Preoperative Nd:YAG laser anterior capsulotomy in white intumescent cataracts: report of 11 cases

Coelho, Roberto Pinto; Paula, Jayter Silva; Silva, Rafael Nery e; Garcia, Tatiana Vannucci; Martin, Luiz Fernando Taranta

doi:10.1590/s0004-27492009000100024

Cited by 8 publications

(10 citation statements)

References 10 publications

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“…1 Any device that can create a more precise and repeatable capsulotomy will help both experienced and less experienced surgeons produce a more consistent outcome even in the most difficult cases, such as intumescent cataract in which the capsule may be more prone to tearing. [3][4][5] For maximum benefit, application of the capsulotomy cut should be made with an immobilized eye. To this end, a system that docks the eye to a laser via a suction ring would seem to provide the most stable setting for locating and measuring the ocular structures and then applying the treatment to the eye without risking movement.…”

Section: Discussionmentioning

confidence: 99%

“…2 The size, shape, and centration of the capsulorhexis can be variable depending on the type of cataract [3][4][5] as well as the surgeon's experience.…”

mentioning

confidence: 99%

“…Some authors suggest that the technique avoids radial tears 15 and provides a useful alternative in intumescent cataract, in which the risk for uncontrolled extension of the manual opening is always present. [3][4][5] Lin and Li 16 found improved outcomes with Nd:YAG laser capsulotomy in congenital cataract as well as easier lens aspiration. When assessing the edge of the cut capsulotomy, Radner et al 10 found the erbium:YAG capsulotomy edge to be intermediate between CCC and high-frequency diathermy in signs of denaturation, mechanical disruption, tears, and microtears.…”

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confidence: 99%

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Anterior capsulotomy with an ultrashort-pulse laser

Tackman

Kuri

Nichamin

et al. 2011

Journal of Cataract and Refractive Surgery

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Section: Discussionmentioning

confidence: 99%

“…2 The size, shape, and centration of the capsulorhexis can be variable depending on the type of cataract [3][4][5] as well as the surgeon's experience.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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Anterior capsulotomy with an ultrashort-pulse laser

Tackman

Kuri

Nichamin

et al. 2011

Journal of Cataract and Refractive Surgery

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“…In previous publications by our group, we showed the successful use of the Nd:YAG laser in cases with white intumescent cataracts, which promoted good results and without complications. 2,3 Several authors were also successful using FLACS for capsulotomies. [4][5][6] Four parameters (anterior chamber depth, axial length, lens thickness, and endothelial cell count) were compared between the two groups; they are related to the occurrence of the Argentinian flag sign in intumescent white cataracts.…”

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confidence: 99%

Comparison between FLACS and Nd:YAG laser in preventing the Argentinian flag sign in intumescent white cataracts

Coelho

Neumann²,

Messias³

2023

J Cataract Refract Surg

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“…Alternatively, using high-cohesive viscoelastics is also helpful in maintaining the pressure on the anterior chamber and creating a complete capsulorhexis. Use of high-frequency diathermy and preoperative Nd:YAG laser anterior capsulotomy has also been reported as an optional technique (Pham et al, 1998;Coelho et al, 2009). Phaco capsulotomy is a technique where the anterior capsule is punctured using a phacoemulsification probe and then the probe is used to debulk the lens matter by aspirating the intralenticular fluid.…”

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confidence: 99%

Phaco capsulotomy in intumescent cataract

Mahalingam

Saurabh²

2014

Nep J Oph

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Dear Editor, Intumescent cataracts are challenging cases even for experienced phaco surgeons (Bhattacharjee et al, 1999;Ermiss et al, 2003). In these eyes, during capsulorhexis, there are very high chances of anterior capsule tears with peripheral extension due to the high pressure of the hydrated cataractous lens. Following this, the continuation of phacoemulsification is extremely difficult and is associated with complications such as posterior capsule tear, vitreous loss and posterior migration of the lens matter. Different methods have been tried to prevent this uncontrolled extension of capsulorhexis. These include direct aspiration of lens fluid using a 26 G needle mounted onto a syringe. Alternatively, using high-cohesive viscoelastics is also helpful in maintaining the pressure on the anterior chamber and creating a complete capsulorhexis. Use of high-frequency diathermy and preoperative Nd:YAG laser anterior capsulotomy has also been reported as an optional technique (Pham et al, 1998;Coelho et al, 2009). Phaco capsulotomy is a technique where the anterior capsule is punctured using a phacoemulsification probe and then the probe is used to debulk the lens matter by aspirating the intralenticular fluid. Once intralenticular pressure is relieved, the capsule is grasped with a capsulorhexis forceps and the rhexis is completed. The initial surgical steps of cataract removal are the creation of the paracentesis and the main wound, capsular staining using trypan blue and maintenance of the anterior chamber using viscoelastics. Using the main wound, the phacoemulsification probe is introduced into the anterior chamber and the tip of the bevel of the phaco hand piece is directed upwards, centered over the center of the anterior capsule. The settings used during phaco capsulotomy are a power 40 %, a vacuum of 200 mm Hg and an aspiration flow rate of 28 cc/min. The foot pedal is pressed to position three and the anterior capsule is punctured with the phaco tip (Figure). This creates the initial anterior capsule puncture with the release of intra-lenticular fluid which is aspirated. The phaco hand piece is then removed from the eye and the viscoelastics are injected into the anterior chamber to pressurize the anterior surface of the capsule. The anterior capsular tear is visualized and grasped with a capsulorhexis forceps. The continuous curvilinear capsulorhexis is then fashioned with the forceps keeping the force of the pull of the rhexis margin to the centre. Following this, the nucleus is removed by phacoemulsification (Song et al, 1998). In conclusion, phacocapsulotomy is a safe and effective technique which prevents sudden extension of capsulorhexis by depressurizing the intralenticular pressure and debulking the lens. This technique prevents the spontaneous peripheral migration of the capsulorhexis edge, thus reducing the concurrent complications. A large series of cases will be required to prove the efficacy and safety of this novel technique.

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Preoperative Nd:YAG laser anterior capsulotomy in white intumescent cataracts: report of 11 cases

Cited by 8 publications

References 10 publications

Anterior capsulotomy with an ultrashort-pulse laser

Anterior capsulotomy with an ultrashort-pulse laser

Comparison between FLACS and Nd:YAG laser in preventing the Argentinian flag sign in intumescent white cataracts

Phaco capsulotomy in intumescent cataract

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