Adverse clinical consequences of neodymium:YAG laser treatment of posterior capsule opacification

Abstract

Purpose: To evaluate the clinical consequences of complications from neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO) over the lives of cataract patients.Setting: CHU de Caen, Caen, France. Methods: A model was constructed to estimate the lifetime clinical consequences of postoperative PCO treated by Nd:YAG laser capsulotomy. The probability of death was modeled from French mortality tables as a polynomial function of sex and age. The probability of becoming blind was modeled as a function of age from data in the literature. The incidence of Nd:YAG complications came from the literature. The rate of Nd:YAG capsulotomy over time was modeled as a survival curve using data from a cohort of 3335 patients. Results:Over 9 years in a 70-year-old population, switching from an IOL with a 20% Nd:YAG capsulotomy rate at 3 years to an IOL with a 5% rate would avoid 1 chronic intraocular pressure increase requiring medical follow-up in every 54 surgeries, 1 case of glaucoma in every 237 surgeries, 1 case of cystoid macular edema in every 265 surgeries, and 1 retinal detachment in every 265 surgeries. A 3-year clinical study would only capture one-third to one-half of long-term adverse events of Nd:YAG capsulotomy. Conclusion:Reducing PCO and the associated use Nd:YAG laser capsulotomy may contribute to preserving visual acuity in patients over their lifetimes. C ataract is a normal consequence of aging and is proliferate and migrate into the space between the postereported to develop in 18% of people between rior surface of the intraocular lens (IOL) and the postethe ages of 65 years and 74 years and in 46% between 75 years and 85 years. 1 Surgery remains the only effective rior capsule. treatment for cataract.Several studies 4-15 have compared the incidence of Surgical treatment of cataract improves the patient's postoperative PCO between different IOL types. These vision and quality of life. 2,3 The most frequent poststudies had various experimental designs (eg, prospecoperative complication of cataract surgery is posterior tive randomized clinical trial including cross-over decapsule opacification (PCO). 2 Posterior capsule opacifisign, retrospective cohort analysis, patient chart analysis) and assessed a variety of outcomes (eg, PCO rate, use of the neodymium:YAG [Nd:YAG] laser). The results Accepted for publication February 26, 2004. were fairly consistent and show a decreased PCO rate From CHU de Caen (Billotte), Caen, and Alcon France (Berdeaux), in recent years. The difference in the PCO rate between Rueil-Malmaison, France.IOLs may also be the result of methodology such as Supported by an unrestricted grant from Alcon Laboratories Inc.

Influence of size of neodymium:yttrium-aluminium-garnet laser posterior capsulotomy on visual function

“…Furthermore, it has been shown that the incidence of retinal detachment and cystoid macular oedema after Nd:YAG laser capsulotomy is uncommon in eyes that have previously undergone phacoemulsification and in-the-bag implantation of an IOL. [19][20][21][22] These findings suggest that the incidence of the adverse effects may not differ markedly between eyes with a small capsulotomy and those with a large capsulotomy.…”

AGEs in human lens capsule promote the TGFβ2‐mediated EMT of lens epithelial cells: implications for age‐associated fibrosis

“…PCO impedes vision and requires YAG‐laser treatment to remove the fibrotic mass to clear the visual axis. However, laser treatment could have unintended ill effects, albeit at a low occurrence; these effects can include retinal detachment, macular edema, corneal edema, and displacement of intraocular lens (Billotte & Berdeaux, 2004). Thus, efforts are being made to inhibit PCO development.…”

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

“…Although various methods to treat PCO have been attempted, neodymium yttrium-aluminum-garnet (YAG) capsulotomy is yet the gold standard because it is non-invasive, can be applied rapidly under polyclinic conditions, and has a high success rate. However, some complications may occur after YAG capsulotomy (1)(2)(3) . Changes in intraocular pressure are frequently observed following YAG capsulotomy (4) and may have an impact on the choroid, which is sensitive to fluctuations inintraocular pressure (IOP).…”