Cumulative probability of neodymium: YAG laser posterior capsulotomy after phacoemulsification

Five-Year Incidence of Nd:YAG Capsulotomy After Cataract Surgery with Different Single-Piece Monofocal Intraocular Lenses: A Follow-Up Study of 3955 Eyes

Purpose

To estimate the incidence of neodymium-doped yttrium aluminum garnet laser (Nd:YAG) capsulotomy up to five years after cataract surgery with different single-piece acrylic monofocal IOLs in a Spanish cohort.

Patients and Methods

Data were extracted from electronic medical records. Eligible participants were aged ≥65, had cataract surgery with one of five different acrylic monofocal IOLs (Alcon AcrySof, AJL LLASY60, Medicontur Bi-flex, IOL Tech Stabibag and Zeiss Asphina), and more than six months baseline data. Participants were followed up to five years from surgery and up to six months from Nd:YAG. The incidence of Nd:YAG was compared between the IOLs and multivariate analyses were conducted to identify predictors of Nd:YAG incidence at five-years after cataract surgery.

Results

The initial cohort included 9545 patients with 14,519 eyes (53% female, average age 75 years). Of those, 3955 eyes were available for analysis five years after cataract surgery. Throughout the five years post-surgery, Nd:YAG incidence was consistently lower with Alcon Acrysof IOLs than the other IOLs. At five years the Nd:YAG incidence rate for Alcon Acrysof was 8.8%. In comparison, the incidence was 47.4% for AJL LLASY60 (OR = 9.54, 95% CI [6.57, 13.84]), 44.3% for Zeiss Asphina (OR = 8.35, 95% CI [5.85, 11.94]) and 44.0% for IOL Tech Stabibag (OR = 8.02, 95% CI [4.60, 13.84]).

Conclusion

Alcon AcrySof IOLs have a consistently lower risk of Nd:YAG incidence over a long follow-up period after cataract surgery, highlighting the importance of IOL choice for patients' long-term outcomes.

Development and Validation of a Prediction Model for Nd:YAG Laser Capsulotomy: A Retrospective Cohort Study of 9768 eyes

INTRODUCTION

Posterior capsular opacification (PCO) is the most common complication of cataract surgery. In this study, we develop a model to quantitatively predict the probability of Nd:YAG laser capsulotomy for vision-threatening PCO to improve the life quality of postoperative patients.

METHODS

A registry analysis of cataract procedures performed between the years 2010 and 2021. Following the screening of 16,802 patients (25,883 eyes), 9768 patients (eyes) were enrolled. The cohort was randomly divided into two groups: training (n = 6838) and validation (n = 2930). To identify relevant risk factors, univariate, multivariate, and Least Absolute Shrinkage and Selection Operator (LASSO) algorithm Cox regression analysis were employed, and a nomogram was created to demonstrate the prediction result.

RESULTS

At 5 years, the overall cumulative incidence of Nd:YAG laser capsulotomy was 12.0% (1169/9768). The following variables were included in the prediction model: sex [hazard ratio (HR) = 1.53, 95% CI 1.32-1.76], age (HR = 0.71, 95% CI 0.56-0.88), intraocular lens (IOL) material (HR = 2.65, 95% CI 2.17-3.24), high myopia (HR = 2.28, 95% CI 1.90-2.75), and fibrinogen (HR = 0.79, 95% CI 0.72-0.88). In the validation cohort, the area under the curve (AUC) of 1-, 3-, and 5-year predictions for Nd:YAG laser capsulotomy were 0.702, 0.691, and 0.688, respectively. For a subgroup of patients with high myopia, the protective effect of hydrophobic IOL disappeared (HR = 0.68, 95% CI 0.51-1.12, P = 0.127).

CONCLUSION

This model could predict the probability of Nd:YAG laser capsulotomy for vision-threatening PCO after cataract surgery by taking into account factors such as age, gender, IOL material, high myopia, and fibrinogen. Meanwhile, implantation of a hydrophobic IOL in individuals with high myopia did not demonstrate a protective impact against vision-threatening PCO.

Cataract surgery in patients with retinitis pigmentosa: systematic review

Retinitis pigmentosa (RP) is an inherited bilateral retinal degenerative disease with an incidence of 1 in 4000 people. RP affects more than 1 million individuals worldwide. Although night blindness and restricted visual field are the most typical symptoms of these individuals, generalized vision loss due to cataracts can be expected in the latter stages of the disease. It has been demonstrated that posterior subcapsular cataract is the most prevalent cataract in younger individuals with RP, as opposed to age-related cataracts. Although most ophthalmologists may have a negative view of cataract surgery in patients with RP, it appears that it can play an important role in the visual restoration of patients with RP. However, there are concerns about performing cataract surgery for patients with RP. Herein, a systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses on databases of MEDLINE and Scopus.

The Protective Effect of Metformin Use on Early Nd:YAG Laser Capsulotomy

Purpose

To determine the effect of metformin on early Nd:YAG laser treatment for posterior capsule opacification (PCO) and to explore a molecular mechanism to explain a possible protective effect of metformin against PCO.

Methods

We conducted: 1) a retrospective cohort study of patient eyes undergoing phacoemulsification at our institution; and 2) laboratory investigation of the effect of metformin on the behavior of lens epithelial cells in the context of an animal model for PCO. Population-averaged Cox proportional hazards modeling was used to estimate risk for time to Nd:YAG. For laboratory studies, expression of markers for epithelial-to-mesenchymal transition (EMT) implicated in PCO pathogenesis was measured in tissue culture and following extracapsular lens extraction in a mouse model.

