.0% of eyes with AcrySof and 21.7% of eyes with Tecnis had Nd:YAG (P<0.0001). Nd:YAG risk was 2.4 times higher in eyes with Tecnis versus AcrySof IOLs. Overall, mean time to PCO diagnosis and Nd:YAG was 150.7 and 180.7 days. Mean time to PCO for monofocal versus diffractive MF or diffractive EDOF IOLs was 165.3 versus 139.7 days (P<0.0001). Mean time to Nd:YAG for monofocal versus diffractive MF or diffractive EDOF IOLs was 196.4 versus 175.3 days (P<0.05).ConclusionReal-world data for AcrySof and Tecnis IOLs revealed lower Nd:YAG rates and longer time to PCO diagnosis and Nd:YAG after monofocal versus diffractive multifocal or diffractive EDOF implantation. Nd:YAG rates were significantly lower with AcrySof versus Tecnis IOLs.

Comparing the effects and safety of dorzolamide hydrochloride + timolol maleate versus brimonidine after neodymium-doped yttrium aluminium garnet laser capsulotomy posterior capsule opacification.

Posterior capsular opacification is treated using neodymium-doped yttrium aluminium garnet laser capsulotomy that leads to increased intraocular pressure. Here, we compare the effects of dorzolamide hydrochloride + timolol maleate versus brimonidine on intraocular pressure. We also investigate their side effects after neodymium-doped yttrium aluminium garnet laser capsulotomy. In these patients, there are no prior studies comparing the results of these two drugs. Ninety patients with posterior capsule opacification contributed to the study. They received yttrium aluminium garnet laser capsulotomy. After yttrium aluminium garnet laser capsulotomy, they were randomized into three groups. Group 1 received dorzolamide hydrochloride + timolol maleate; Group 2 took brimonidine; and Group 3, the control group, took no drug. Group 1 took dorzolamide hydrochloride + timolol maleate eye drops 1 h before the procedure and on the third hour of the first day and two times per day between the second and the seventh days. Group 2 took brimonidine eye drops 1 h before the procedure and on the third hour of the first day, two times per day between the second and the seventh days. Brimonidine had a similar side effect profile to the fix combination. Intraocular pressure on the first (p = 0.87) and third days (p = 0.124) were similar in Group 1 (dorzolamide hydrochloride + timolol maleate), Group 2 (brimonidine) and the control group. The mean intraocular pressure value of the control group was significantly higher than Groups 1 and 2 because the anti-glaucomatous effects of the drugs become prominent on the seventh day (p = 0.041). In Group 1 and Group 2, intraocular pressure was significantly lower than the control group on the seventh day (p = 0.041). Stinging, itching, hyperemia and Tyndall rates were similar in Group 1, Group 2 and the control group. Watery eyes were less common in the brimonidine group than in the dorzolamide hydrochloride-timolol maleate and the control groups on the seventh day (p = 0.02). Brimonidine also significantly lowered the chemosis rate on the third (p = 0.04) and seventh (p = 0.03) days. We suggest that brimonidine and a combination of dorzolamide + timolol are similarly effective at reducing eye pressure for routine cases. In cases where intraocular pressure attacks might be at higher risk, using the dorzolamide + timolol combination would be more appropriate.

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)

Study of Intraocular Pressure following Neodynium Yttrium Aluminium Garnet Laser Capsulotomy with the Use of Brimonidine: A Descriptive Cross-sectional Study.

