Experience of Nd: Yag Laser Posterior Capsultomy on Various Body Lumps

Abstract

BACKGROUND/ OBJECTIVES: Posterior capsular opacification (PCO) is the commonest cause of glare and reduced visual acuity after cataract surgery. The Nd: YAG Laser is the alternate to surgical treatment for capsulotomy. To determine the time period of development of PCO, the complications of Nd: YAG laser during capsulotomy and post laser best corrected visual acuity, this study was carried out. SETTING: METHODS: Five hundred pseudophakic eyes of 500 patients older than 15 years having PCO with decreased best corrected Visual Acuity (VA) of two or more Snellen's chart line and met the inclusion and exclusion criteria were selected from out patients department for Nd: YAG laser capsulotomy. Before laser treatment, the VA was assessed and all patients were examined on slit lamp for IOP and to rule out the causes for reduced vision other than PCO. Then 2-3 mm size capsulotomy was done with Q-switched Nd: YAG Laser, with Abraham's posterior capsulotomy lens, after topical anesthesia, by using minimum amount of energy and fewest numbers of pulses. Patients were followed for assessment of best corrected VA and for possible complications just after laser and at the end of 1 st week, 2 nd week and the 4 th week. The post-laser treatment was advised in accordance with complications to each patient. RESULTS: Of the five hundred eyes, 230 (46.0%) belonged to male sex and 270 (54.0%) females. The majority of patients i.e. 230 eyes (46%) had PCO between 3 to 12 months postoperatively. The mean period between cataract surgery and Nd: YAG laser capsulotomy was 2.06 years. The types of PCO were fibrosis in 339 (67.8%) eyes, Elschnig pearls in 102 (20.4%) eyes and wrinkling in 59 (11.8%) eyes. Pre-laser visual acuity was CF-6/60 in 262 (52.4%) eyes, 6/36-6/24 in 140 (28.0%) eyes and 6/18-6/12 in 98 (19.6%) eyes. Post-laser VA was improved to 6/9-6/6 in 372 (74.4%) eyes. Out of 500 patients, 40 (8.0%) eyes developed the complications due to YAG laser which included IOL pitting in 27 (5.40%) eyes, raised IOP in 04 (0.80%), uveitis in 03 (0.60%), iris bleeding (hyphema) in 03 (0.60%), vitreous in anterior chamber in 02 (0.40%), and cystoids macular edema (CME) in 01(0.20%) eye. None of the eye developed sight threatening complications like retinal detachment or macular hole. The 128 (25.6%) eyes did not achieve the significant improvement because of pre-existing pathology in the posterior segment that was not diagnosed at the time of screening due to thick PCO. CONCLUSION: Nd: YAG laser capsulotomy is effective and convenient method for doing capsulotomy in all types of PCO. It is free from the risk of endophthalmitis found in surgical capsulotomy.

Evaluation of Nd:YAG laser capsulotomy results in patients who underwent cataract extraction and intraocular lens implantation with the endocapsular phacoemulsification method

“…It has been suggested that the incidence of RD increases after Nd:YAG capsulotomy in myopic patients, and that surgeons exercise greater caution and should use minimum energy when performing their surgeries. In contrast, Javed et al [13], Şimsek et al [39], and Khanzada et al [40] found no RD development after Nd:YAG laser capsulotomy. We also did not observe RD development in any of our cases after capsulotomy.…”

“…In previous studies, GIL damage following Nd:YAG laser capsulotomy was reported at a rate of 17.1% by Özkağnıcı et al [43], 11.5% by Esgin et al [22], 7.8% by Rahul et al [28], 5.4% by Khanzada et al [40] 3.3% by Javed et al [13], and 0.5% by Dawood et al [12]. Consistent with the literature, we determined that 3.9% of our patients IOL damage after this surgery.…”

Complications of Nd Yag Laser Capsulotomy

“…IOL Damage (IOl pitting) Hasan KS et al has noted IOL pitting 19.8% in a study of 86 eyes 18 and Haris WS noted 11.7% significant marks on IOL during laser capsulotomy in 342 eyes 19 . The Retro -focusing of laser beam can reduce the risk of IOL damage 20 .…”

“…The mean raised of IOP were 7 mm Hg above the baseline. The frequency of elevation of IOP after yag laser capsulotomy is highly variable ranging from 0.8mm Hg (B) to 82mm Hg 18 in different studies 20,21,22 IOP elevation is usually transient. In another study transient raised of intraocular pressure were 8.69%.…”