Results

The rate of Nd:YAG laser capsulotomy was 13.1% among the 9798 eyes. Both metformin use and diabetes were protective factors for Nd:YAG laser capsulotomy in univariate analysis. However, in multivariable analysis with nondiabetics as the reference group, only metformin use among diabetics was significantly protective of Nd:YAG (hazard ratio: 0.68, 95% CI: 0.54–0.85, P = 0.0008), while eyes of patients with diabetes without metformin use did not significantly differ (P = 0.5026). Treatment of lens epithelial cells with metformin reduced the level of the EMT markers ⍺-SMA and pERK induced by TGF-β2. Similarly, metformin treatment reduced ⍺-SMA expression in lens epithelial cells following extracapsular lens extraction in a mouse model.

Conclusions

The protective effect of metformin against early Nd:YAG may relate to its ability to downregulate EMT in residual lens epithelial cells that otherwise trend toward myofibroblast development and PCO.

A Review of Complicated Cataract in Retinitis Pigmentosa: Pathogenesis and Cataract Surgery

Retinitis pigmentosa (RP) is a set of inherited retinal degenerative diseases that affect photoreceptor and retinal pigment epithelial cells (RPEs), possibly associated with some ocular complications, including cataract. The complicated cataract formation is most likely the result of RP-related inflammation response, and the most common morphology category is posterior subcapsular cataract (PSC). Despite the absence of curative pharmacologic treatment, phacoemulsification with intraocular lens implantation to deal with opacification in the lens is preferred due to the considerable visual outcomes. However, the incidence of intraocular and postoperative complications is higher in RP patients than those without, including intraoperative phototoxic retinal damage, posterior capsular opacification (PCO), capsular contraction syndrome (CCS), pseudophakic cystoid macular edema (PCME), increased postoperative intraocular pressure (IOP), and intraocular lens (IOL) dislocation. Hence, it needs much attention to surgery progress and close follow-up. In this review, we discuss the current understanding of RP patients with complicated cataracts from morphology to potential pathogenesis to cataract surgical procedure and provide a concise description and the recommended management of related surgery complications to broaden the knowledge and lower the latent risks to yield better clinical outcomes.

Intraocular Lens Power, Myopia, and the Risk of Nd:YAG Capsulotomy after 15,375 Cataract Surgeries

The present study estimated the 5-year cumulative probability of Nd:YAG laser posterior capsulotomy according to the diopter power of implanted hydrophobic acrylic intraocular lenses (IOLs). Data were retrospectively collected of 15,375 eyes having cataract surgery and in-the-bag implantation of hydrophobic acrylic monofocal IOLs at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland between the years 2007 and 2016. The cumulative probability of Nd:YAG capsulotomy was calculated by Kaplan-Meier estimates, and potential risk factors were analyzed using the Cox proportional hazards model. The 5-year cumulative probability of Nd:YAG capsulotomy after cataract surgery was 27.4% (95% confidence interval (CI) 22.9-32.6%) for low-diopter (5-16.5 D) IOLs, 14.6% (13.8-15.5%) for mid-diopter (17-24.5 D) IOLs, and 13.6% (11.7-15.6%) for high-diopter (25-30 D) IOLs. A multivariate Cox regression analysis showed that low-diopter IOLs (HR 1.76; 95% CI 1.38-2.25; p < 0.001) were associated with an increased risk of Nd:YAG capsulotomy compared to mid-diopter IOLs over the follow-up period after accounting for other predictors. Real-world evidence shows that low-diopter IOLs are associated with significantly higher risk of Nd:YAG capsulotomy within five years following implantation. Estimation should help in evaluating the risks of cataract surgery in myopic eyes.

Anti-inflammatory Medication After Cataract Surgery and Posterior Capsular Opacification

PURPOSE

To assess the role of anti-inflammatory medication following cataract surgery on the formation of posterior capsular opacification.

DESIGN

Cohort study.

METHODS

A retrospective registry analysis of 25,818 consecutive patients who underwent cataract surgery between the years 2014 and 2018 at Helsinki University Hospital in Finland. Nd:YAG laser capsulotomy rates were compared between patients treated postoperatively with topical steroids, nonsteroidal anti-inflammatory medications (NSAIDs), or their combination. Kaplan-Meier and Cox regression analyses were used. A single eye of each patient was included. Main outcomes were confirmed against a second independent dataset.

RESULTS

A total of 13,368 patients were included in the analysis, with a mean age of 73.2 ± 9.7 years; 61.7% were female. Pseudoexfoliation was noted in 10.1% of cases. The mean follow-up time was 22.8 ± 15.7 months. Patients were treated with steroid monotherapy (28.9% of cases), NSAID monotherapy (62.2%), or a combination of both (8.9%). Treatment with steroids resulted in significantly lower Nd:YAG capsulotomy rates compared to NSAIDs (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.62-0.93, P = .009). Treatment with combination therapy of steroids and NSAIDs showed no added benefit over steroid monotherapy (HR 1.11, 95% CI 0.68-1.80, P = .674). Cox regression analysis adjusted for patients' age, sex, pseudoexfoliation, and risk stratification remained significantly predictive for lower capsulotomy rates with steroid treatment over NSAIDs (HR 0.70, 95% CI 0.52-0.88, P = .001).

CONCLUSIONS

Postoperative treatment with steroids among patients undergoing uncomplicated cataract surgery was associated with lower rates of clinically significant posterior capsule opacification compared to treatment with NSAIDs alone. Combination therapy of steroids and NSAIDs had no added benefit over steroids alone.

Five-Year Cumulative Incidence and Risk Factors of Nd:YAG Capsulotomy in 10 044 Hydrophobic Acrylic 1-Piece and 3-Piece Intraocular Lenses

PURPOSE

To evaluate the 5-year cumulative incidence and risk factors of Nd:YAG capsulotomy between hydrophobic acrylic intraocular lenses (IOLs).

DESIGN

A retrospective cohort study.

