Neodymium YAG Laser and Surgical Synechiolysis of Iridocapsular Adhesions

Abstract

PurposeSeveral articles have been published on the successful elimination of iridolenticular synechiae after cataract extraction with a neodymium YAG laser (Nd:YAG laser) and surgical synechiolysis during cataract surgery, but the indications recommending which method is proper to use for specific kinds of adhesions have not yet been established.MethodsWe retrospectively reviewed the medical records of 106 patients who had undergone Nd:YAG laser or surgical synechiolysis between January 2002 and December 2007 in our clinic. Laser synechiolysis was performed in the synechiae not exceeding the extent of one clock hour and reaching only to the iris sphincter, whereas surgical synechiolysis was performed in other diffuse and/or thick synechiae.ResultsSurgical synechiolysis was performed in 93 eyes, and YAG laser synechiolysis was done in 21 eyes. Increases in best-corrected visual acuity (BCVA) were observed in 61 eyes (53.51%). Intraocular pressure spikes after the procedure were present in only 4 eyes, and all of them were transient except for 1 eye, which needed additional glaucoma eyedrops.ConclusionsWith suitable indications, laser or surgical synechiolysis can be performed safely, and a small rise in visual acuity may also be expected.

Occlusio Pupillae: A Duet of Darkness Where the Patient Sees Naught, and the Doctor Discerns Not

“…Nd:YAG synechiolysis was performed in 21 eyes with synechiae limited to 1 clock hour and to the pupillary sphincter alone. Shots of 0.6 to 1.5 mJ energy were used following the instillation of a mydriatic-cycloplegic to expose the synechiae; three eyes had recurrence needing re-laser [ 9 ].…”

Microperipheral Iridectomy for Troublesome Posterior Synechiolysis in Secondary Intraocular Lens Implantation

“…In the literature, there are several reported methods that may be used to perform synechiolysis. Focal posterior synechia may be treated by initially performing a dissection using a 27-gauge needle [ 15 ], spatula [ 13 ], or Nd:YAG laser [ 13 ]. By contrast, extensive and sticky iridolenticular adhesions may be separated using vitreoretinal scissors through two corneal paracenteses, whereas fibrosis of the iris and capsule may be removed with a vitrector [ 15 ].…”

“…Therefore, it is necessary to separate the posterior synechiae in order to allow the enlargement of the pupil prior to IOL implantation. Insufficient posterior synechiolysis may lead to dislocated IOL, eccentrically positioned IOL, pupillary capture, and deformed pupil, which may cause symptoms such as the edge effect, marked reduction in visual acuity, diplopia, glare [ 12 ], decreased focal depth, and the release of potential inflammatory mediators [ 13 ], thus requiring additional surgery. Local posterior synechiae and synechiae that are located at a site distant from the primary incision are usually easily manageable.…”