Neodymium:YAG laser peripheral iridotomy as a possible cause of zonular dehiscence during phacoemulsification cataract surgery

Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project

“…[21][22][23][24][25][26] Performing LPIs on 2 separate visits could possibly reduce the rate of complications occurring in both eyes simultaneously. In the current study, the most commonly reported complication was an IOP spike, which was treated medically in 6 (9.1%) patients.…”

Reply to Athanasiadis et al

“…We would advocate the use of sequential argon/YAG iridotomy in patients with thick, dark brown irides. 4 Regarding the risk of cataract formation/progression after PI, similar principles to those outlined above apply. With excess power or inappropriately applied laser treatment, it is possible to induce lens opacities, but this can be avoided with careful and precise treatment.…”

Reply to Yip et al

“…Our paper includes reports suggesting the same effect of LPI (both with Nd:YAG and with argon lasers), resulting in spontaneous dislocation of the crystalline lens. 4 We suggested that Nd:YAG LPI may be regarded as an isolated risk factor for structural zonular damage and instability of the crystalline lens, and appropriate precautions should be taken during intraocular surgery. Regardless of the opacification being the result of the LPI, age-related or of any other cause, zonular damage could have considerable implications in subsequent cataract surgery, especially in cases where the zonules are already compromised, such as in pseudoexfoliation syndrome, previous ocular trauma, and congenital systemic diseases like Marfan's syndrome.…”

“…4 This involves damage to the zonules with subsequent dehiscence during routine phacoemulsification cataract surgery, affecting an otherwise healthy female with narrow angles. Our paper includes reports suggesting the same effect of LPI (both with Nd:YAG and with argon lasers), resulting in spontaneous dislocation of the crystalline lens.…”

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