METHODS

A review of the registry of operations between the years 2007 and 2016 was carried out at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland. A total of 10 044 eyes having cataract surgery and in-the-bag implantation of ZCB00 (Abbott Medical Optics Johnson & Johnson Vision, Inc, Abbott Park, Illinois, USA), SN60WF (Alcon Laboratories, Inc, Fort Worth, Texas, USA), or ZA9003 (Abbott Medical Optics Johnson & Johnson Vision, Inc) IOLs were included in the study. The cumulative incidence of Nd:YAG capsulotomy was estimated with competing risks methodology. Competing risks regression modeling was used to evaluate potential risk factors, including the patient's age, sex, type of IOL, dioptric power of IOL, and operating surgeon's seniority.

RESULTS

The 5-year cumulative incidence of Nd:YAG capsulotomy after cataract surgery was 13.2% (95% confidence interval [CI] 12.5%-14.0%) for all eyes and 18.1% (16.5%-20.0%), 11.5% (10.5%-12.6%), and 9.6% (8.2%-11.4%) for ZCB00, SN60WF, and ZA9003 IOLs, respectively. Implantation of SN60WF and ZA9003 IOLs was associated with a 38% and 47% subhazard reduction (SHR), respectively, compared to ZCB00, after accounting for other predictors (SHR = 0.62; 95% CI 0.54-0.71; P < .001 and SHR = 0.53; 95% CI 0.43-0.64; P < .001). Increased risk of Nd:YAG capsulotomy was associated with eyes of patients aged younger than 60 years, female sex, and eyes implanted with an IOL of <22.5 diopters power.

CONCLUSION

Real-world evidence suggests that the cumulative incidence of Nd:YAG capsulotomy is significantly lower in eyes receiving SN60WF or ZA9003 IOLs compared to ZCB00.

Laser capsulotomy following cataract surgery: Comparing time to capsulotomy with implantation of two broadly used intraocular lenses

PURPOSE

The aim of this study is to compare the length of time from uneventful cataract surgery using one of two common posterior chamber intraocular lenses (IOLs) (hydrophilic versus hydrophobic acrylic) to laser capsulotomy.

MATERIALS AND METHODS

Retrospective analysis of all patients who underwent neodymium: yttrium-aluminum-garnet laser capsulotomy between 2011 and 2014 following uneventful phacoemulsification surgery at a tertiary university-affiliated medical center. Medical records were reviewed for demographics, ocular comorbidities, operative details, postoperative follow-up, and findings of the precapsulotomy ophthalmologic examination. Parameters, including age, sex, laterality, visual acuity, surgeon's experience, and time from cataract surgery to capsulotomy, were compared between patients who received hydrophilic (SeeLens AF, Kibbutz Hanita, Israel) or hydrophobic (AcrySof SA60AT, Alcon Laboratories, Fort Worth, TX, USA) IOLs.

RESULTS

The cohort included 222 patients (255 eyes), of which, 107 were male and 115 female, of mean age 73 ± 8 years. Mean interval from cataract surgery to laser capsulotomy was 24 months (range 2-70) and was significantly shorter in patients with SeeLens (23 ± 13 months) than AcrySof IOL implantation (28 ± 13 months, P = 0.04). Lens type remained significant in multivariate analysis after including surgeon's experience and age as potential confounders (P = 0.04).

CONCLUSION

The hydrophilic SeeLens IOL is associated with a significantly shorter time interval from cataract surgery to laser capsulotomy than the hydrophobic AcrySof IOL.

Outcomes of phacoemulsification in patients with chronic ocular graft-versus-host disease

PURPOSE

The purpose of this study was to evaluate the outcomes of phacoemulsification in patients with ocular graft-versus-host disease (GVHD).

METHODS

The occurrence of cataracts, cataract surgery, and its outcomes were analyzed in the medical records of 229 patients (458 eyes) with ocular GVHD. Outcome measures included pre- and postoperative corrected distance visual acuity (CDVA) and the rate of postoperative complications.

RESULTS

Of the 458 eyes evaluated, 58 were pseudophakic; from the 400 phakic eyes, 238 (59 %) presented with cataracts and 62 (26 %) underwent cataract surgery. Analysis of postoperative complications and visual outcomes at 1 month was performed in 51 eyes in which detailed surgical and immediate postoperative records were available. Preoperatively, the mean CDVA was 0.67 ± 0.57 LogMAR (Snellen 20/93), improving postoperatively to 0.17 ± 0.18 (Snellen 20/29) at 1 month (P < 0.0001), and to 0.13 ± 0.14 (Snellen 20/26) by the final follow-up visit (P < 0.0001). Postoperative complications included corneal epithelial defects (8 %), filamentary keratitis (6 %), worsening of corneal epitheliopathy (16 %), posterior capsular opacification (18 %), and cystoid macular edema (4 %). A corrected distance visual acuity of 20/30 or better was achieved in 87 % of the eyes; suboptimal CDVA improvement was attributable to severe ocular surface disease, pre-existing advanced glaucoma, and prior macular surgery.

CONCLUSIONS

Phacoemulsification in patients with chronic ocular GVHD is a safe and efficacious procedure resulting in significant visual improvement. Overall, postoperative adverse events responded well to timely management.

[Posterior capsule opacification, capsular bag distension syndrome, and anterior capsular phimosis: A retrospective cohort study]

OBJECTIVE

To determine the incidence and the risk factors involved in the development of the three main postoperative capsular complications: posterior capsule opacification (PCO), capsular bag distension syndrome (CBDS), and anterior capsular phimosis syndrome (ACP).

SUBJECTS, MATERIAL AND METHODS

A retrospective cohort study was conducted on 801 patients submitted to cataract surgery in the ophthalmology unit of Hospital del Henares (Madrid) from March 2, 2009 to February 28, 2010. Computerized clinical charts were reviewed during July 2012. PCO was studied using the Kaplan-Meier method (log rank test).