Posterior capsular opacification is a common complication after cataract surgery. Neodynium Yttrium Aluminium Garnet laser capsulotomy is still the preferred treatment for posterior capsular opacification. This study was done to determine the use of Brimonidine eye drop in preventing the rise of intraocular pressure post-Neodynium Yttrium Aluminium Garnet laser capsulotomy. A descriptive cross-sectional study was conducted in Lumbini eye institute and research center, Bhairahawa, Nepal, in 200 eyes with posterior capsular opacification using Brimonidine from Feb 1, 2019, to July 30, 2019. The Institutional Review Committee approved the study with approval number 0237. A convenient sampling method was used. Pre-capsulotomy best-corrected visual acuity, slit-lamp examination of the anterior segment, and dilated fundus examination were done. Intraocular pressure was measured with Goldmann Applanation Tonometer. Post capsulotomy patients were evaluated after one hour, two hours, and two weeks for intraocular pressure and any complications. The statistical analysis was done using Statistical Package of Social Sciences version 20.0 statistical analysis software. The descriptive statistical analysis of the study was done after the collection of the data. Mean age of patients at presentation was 61.61±SD 1.09. The mean intraocular pressure following Neodynium Yttrium aluminum garnet laser capsulotomy using brimonidine at 1 hour was 12.73±3.3 mmHg.and two hours was 11.98±3.2 mmHg. The mean energy per pulse was 2.3±SD 0.3 mJ. The mean duration of posterior capsular opacification from cataract surgery was 22.28 weeks. Neodynium Yttrium Aluminium Garnet laser capsulotomy had lower intraocular pressure after the Brimonidine eye drop procedure. The maximum mean reduction in intraocular pressure was observed after two hours.

An uncommon complication from a common procedure

The study aims to highlight the importance of appropriate sizing of yttrium-aluminum-garnet (YAG)–capsulotomy. We report a case of a patient who developed sudden loss of vision, due to an unprecedented posterior dislocation of the posterior chamber intraocular lens, following an apparently uncomplicated YAG laser capsulotomy for a posterior capsular opacification (PCO), which was restored to complete visual recovery. We also stress the importance of appropriate size of the YAG openings. Although neodymium: YAG laser posterior capsulotomy is a safe procedure for treating PCO, it is not free from complications. Limiting the size of the YAG opening to meet the basic requirements is necessary.

The Effect of Capsulotomy Shape on Intraocular Light-Scattering after Nd:YAG Laser Capsulotomy.

Purpose To investigate the effects of capsulotomy shape on the visual acuity and visual quality after neodymium: yttrium aluminum garnet laser capsulotomy. Methods In this study, a total of 42 eyes from 35 patients with posterior capsule opacification were divided into the circular and cruciate groups. The corrected distance visual acuity (CDVA), objective scatter index (OSI), modulation transfer function cutoff (MTF cutoff), Strehl ratio, and Optical Quality Analysis System values at contrasts of 100%, 20%, and 9% (OV-100, OV-20, and OV-9) were measured at precapsulotomy and 1 week and 1 month postcapsulotomy. The pseudophakic dysphotopsia questionnaire (PDQ) was used to evaluate the subjects' satisfaction with treatment. Results OSI values were significantly higher in the cruciate group than in the circular group at 1 week and 1 month after capsulotomy (P=0.013 and P < 0.001). No significant difference was found in the OSI values between the two groups before capsulotomy (t = 0.52; P=0.61). The decrease in OSI was higher in the circular group than in the cruciate group at 1 week and 1 month after capsulotomy (P=0.036 and P=0.019). No significant differences were found in the Strehl ratio, MTF cutoff, CDVA, OV-100, OV-20, and OV-9 between the two groups at 1 week and 1 month after capsulotomy (P > 0.05). The PDQ results showed that patients with circular-shaped capsulotomy complained less with intolerance of bright lights than those with cruciate-shaped capsulotomy. Conclusions Circular-shaped capsulotomy can induce less intraocular light scattering and increase patient satisfaction.

An Audit of IO6 YAG Laser Capsulotomies Done between January 2017 - December 2017 in St. Joseph Eye Hospital, Mgbirichi, Owerri, Imo State and Viandra Eye Clinic, Port Harcourt, Rivers State of Nigeria

