Which procedure has more effect on macular thickness: primary posterior continuous capsulorhexis (PPCC) combined with phacoemulsification or Nd:YAG laser capsulotomy?

Impact of Neodymium-Doped Yttrium Aluminum Garnet (ND-YAG) Posterior Capsulotomy Laser Treatment on Central Macular Thickness: A Prospective, Observational Study From a Tertiary Care Center

Introduction

Opacification of the posterior capsule is labeled as a secondary cataract. The objective of the current study was to assess central macular thickness (CMT) changes following neodymium-doped yttrium aluminum garnet (ND-YAG) posterior capsulotomy and to find out the correlation between CMT with the age, energy, and total shots utilized during the procedure.

Methodology

In this single-centered prospective observational study, 137 patients with a mean age of 57 ± 12.61 years, who had cataract surgery previously and were candidates for ND-YAG posterior capsulotomy were recruited through consecutive sampling. The study was conducted at Layton Rahmatulla Benevolent Trust (LRBT) Free Eye Hospital, Township, Lahore, Pakistan, between April 2020 to April 2021. The CMT, total energy, and sum total of shots used were recorded. The thickness of the central macula was measured preoperatively and postoperatively after two weeks. The paired sample t-test was used to find out any significant changes in CMT pre and two weeks postoperatively. The comparison of changes in CMT to age, energy, and the total number of shots was made through Pearson correlation. Means of CMT were compared using an independent sample t-test, at two weeks postoperatively among two energy groups.

Results

No statistically significant differences were found between preoperative and two weeks postoperative values of the CMT (P-value= 0.209). No significant difference was found in CMT statistically among the two energy groups (p=0.11). The patient's age, sum total of laser shots, and aggregate of laser energy did not have any significant correlation with CMT changes. The time period between cataract surgery and ND-YAG surgery showed a moderately positive correlation with a p-value of 0.01.

Conclusion

The current study revealed that ND-YAG capsulotomy does not affect the CMT significantly postoperatively. The patient's age, total energy applied, and the total number of laser shots used do not influence the macular thickness. However, the length of duration from the last cataract surgery to the current surgery was significantly associated with a change in the CMT.

Primary posterior capsulotomy in adults with posterior capsule opacification

PURPOSE

To evaluate the efficacy and safety of primary posterior continuous curvilinear capsulorhexis (PCCC) in adult patients with cataract.

SETTING

Zagazig University Hospital, Ash-Sharkya, Egypt.

DESIGN

Prospective nonrandomized case series.

METHODS

This study comprised patients with senile cataract who had phacoemulsification. All patients had a dense posterior capsule opacification (PCO) discovered intraoperatively. Primary PCCC was performed to remove the residual opacification after posterior capsule polishing. All patients were followed for 3 months postoperatively. The outcome measures were corrected distance visual acuity (CDVA), macular edema detected by optical coherence tomography, and the occurrence of intraoperative or postoperative complications.

RESULTS

Twenty-five eyes of 25 cataract patients had phacoemulsification. The mean age was 61.9 years ± 7.5 (SD). The mean CDVA preoperatively was 0.14 ± 0.08 and postoperatively it was 0.86 ± 0.15 at 1 week, 0.93 ± 0.08 at 1 month, and 0.94 ± 0.08 at 3 months (P = .001). The mean central macular thickness was 313.16 ± 8.39 μm preoperatively and 315.04 ± 10.6 μm, 319.88 ± 26.06 μm, and 316.4 ± 13.7 μm at 1 week, 1 month, and 3 months postoperatively, respectively (P = .35). Posterior capsule opening contracture occurred in 1 eye (4%), although it did not affect the patient's vision. Intraoperative posterior capsule extension occurred in 1 eye (4%). No serious complications, such as retinal detachment or endophthalmitis, were detected in any patient.

CONCLUSION

Cataract surgery with primary PCCC was a safe procedure to treat residual PCO in adults and had a low rate of complications.

FINANCIAL DISCLOSURE

Neither author has a financial or proprietary interest in any material or method mentioned.

The assessment of changes in macular thickness in diabetic and non-diabetic patients: the effect of topical ketorolac on macular thickness change after ND:YAG laser capsulotomy

PURPOSE

The purpose of our study is to assess the changes in macular thickness (MT) in diabetic and non-diabetic patients and to research effects of topical ketorolac (Acular®, Allergan, Irvine, CA) on MT change after neodymium:yttrium aluminum garnet (Nd:YAG) laser capsulotomy.

MATERIAL AND METHODS

This study involved 88 eyes of 88 patients diagnosed as posterior capsule opacification (PCO). Patients were divided into four groups according to presence of diabetes mellitus (DM) and drugs used after capsulotomy. Group 1: Patients with DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy (22 patients). Group 2: Patients with DM using 0.5% ketorolac (Acular®) and 0.1 Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy (20 patients). Group 3: Patients without DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) (22 patients). Group 4: Patients without DM using 0.5% ketorolac (Acular®) and 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) (24 patients). A plus-shaped capsulotomy was performed using VISULAS® YAGIII (Carl Zeiss) laser microscope. MT measurement with Cirrus SD-OCT (Carl Zeiss Opthalmic System Inc., Model 400, Dublin, CA, Software 5) were done. Measurements were done before laser, and on the first day, first week, first month, third month and sixth month after laser capsulotomy. We compared the four groups for MT change during 6 months.

RESULTS

Group 1 involving patients with DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy had increased MT at the first week, and the first, third, and sixth month after laser (p < 0.001). Group 3 involving patients without DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) had increased MT at the first week, and at the first and third month, there was no statistically significant difference at the sixth month (p > 0.05). There was no statistically significant increase in MT during the follow-up period in group 2 involving patients with DM using 0.5% ketorolac (Acular®) and 0.1 Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy and group 4 involving patients without DM using 0.5% ketorolac (Acular®) and 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) (p > 0.05).

CONCLUSION

An increase in MT can be observed after Nd:YAG laser capsulotomy, especially in diabetic patients. Adding topical ketorolac (Acular®, Allergan, Irvine, CA) to topical Fluorometholon (FML®, Allergan, Irvine, CA) therapy after YAG laser capsulotomy can prevent this increase.