RESULTS

A total of 167 patients developed PCO. No association could be demonstrated between PCO and age, sex, diabetes mellitus, phaco technique, IOL model, tamsulosin intake, glaucoma, and age-related macular degeneration. Three patients developed CBDS, all of them have received and Akreos Adapt AO(®) (Bausch & Lomb). Two of them were young men who had received surgery for posterior subcapsular cataracts. Three patients developed ACP, 2 of whom had received a MicroSlim(®) IOL (PhysIOL).

CONCLUSIONS

No association was found between PCO and any of the studied variables. Male gender, young age, subcapsular cataract and large non-angulated lens such as Akreos Adapt AO(®) could be associated with CBDS. ACP could be more frequent when microincision IOLs (like MicroSlim(®)) are implanted.

Five-year incidence of Nd:YAG laser capsulotomy and association with in vitro proliferation of lens epithelial cells from individual specimens: a case control study

Background

The aims of this study were to determine the 5-year incidence of posterior capsule opacification (PCO) requiring Nd:YAG laser capsulotomy in a representative mixed cohort of cataract patients, to determine risk factors for PCO and to investigate possible association with growth of human lens epithelial cells (HLEC) in vitro.

Methods

Pieces of the anterior lens capsule and adhering HLEC were obtained at cataract surgery and cultured individually. After one and two weeks respectively, cultured cells were stained with carboxy-fluorescein diacetate succinimidyl ester (CFDA SE), after which image processing software was used to determine the area of the confluent cell layer. The 5-year incidence of Nd:YAG laser capsulotomy in this cohort was determined through medical records and by mail or telephone interviews. For statistic analyses Mann–Whitney U-test, Fisher’s exact test and binary logistic regression were used.

Results

Data on treatment/no treatment for PCO was obtained from 270 patients with a median follow-up time of 57 months (range 50–64 months). The three-year cumulative incidence of PCO was 5.2% and the cumulative 5-year incidence was 11.9%. Patients who had undergone Nd:YAG laser capsulotomy were significantly younger (median 71 years) than patients who did not receive treatment for PCO (median 75 years, p = 0.022). Logistic regression demonstrated that apart from younger age, follow-up time and type of intraocular lens (IOL) were associated with risk of PCO, with hydrophilic 1-piece IOLs conferring a higher risk than hydrophobic acrylic 1-piece or 3-piece IOLs (adjusted OR = 9.4, 95% CI 2.5-35.7, p = 0.001). Of the 270 patients from whom information could be retrieved regarding PCO treatment, in vitro cell culture could be established and quantified from 185 patients. No significant difference in cell growth in vitro was shown between patients subsequently requiring/not requiring Nd:YAG laser capsulotomy.

Conclusions

The cumulative 5-year incidence of 11.9% is comparable or slightly higher than reported in other recent studies. The type of IOL was the most important risk factor for PCO in this study, whereas intrinsic proliferative capacity of the individual’s lens epithelial cells seems to be less important for subsequent PCO development.

Cumulative probability and risk analysis for Nd:YAG laser capsulotomy

AIM: To estimate the cumulative probability of Nd:YAG capsulotomy at a teaching institution and evaluate secondary risk factors.

METHODS: The records of all patients who underwent phacoemulsification with intraocular lens (IOL) placement between 2005-2010 were retrospectively reviewed. The cumulative probability of Nd:YAG capsulotomy (capsulotomy) was calculated using Kaplan-Meier survival analysis and secondary risk factors were evaluated using the Cox proportional hazards regression model.

RESULTS: One thousand three hundred and fifty four charts were reviewed. A total of 70 capsulotomies were performed. The mean follow-up was 19.4 mo (standard deviation 17 mo). The cumulative probability of capsulotomy was 4% at 1 year, 5% at 2 years, and 9% at 3 years. Multivariate analysis demonstrated an increased risk with younger age (HR = 1.03, CI 1.01-1.05, P = 0.007), placement of sulcus IOL (HR = 2.57, CI 1.32-4.99, P = 0.005), ocular trauma (HR = 2.34, CI 1.13-4.83, P = 0.02), and phacoemulsification by a more experienced surgeon (HR = 4.32, CI 1.89-9.87, P = 0.001).

CONCLUSION: Cumulative probability of capsulotomy was lower than previously reported. Posterior capsule opacification was strongly associated with younger age and factors associated with high-risk cataract surgery. Surgeon awareness to the risk factors that correlate with posterior capsulotomy may allow for more thorough pre-operative disclosure and enhance patient satisfaction.

In vitro growth of lens epithelial cells from cataract patients - association with possible risk factors for posterior capsule opacification

AIM

Inter-individual differences in intrinsic proliferative capacity of lens epithelial cells may have importance for the risk of developing posterior capsule opacification (PCO) after cataract surgery. The purpose of the present study was to determine growth of human lens epithelial cells (HLEC) in culture and investigate possible associations with clinical characteristics of the donors, such as age, sex, pseudoexfoliation, uveitis and diabetes.

METHODS

Pieces of lens capsule and adhering lens epithelial cells were obtained through capsulorhexis at cataract surgery. Specimens were cultured in a humidified CO2-incubator using standard culture medium and 5% fetal calf serum for two weeks after which cultured cells were stained with carboxy-fluorescein diacetate succinimidyl ester. Image processing software was used to determine the area of the confluent epithelial cell layer in relation to the size of the original capsule specimen.

RESULTS

The increase in area of confluent HLEC showed a negative correlation with diabetes at the first week after surgery. Lower age and female sex showed border-line significant associations with a higher rate of cell proliferation. The presence of pseudoexfoliation in vivo did not significantly affect cell growth in culture postoperatively. Nor did installation of xylocain in the anterior chamber during surgery.