Aim: To audit the YAG Laser Capsulotomy procedures done over a 12 month period from January to December 2017.&#x0D; Objective: To review YAG LASER capsulotomies done over a 12 months period from January 2017 – December 2017.&#x0D; Methods: The audit was retrospective in nature, involving collation of parameters such as age, sex, presenting visual acuity, post laser visual acuity, complications and post operative management from the patient records. The lasers were performed with SYL 9000 Ophthalmic yttrium aluminum garnet (YAG) Laser systems [Lightmed Corporation, Taiwan]. This is a class 3b Laser with a wavelength of 1064 nm and Q-switched operational mode and a spot size of 8 um.&#x0D; Results: The audit involved 106 subjects. The mean age was 56.76 years. Fifty nine (55.7%) subjects were females while 44.3% were males. Eleven (10.4%) subjects had bilateral neodymium‐doped yttrium aluminum garnet ND YAG laser treatment while 89.6% had unilateral treatment. Seventy five (72.8%) of the subjects had visual improvement following treatment. Seventy four (69.8%) had less than 3 mJ quantum of energy and only 5.7% required repeat treatment. Fifty (47.2%) had between one to three days post op treatment with anti-inflammatory and/or pressure reducing drugs.&#x0D; Conclusion: Use of low energy in ND YAG laser treatment of Posterior Capsule Opacification offers good visual outcome, precludes the complication associated with higher energy treatment and does not necessarily lead to repeat treatment.

Visual outcomes and complications after Neodymium-doped yttrium aluminium garnet laser capsulotomy in Posterior capsular opacification

Visual outcomes and complications after Neodymium-doped yttrium aluminium garnet laser capsulotomy in Posterior capsular opacification - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/j.ijceo.2019.116, Indian Journal of Clinical and Experimental Ophthalmology-Indian J Clin Exp Op

Trends in Retina Specialist Imaging Utilization from 2012 to 2016 in the United States Medicare Fee-for-Service Population

To characterize temporal trends and regional variance in retinal imaging utilization in the United States Medicare fee-for-service population from 2012-2016. Cross-sectional, retrospective database analysis. This study addresses office or operating-room based retinal imaging. Our study population included retina specialists, defined as ophthalmologists performing either intravitreal anti-vascular endothelial growth factor injections or posterior segment laser photocoagulation and no neodymium-doped yttrium aluminum garnet laser capsulotomy. We recorded fundus photography, optical coherence tomography (OCT), intravenous fluorescein angiography (IVFA), indocyanine-green angiography, and ophthalmic ultrasound (B-scan) billed in the Medicare fee-for-service population from 2012-2016. Imaging obtained on any platform or device was eligible for inclusion (eg, posterior pole imaging vs ultrawidefield imaging). The main outcome measure was the relative utilization of retinal imaging modalities. National relative utilization of OCT increased from 61.5% in 2012 to 70.5% in 2016 (P<.001), while IVFA fell from 20.9% to 15.1% over the same interval (P < .001). Fundus photography decreased from 14.6% in 2012 to 11.7% in 2016 (P<.001). By 2016, the Midwest region had the highest relative utilization of OCT (75.2%) and lowest of IVFA (12.0%), while the West region had the lowest OCT (68.4%) and highest IVFA (17.0%). Among retina specialists, OCT usage increased while the utilization of fundus photography and IVFA has declined. The Midwest region had the highest utilization of OCT and lowest of IVFA.

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.

Comparing Access to Laser Capsulotomy Performed by Optometrists and Ophthalmologists in Oklahoma by Calculated Driving Distance and Time

To quantify Medicare beneficiary proximity to his or her yttrium-aluminum-garnet (YAG) laser capsulotomy-providing ophthalmologist and optometrist in Oklahoma by calculating driving distances and times. Cross-sectional cohort study using 2014 Oklahoma Medicare 100% and 5% data sets and Google Maps distance and travel time application programming interfaces. U.S. fee-for-service Medicare beneficiaries and Oklahoma ophthalmologist and optometrist laser capsulotomy providers. The 2014 Medicare Provider Utilization and Payment Limited 100% and 5% datasets from the Centers for Medicare and Medicaid (CMS) were obtained to identify the office street addresses of Oklahoma ophthalmologists and optometrists who submitted claims to Medicare for a YAG laser capsulotomy, and the county addresses of the corresponding Medicare beneficiaries who received the laser capsulotomy. The shortest travel distances and travel times between the beneficiary and the laser provider were calculated by using Google Maps distance and travel time application programming interfaces. Beneficiary driving distances and times to his or her YAG laser capsulotomy-providing Oklahoma ophthalmologist and optometrist. In 2014, 90 (57%) of 157 Oklahoma ophthalmologists and 65 (13%) of 506 Oklahoma optometrists submitted a total of 7521 and 3751 YAG laser capsulotomy claims to Medicare, respectively. By using the Medicare Limited 5% dataset, there was no difference in driving distance between beneficiaries who received a laser capsulotomy from an ophthalmologist (median, 39 miles; interquartile range [IQR], 13-113 miles) compared with an optometrist (median, 46 miles; IQR, 13-125 miles; P= 0.93) or in driving time to an ophthalmologist (median, 47 minutes; IQR, 19-110 minutes) compared with an optometrist (median, 50 minutes; IQR, 17-117 minutes; P= 0.76). For Medicare beneficiaries, there was no difference in geographic access to YAG laser capsulotomy whether performed by an Oklahoma ophthalmologist or optometrist as determined by calculated driving distances and times.