CONCLUSION

Diabetes is associated with lower rate of proliferation of lens epithelial cells in culture. The lack of strong correlations between in vitro growth and known risk factors for PCO in the donors suggest that other factors than the proliferative capacity of the cells per se are important for PCO formation.

Three-year incidence and factors associated with posterior capsule opacification after cataract surgery: The Australian Prospective Cataract Surgery and Age-related Macular Degeneration Study

PURPOSE

To assess 3-year incidence and associated factors of posterior capsule opacification (PCO) after phacoemulsification surgery.

DESIGN

Cohort study.

METHODS

A total of 1934 consecutive patients aged ≥64 years undergoing phacoemulsification surgery at Westmead Hospital were recruited, of whom 1495 (77.3%) had retroillumination anterior segment images taken of the surgical eyes after 1 month and at a further postoperative visit within 3 years. Severe PCO was defined if the view of the optic disc was obscured, or neodymium-yttrium-aluminum-garnet capsulotomy was performed. Cumulative incidence of PCO was estimated using Kaplan-Meier methods. Associations of PCO with surgeon groups and different types of implanted intraocular lenses (IOLs) were assessed, adjusting for age, sex, diabetes, and ethnicity.

RESULTS

Three-year cumulative incidence of PCO was 38.5% (95% confidence interval [CI] 36.1%-40.9%) among the 1495 patients, including 4.7% (95% CI 3.5%-5.8%) with severe PCO. PCO incidence was higher in: (1) eyes operated on by junior trainees (49%) compared to those by senior ophthalmologist surgeons (36%) (adjusted odds ratio [OR] 1.6, 95% CI 1.2-2.0); and (2) eyes with hydrophobic, 3-piece (either square-edged [51%, OR 2.3, 95% CI 1.4-3.6] or partial-round-edged [39%, OR 1.5, 95% CI 1.1-2.1]), or hydrophilic IOLs (64%, OR 2.9, 95% CI 1.9-4.4) compared to those with single-piece, square-edged, hydrophobic IOLs (34%), after additional adjustment for surgeon group.

CONCLUSIONS

Predominantly mild PCO occurred in one-third of eyes after phacoemulsification surgery. Possible predisposing factors associated with PCO development include surgery performed by ophthalmologic trainees and the use of hydrophilic or other hydrophobic IOLs apart from the single-piece, square-edged one.

Cataract extraction outcomes and the prevalence of zonular insufficiency in retinitis pigmentosa

PURPOSE

To examine surgical outcomes in patients with retinitis pigmentosa (RP) undergoing phacoemulsification cataract extraction.

DESIGN

Retrospective observational case series.

PATIENTS AND METHODS

In this single-institution study of consecutive RP patients who underwent phacoemulsification cataract extraction and intraocular lens implantation by a single surgeon between 2002 and 2012, preoperative, intraoperative, and postoperative records were analyzed with attention to best-corrected visual acuity (BCVA), lens and zonular status, capsular tension ring use, incidence of posterior capsular opacification and neodymium-doped yttrium-aluminum-garnet (YAG) laser capsulotomy, and surgical complications.

RESULTS

Eighty eyes of 47 RP patients (21 male) underwent cataract surgery during the study period at an average age of 48.9 years (range, 31-78 years). Mean follow-up time was 23.3 months (range, 1 day - 95 months). Posterior subcapsular cataracts were present in 97.5% of patients. Mean BCVA improved from 20/340 (logarithm of the minimal angle of resolution [logMAR] 1.23) to 20/129 (0.81) within 3 months of surgery, P < .0001. Eyes with a preoperative vision of 20/40 to 20/200 (47 eyes) improved from a mean of 20/81 (logMAR 0.61) preoperatively to 20/43 (0.33), P < .0001, postoperatively. Posterior capsule opacification occurred in 66 eyes (82.5%), and 42 eyes (52.5%) underwent a YAG laser capsulotomy at a mean of 10.8 months after surgery. Fifteen eyes (18.8%) of 10 patients (21.3%) had signs of phacodonesis (3 eyes noted preoperatively, 8 intraoperatively, and 4 postoperatively). One patient had bilateral dislocated in-the-bag intraocular lenses at 5.5 years and 6 years after surgery.

CONCLUSION

Cataract surgery yields significantly improved Snellen visual acuity in a majority of RP patients with a preoperative vision of 20/200 or better. Conversely, patients with a preoperative visual acuity of 20/400 or worse generally have more limited objective improvements, likely because of macular involvement, but usually report noticeable subjective improvement. A high prevalence of zonular instability is seen in RP patients undergoing cataract extraction. It is therefore important to conduct a careful preoperative assessment of lens stability with preparation for adjunctive methods that augment intraoperative and postoperative lens stabilization.

Visual function and quality of life in pseudophakic patients before and after capsulotomy

PURPOSE

To assess the correlation between visual acuity, visual function, and health-related quality of life before and after neodymium:YAG laser posterior capsulotomy.

METHODS

A total of 150 patients with posterior capsule opacification (PCO) were examined before and after capsulotomy. Ocular examination, visual acuity, patient reports of satisfaction with vision, and disease-specific (VF-14 Index of Visual Functions) and generic (EuroQol: EQ-5D) outcomes were measured at baseline and 3 weeks after treatment.

RESULTS

After capsulotomy, patients showed significant improvements in binocular visual acuity, VF-14 index, satisfaction with vision, and EQ-5D measures. The average gains in visual function and quality of life were apparent in groups with good visual outcome and poor visual outcome. The VF-14 score improvement was moderately correlated with the EuroQol Visual Analogue Scale score improvement, showing stronger correlations with changes in self-reported satisfaction with vision than did gains in binocular visual acuity.

CONCLUSIONS

Measuring of the outcomes of capsulotomy by clinical indicators alone may underestimate the overall benefits of treatment. Visual acuity in conjunction with visual function and health-related quality of life questionnaires will likely prove to be better indicators of the need for and outcome of capsulotomy.

[Phacoemulsification and acrylic intraocular lens in uveitis: a comparative study]

OBJECTIVE

To describe the outcomes of phacoemulsification with the implant of an acrylic intraocular lens (IOL) in cataracts of adult patients with and without uveitis

METHODS

Descriptive retrospective comparative study of 35 patients (45 eyes) with uveitis (group 1) and 38 (44 eyes) control patients (group 2), who were operated on by the same surgeon, and were homogeneous as regards sex, surgical technique, IOL (hydrophobic or hydrophilic) and follow-up. The pre-surgical characteristics of risk, the difficulties and intra-surgical and postsurgical complications, the date of posterior capsulotomy (PC) and the pre- and post-surgical visual acuity (VA), were analysed.

RESULTS

In both groups the coaxial phacoemulsification was used in 75% of the eyes, bimanual microincision cataract surgery (MICS) in 20% and micro-coaxial in the rest. The pre-surgical risk factors (P = .002, OR 6.83), the surgical difficulties and complications (P = .001, OR 7.54) and postsurgical complications (P = .069, OR 3.42) were more frequent in the uveitis group. In both 93% and 91% respectively of eyes improved 2 or more lines of VA. After an average follow-up of 4.9 years in both groups, 22.7% and 32% eyes (log-rank P = .357) needed PC. The hydrophilic IOLs needed PC earlier than the hydrophobic ones (log rank P = .001), neither the location nor the uveitis course influenced the PC rate.

CONCLUSIONS

The consequences because of previous ocular inflammation make cataract surgery in uveitis more difficult, but with postsurgical complications, visual results and need of PC similar to our patients without inflammation.

[Impact of Nd: YAG capsulotomy on quality of life in pseudophakic patients]

OBJECTIVE

To determine whether visual acuity (VA) improvement in patients with posterior capsule opacification (PCO), accepted after the capsulotomy, is followed by positive changes in the perception of their quality of life.

METHOD

A total of 130 patients with PCO were examined before and after capsulotomy. In addition to the ophthalmic examination, the EuroQol questionnaire was completed. We analyzed the influence of demographic characteristics on the outcome of the test.

RESULTS

The mean binocular visual acuity (BVA) and the mean scores in the EuroQol dimensions and EQ-VAS improved significantly after capsulotomy. VA did not have the same effect on daily common tasks. After treatment, the problems in the usual activities dimension have seen the largest reduction. Mobility is still the dimension with more problems regarding patients after capsulotomy.

CONCLUSIONS

Decreased VA induced by PCO is associated with difficulties performing daily living activities. Capsulotomy results in a gain in VA and functional ability of the majority of patients, improving the perception of their quality of life.

Rapid capsular phimosis in retinitis pigmentosa

This case report retrospectively reviews the outcome of a 43-year-old man with retinitis pigmentosa who suffered rapid anterior capsular phimosis in each eye within 3 weeks following uncomplicated phacoemulsification with continuous curvilinear capsulorrhexis and single-piece acrylic intraocular lens (IOL) implantation. Anterior YAG capsulotomy was successfully performed in both eyes. It has been previously documented in the literature that capsular phimosis is more common in patients with retinitis pigmentosa. However, in the cases that were reviewed, capsular contracture progressed much less rapidly than in this patient. It is proposed that zonular dehiscence or increased lens epithelial cell fibrosis accompanying retinitis pigmentosa may be responsible for phimosis following phacoemulsification; in this case, the single-piece IOL may have offered less resistance to capsular contraction. Using a three-piece IOL, capsular tension ring, or making radial relaxing incisions in the anterior lens capsule may be useful approaches to minimize the aforementioned complications in patients with retinitis pigmentosa and cataracts.

Misdiagnosis of Hydrophilic Acrylic Intraocular Lens Optic Opacification

PURPOSE

To report 8 patients with misdiagnosis of MemoryLens intraocular lens (IOL) late postoperative calcification and the resulting potentially avoidable procedures leading to secondary complications.

DESIGN

Retrospective interventional case series.

PARTICIPANTS

Eight patients with an opacified hydrophilic acrylic MemoryLens.

METHODS

Eight cases of MemoryLens IOL opacification that were originally misdiagnosed were reviewed. The following parameters were noted: baseline patient characteristics, time frame of IOL opacification, original misdiagnosis, subsequent surgical procedures, and postexplantation outcomes and complications. Two explanted lenses from this series were available for laboratory analyses. They underwent gross and light microscopic evaluation and scanning electron microscopy with energy-dispersive x-ray spectroscopy (EDS).

MAIN OUTCOME MEASURES

Patient parameters noted above. The IOLs were examined for distribution, structure, and composition of the deposits causing opacification of their optic components.

RESULTS

All 8 patients' IOLs were implanted between August 1999 and March 2000. Complaints of decreased visual function occurred 13 to 58 months after implantation. Half of the patients were initially diagnosed as having posterior capsular opacification and underwent neodymium:yttrium-aluminum-garnet laser capsulotomy. The other half were initially diagnosed with some form of vitreous involvement and underwent vitrectomies. Six of the 8 patients underwent subsequent lens exchanges, with 3 of them having postexchange complications including endophthalmitis, cystoid macular edema, and retinal detachment. Scanning electron microscopy with EDS confirmed the presence of calcified deposits on the surface of the 2 explants available for analysis. The deposits also stained positive for calcium.

CONCLUSIONS

Despite previous reports, misdiagnosis of MemoryLens IOL calcification leading to optic opacification still occurs. Not recognizing this process can lead to potentially avoidable surgical procedures and increased risk of complications after repeated interventions.