Biometric and intraocular pressure changes after Nd:YAG laser capsulotomy

Objective. We aimed to investigate the influences of Nd:YAG ( neodymium-doped yttrium aluminum garnet ) laser capsulotomy on ocular biometric parameters. Methods. In this prospective study, 117 eyes of 117 pseudophakic patients were included. Full ocular examination, the best-corrected visual acuity (BCVA), and intraocular pressure (IOP) measurements were performed before the procedure as well as one week, one month, and three months after Nd:YAG laser capsulotomy. The axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), and pupil diameter (PD) were measured by LenStar 900 optical biometry. The measurements were repeated one week, one month, and three months. Results. The BCVA improvements at preoperative, one week, and one month were statistically significant, but no significant changes in the BCVA were found at one month and three months ( p =0.345). No association was found between the capsulotomy and mean IOP changes during the follow-up period ( p =0.300). No significant changes were found in the CCT ( p =0.059). The ACD changes occurred at preoperative; the first week and the first month were statistically significant ( p <0.001). No statistically significant differences were found between the first month and the third month ( p =0.365). No significant changes in the pupil size ( p =0.200) and AL ( p =0.112) were found after Nd:YAG laser capsulotomy. Conclusions. Our study demonstrated that the BCVA parameter changed after Nd:YAG laser capsulotomy. The BCVA and ACD values follow-up period should be at least one month after Nd:YAG capsulotomy.

Intraocular Pressure Spikes following Neodymium-doped Yttrium Aluminum Garnet Laser Capsulotomy: Current Prevalence and Management in Israel.

ABSTRACTAim The current treatment for posterior capsular opacification (PCO), neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy, may lead to increased intraocular pressure (IOP). Our aim was to survey routines in the management of IOP spikes and to identify the rate of IOP spikes following prophylactic apraclonidine treatment.Materials and methods A survey questionnaire among ophthalmologists and a retrospective registry review was used. Patients were administered apraclonidine 0.5% prior to capsulotomy. The IOP was measured before and 1 hour postprocedure.Results A total of 71% of responders (n = 45) routinely prescribe topical IOP-lowering medication and 82% routinely measure IOP before or after capsulotomy. The registry analysis included 87 eyes of 75 patients. Mean IOP decreased by 0.9 ± 3.3 mm Hg (p = 0.01, range: -6 to 10) following capsulotomy. No patient reached IOP values above 21 mm Hg following the procedure, with 3.4 and 1.1% of patients demonstrating an IOP elevation of more than 3 and 5 mm Hg respectively. No association was found between number of laser shots, mean laser power, or comorbid conditions, such as diabetes, hypertension, or glaucoma status with posttreatment IOP.Conclusion Most ophthalmologists surveyed routinely prescribe prophylactic IOP-lowering medication and measure IOP before or after capsulotomy. Mean IOP remained clinically stable following capsulotomy with prophylactic apraclonidine instillation, and no patient reached IOP values above 21 mm Hg. Differences in laser delivery or comorbid conditions were not associated with posttreatment IOP. Considering that no patient demonstrated a clinically significant IOP spike following prophylactic apraclonidine instillation, perhaps routine measurement of IOP following primary Nd:YAG laser may be reserved for high-risk patients only.Clinical significance In this work, we showed the prophylactic effect of apraclonidine 0.5% and suggest that measuring IOP after the procedure is necessary only in certain high-risk cases, possibly helping to reduce workload and patient waiting time and improving quality of service.How to cite this article Achiron A. Intraocular Pressure Spikes following Neodymium-doped Yttrium Aluminum Garnet Laser Capsulotomy: Current Prevalence and Management in Israel. J Curr Glaucoma Pract 2017;11(2):63-66.