Status of accommodative intraocular lenses

PURPOSE OF REVIEW

This review examines the recent peer-reviewed literature of the past 18 months, with the goal of providing an overview of the pseudophakic lenses designed to provide accommodative action. Accommodative lenses take advantage of axial movement, refractive change and bag filling to provide their effect. Single and dual optic design, as well as unique technologies, were reviewed.

RECENT FINDINGS

An overview is presented of the various accommodative lenses available for investigation and use. There is positive evidence that current accommodative intraocular lenses provide superior potential for near vision compared with standard intraocular lenses.

SUMMARY

The available data suggest that accommodative amplitude and pseudoaccommodation are both important factors in the functional ability of accommodative intraocular lenses to provide a range of distance, intermediate and near vision.

Phacoemulsification cataract extraction and intraocular lens implantation in patients with uveitis

PURPOSE

To analyze the outcomes of phacoemulsification cataract extraction and intraocular lens (IOL) implantation in patients with uveitis.

SETTING

Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan.

METHODS

The records of 95 patients (131 eyes) with uveitis who had phacoemulsification cataract extraction and IOL implantation between 1990 and 2001 were retrospectively examined. The postoperative visual outcomes and complications were analyzed.

RESULTS

The mean age of the 36 men and 59 women was 61.7 years (range 30 to 87 years) At the final follow-up examination, 111 eyes (84.7%) had improved visual acuity and 97 eyes (74.0%) had a final visual acuity of 0.5 or better. Patients with Behçet's disease had significantly worse visual outcomes than patients with other clinical etiologies of uveitis such as human T-lymphotropic virus type 1 uveitis and Vogt-Koyanagi-Harada disease. In 17 eyes (13.0%), relapse of intraocular inflammation occurred within 6 months after surgery; the rate of relapse was highest in patients with Behçet's disease (35.2%). Posterior synechias occurred in 8 eyes (6.1%), pupillary capture in 1 eye (0.8%), intraocular pressure elevation in 11 eyes (8.4%), and cystoid macula edema in 8 eyes (6.1%). In 31 eyes (23.7%), posterior capsule opacification required neodymium:YAG capsulotomy.

CONCLUSIONS

The outcomes of phacoemulsification cataract extraction and IOL implantation in patients with uveitis were satisfactory. Patients with Behçet's disease related to intraocular inflammation, however, appeared to have a higher risk for complications and therefore worse outcomes than patients with other clinical etiologies of uveitis.

Posterior capsule opacification: comparisons between morphology, visual acuity and self-assessed visual function

PURPOSE

To investigate whether posterior capsule opacification (PCO) morphology, visual acuity (VA) and self-assessed visual function correlate, and to compare perceived visual disabilities with those of cataract patients with corresponding VA.

METHODS

Twenty-one patients with PCO were examined before capsulotomy. In adjunct to the ophthalmological examination, the patients completed a Catquest questionnaire and a digitized retroillumation image was acquired. The images were analysed with the Evaluation of Posterior Capsule Opacification (EPCO) program. Data for visual function were compared with data from the National Swedish Cataract Register (NCR).

RESULTS

The epco values were correlated with VA in the PCO eyes: the higher the epco score, the lower the VA. There were also correlations between the epco scores, satisfaction with vision, and perceived disabilities in daily life. Symptoms of glare were not significantly correlated with epco scores or with VA. Visual acuity in PCO eyes was better correlated with perceived disabilities and satisfaction with vision than VA in eyes with cataract.

CONCLUSIONS

There was a significant correlation between epco scores and VA and between epco scores and Catquest. Consequently, the morphological method was related to the self-assessed visual function. Patients with PCO seemed to have more disturbed visual function, as defined by Catquest, than cataract patients with the same VA.

Effect of ophthalmic Nd:YAG laser energy on intraocular lenses after posterior capsulotomy in normal dog eyes

OBJECTIVE

To determine Nd:YAG laser energy requirements for posterior capsulotomy and intraocular lens (IOL) damage threshold for foldable acrylic IOLs as compared to traditional polymethylmethacrylate (PMMA). MATERIALS AND PROCEDURES: Four groups of five-six fresh canine cadaver eyes were used in this study. The groups included (1) unaltered eyes (2) aphakic eyes (3) eyes implanted with PMMA IOLs, and (4) eyes implanted with acrylic IOLs. Laser energy was delivered to the posterior capsule in grid fashion for 10 sites each of five levels of laser energy ranging from 0.5 mJ to 9 mJ. Number of successful capsulotomy sites was recorded based on slit-lamp observation. Sites of IOL damage were evaluated using scanning electron microscopy (SEM). Statistical analysis of number of capsulotomies and IOL defects per laser energy level was conducted among and between groups using anova with Tukey's HSD test.

RESULTS

When comparing groups (a) including all energy levels (n = 25) and (b) by specific energy levels (n = 5), there was no significant difference (P < 0.05) in number of successful capsulotomy sites between IOL types. The 50% incidence threshold for successful capsulotomy was 2.74 mJ for acrylic IOLs and 2.64 mJ for PMMA IOLs. Energy-dependent damage to both types of IOL was detected for medium, high-medium, and high laser energy. Calculated 50% damage threshold was 4.9 mJ for acrylic IOL and 5.7 mJ for PMMA IOL. Damage to the IOL varied subjectively between IOL type, but there was no significant difference in number of defects caused, with the exception of high-medium energy.

CONCLUSIONS

Both posterior lens capsules and IOLs were disrupted in an energy-dependent manner with minimal difference in number of capsulotomy sites or damage to the IOL between acrylic and PMMA IOLs. A therapeutic margin between capsulotomy threshold (2.6-2.7 mJ) and IOL damage threshold (4.9-5.7 mJ) was determined to reliably achieve capsulotomies with minimal IOL damage for both acrylic and PMMA IOLs in normal canine cadaver eyes.