The effects of Nd:YAG laser capsulotomy on anterior segment parameters in patients with posterior capsular opacification

BackgroundThe aim was to investigate the effects of neodymium‐doped yttrium aluminum garnet laser capsulotomy on the main numerical parameters of the anterior segment with Pentacam in patients with opacification of the posterior capsule.MethodsThirty eyes of 30 patients (19 male, mean age 66.9 ± 8.1 years) with visually significant posterior capsular opacification were enrolled. Patients had undergone phacoemulsification surgery with three‐piece intraocular lens (Sensar, AMO, USA) implantation. Full ocular examination was performed before and after capsulotomy. Intraocular pressure (Goldmann applanation tonometry) and refractive changes were measured. Pentacam measurements of the patients before and one week and one month after capsulotomy were obtained.ResultsMean visual acuity (logMAR) improved pre‐operatively (0.50 ± 0.36) to one week (0.04 ± 0.07) and one month after capsulotomy (0.03 ± 0.06; p < 0.001). Mean spherical and cylindrical powers were 0.50 ± 0.98 DS and ‐1.61 ± 1.00 DC before the procedure and 0.10 ± 0.80 DS and ‐0.92 ± 0.66 DC at one month, respectively. There was a significant decrease in cylindrical errors (p = 0.001) and a myopic shift in spherical errors (p = 0.01) after the procedure. Mean anterior chamber depth (ACD) was 4.26 ± 0.63-mm before the procedure, 3.73 ± 0.56-mm at one week and 3.75 ± 0.56-mm at one month. The decrements in anterior chamber depth were significant (p < 0.001). The mean of the anterior chamber angle measurements was 43.41 ± 6.87 degrees before the procedure, increased to 45.56 ± 7.01 degrees at one week and decreased to 44.56 ± 6.13 degrees at one month. The increments in anterior chamber angle at the first week of the procedure were significant (p = 0.01). Mean central corneal thickness was 549.60 ± 41.70 μm before the procedure, increased to 551.40 ± 39.72 μm at one week and decreased to 542.30 ± 35.48 μm at one month. The decrements in central corneal thickness were significant (p = 0.048).ConclusionMean anterior chamber depth decreased by approximately 0.5-mm after capsulotomy. This decrement in anterior chamber depth might be a clue for associated complications, such as unwelcome refractive errors, changes at intraocular lens position, post‐procedure intraocular pressure increases and acute glaucoma.

Optic coherence tomography measurement of choroidal and retinal thicknesses after uncomplicated YAG laser capsulotomy.

Optic coherence tomography (OCT) evaluation of the choroid, retina, and retinal nerve fiber layer after uncomplicated yttrium-aluminum-garnet (YAG) laser capsulotomy. OCT analysis of retinal and choroidal structures was performed in 28 eyes of 28 patients following routine examinations before and 24 h, 72 h, 2 weeks, 4 weeks, and 12 weeks after YAG laser capsulotomy. Data were analyzed using the SPSS software. Data collected before YAG capsulotomy and at the above mentioned follow-up visits are summarized as follows. Mean central subfoveal choroidal thickness before YAG capsulotomy was 275.85 ± 74.78 µm; it was 278.46 ± 83.46 µm, 283.39 ± 82.84 µm, 280.00 ± 77.16 µm, 278.37 ± 76.95 µm, and 278.67 ± 76.20 µm after YAG capsulotomy, respectively. Central macular thickness was 272.14 ± 25.76 µm before YAG capsulotomy; it was 266.53 ± 26.47 µm, 269.14 ± 27.20 µm, 272.17 ± 26.97 µm, 270.91 ± 26.79 µm, and 273 ± 26.63 µm after YAG capsulotomy, respectively. Mean retinal nerve fiber layer thickness before YAG was 99.89 ± 7.61 µm; it was 98.50 ± 8.62 µm, 98.14 ± 8.69 µm, 99.60 ± 8.39 µm, 99.60 ± 8.39 µm, and 99.60 ± 8.35 µm after YAG capsulotomy, respectively. No observed change was statistically significant. No significant changes were observed with regard to mean intraocular pressure. After YAG laser capsulotomy, no statistically significant changes were found in choroidal, retinal, and optical nerve fiber layer thicknesses, although slight thickness changes in these structures were observed, particularly during the first days.

Cataract surgery under systemic infliximab therapy in patients with refractory uveitis associated with Behcet disease.

BACKGROUND AND OBJECTIVESThis study is to evaluate the outcome of cataract surgery in patients with refractory uveitis associated with Behçet disease (BD) treated with infliximab.DESIGN AND SETTINGSA retrospective study in a university-based tertiary referral center in the period between July 2003 and November 2011.METHODSThis is a retrospective study of patients with refractory uveitis associated with BD who underwent phacoemulsification cataract surgery under systemic infliximab therapy between July 2003 and November 2011 at King Abdulaziz University Hospital, Riyadh, Saudi Arabia.RESULTSSix patients (9 eyes), 5 of which were male and 1 female, were identified in this study. The mean (SD) age and follow-up period were 26.2 (6.6) years (range, 16–36 years) and 51.6 (28.8) months (range, 12–84 months), respectively. All the patients underwent phacoemulsification with intraocular lens implantation. Postoperatively, visual acuity improved in all eyes and was 20/40 or better in 7 eyes (77.8%). In the immediate postoperative period, anterior chamber inflammation ranged from 2+ to 3+ cells. None of the patients developed inflammation relapse postoperatively. The most common postoperative complication was posterior capsular opacification in 5 eyes (55%), 4 of which were managed with neodymium:yttrium-aluminum garnet laser capsulotomy. Three eyes had glaucoma, 2 of which underwent successful glaucoma surgery and one was managed with topical antiglaucoma medications.CONCLUSIONIn patients with refractory uveitis associated with BD who are treated with infliximab, cataract surgery is safe and has a good prognosis.

Cataract Extraction Outcomes and the Prevalence of Zonular Insufficiency in Retinitis Pigmentosa

To examine surgical outcomes in patients with retinitis pigmentosa (RP) undergoing phacoemulsification cataract extraction. Retrospective observational case series. In this single-institution study of consecutive RP patients who underwent phacoemulsification cataract extraction and intraocular lens implantation by a single surgeon between 2002 and 2012, preoperative, intraoperative, and postoperative records were analyzed with attention to best-corrected visual acuity (BCVA), lens and zonular status, capsular tension ring use, incidence of posterior capsular opacification and neodymium-doped yttrium-aluminum-garnet (YAG) laser capsulotomy, and surgical complications. Eighty eyes of 47 RP patients (21 male) underwent cataract surgery during the study period at an average age of 48.9 years (range, 31-78 years). Mean follow-up time was 23.3months (range, 1day - 95months). Posterior subcapsular cataracts were present in 97.5% of patients. Mean BCVA improved from 20/340 (logarithm of the minimal angle of resolution [logMAR] 1.23) to 20/129 (0.81) within 3months of surgery, P < .0001. Eyes with a preoperative vision of 20/40 to 20/200 (47 eyes) improved from a mean of 20/81 (logMAR 0.61) preoperatively to 20/43 (0.33), P < .0001, postoperatively. Posterior capsule opacification occurred in 66 eyes (82.5%), and 42 eyes (52.5%) underwent a YAG laser capsulotomy at a mean of 10.8months after surgery. Fifteen eyes (18.8%) of 10 patients (21.3%) had signs of phacodonesis (3 eyes noted preoperatively, 8 intraoperatively, and 4 postoperatively). One patient had bilateral dislocated in-the-bag intraocular lenses at 5.5 years and 6 years after surgery. Cataract surgery yields significantly improved Snellen visual acuity in a majority of RP patients with a preoperative vision of 20/200 or better. Conversely, patients with a preoperative visual acuityof 20/400 or worse generally have more limited objective improvements, likely because of macular involvement, but usually report noticeable subjective improvement. A high prevalence of zonular instability is seen in RP patients undergoing cataract extraction. It is therefore important to conduct a careful preoperative assessment of lens stability with preparation for adjunctive methods that augment intraoperative and postoperative lens stabilization.