Incidence and risk factors of Nd:YAG capsulotomy after phacoemulsification in non-diabetic and diabetic patients

PURPOSE

To estimate the cumulative incidence and identify the risk factors of posterior capsule opacification (PCO) that required Nd:YAG capsulotomy in non-diabetic and diabetic patients.

METHODS

Retrospective case-note review of 806 consecutive patients that underwent phacoemulsification and intraocular lens (IOL) implantation, 327 (40.6%) of whom were diabetic.

RESULTS

The cumulative incidence of Nd:YAG capsulotomy were 10.6%, 14.8%, 21.2% and 28.6% in non-diabetic patients; and 9%, 9.4%, 15.3% and 5.3% in diabetic patients after 1, 2, 3 and 4 years, respectively. A multivariate Cox regression analysis showed that, over the follow-up period, diabetes mellitus was associated with a decreased risk of Nd:YAG capsulotomy (hazard ratio [HR]=0.69; 95% confidence interval [CI] 0.47-0.99; P=0.047), whereas age of 65 years or younger (HR=1.58; 95% CI 1.09-2.27; P=0.02), polymethylmethacrylate (PMMA) (HR=3.98; 95% CI 1.60-9.95; P=0.003) or plate-haptic silicone IOLs (HR=3.75; 95% CI 1.60-8.80; P=0.002) in comparison with three-piece silicone IOLs, postoperative inflammation (HR=2.62; 95% CI 1.56-4.42; P<0.001) and pars plana vitrectomy (HR=1.85; 95% CI 1.20-2.83; P=0.005) were associated with an increased risk. Subgroup analysis showed that in non-diabetic patients, male gender (HR=1.63; 95% CI 1.04-2.57; P=0.03) was an additional risk factor and in diabetic patients there was no significant association between diabetes type, duration or retinopathy grade and the risk of Nd:YAG capsulotomy.

CONCLUSION

Although diabetes mellitus appears to be associated with a lower long-term incidence and a decreased risk of Nd:YAG capsulotomy, younger age, pars plana vitrectomy, postoperative inflammation, plate-haptic silicone and PMMA IOLs in addition to male gender in non-diabetic patients appear to be associated with a greater risk. Estimation of the incidence and risk factors of PCO should help in patient counselling and to design methods to reduce or prevent its development.

Prospective Intrapatient Comparison of 6.0-Millimeter Optic Single-Piece and 3-Piece Hydrophobic Acrylic Foldable Intraocular Lenses

PURPOSE

To compare postoperative performance and stability of 6.0-mm optic single- and 3-piece acrylic foldable intraocular lenses (IOLs).

DESIGN

Prospective, randomized, self-controlled trial.

PARTICIPANTS

Eighty eyes of 40 patients with bilateral senile cataracts.

INTERVENTION

Phacoemulsification and IOL implantation were performed. One eye of a patient was randomly assigned to the SA60AT single-piece IOL, and the contralateral eye was allocated to the MA60AC 3-piece IOL.

MAIN OUTCOME MEASURES

Best-corrected visual acuity (BCVA), spherical equivalent, aqueous flare intensity, anterior chamber depth, amount of IOL decentration and tilt, area of anterior capsule opening, and degree of posterior capsule opacification (PCO) were measured 2 days, 1 week, and 1, 3, 6, and 12 months after surgery. Specular microscopy was performed at 12 months postoperatively.

RESULTS

In the SA60AT group, the anterior chamber depth did not show significant changes after surgery (P>0.05; paired t test), and the refraction remained highly stable throughout the 1-year study period. The MA60AC group showed significant shallowing of the anterior chamber (P<0.05) and a myopic shift (P<0.05) up to 1 month after surgery. There were no significant differences between the 2 groups (P>0.05) in BCVA, aqueous flare intensity, the amount of IOL decentration, IOL tilt, area of anterior capsule opening, and degree of PCO throughout the 12-month follow-up period.

CONCLUSIONS

Both the SA60AT single-piece and MA60AC 3-piece lenses showed a minimum amount of decentration, tilt, anterior capsule contraction, and PCO. Although the MA60AC showed significant forward shift and myopic refractive changes after surgery, the SA60AT displayed little axial movement associated with highly stable refraction after surgery. This feature of the SA60AT should facilitate earlier spectacle prescription and quicker visual/social rehabilitation of patients after cataract surgery.

Self-assessed visual function for patients with posterior capsule opacification before and after capsulotomy

PURPOSE

To describe the functional outcome, as defined using the Catquest questionnaire, for patients with posterior capsule opacification (PCO) after capsulotomy.

METHODS

A total of 47 patients with PCO were examined before and 1 month after capsulotomy. In addition to the ophthalmic examination, Catquest was completed and a digital image of the posterior lens capsule acquired.

RESULTS

Capsulotomy resulted in a good level of benefit, as defined using Catquest, for 77% of the patients. No subgroup of patients who derived an exceedingly good or poor level of benefit was identified. Disabilities in daily life, satisfaction with vision and symptoms of glare improved from treatment (p < 0.001, p < 0.001 and p = 0.002, respectively). The results were comparable with the benefits of cataract surgery.

CONCLUSIONS

Self-assessed visual function as defined using Catquest improved after capsulotomy for the vast majority of patients with PCO. No group of patients with exceptionally good or poor levels of benefit could be identified with certainty. However, the majority of those with a poor outcome were elderly individuals with ocular comorbidity. The overall functional results from treatment of PCO were very similar to those achieved after cataract surgery.

Nd:YAG capsulotomy rates after use of the AcrySof acrylic three piece and one piece intraocular lenses

BACKGROUND/AIM

Acrylic lens size and shape may influence the rate of posterior capsule opacification (PCO) and need for Nd:YAG capsulotomy. The aim of this study is to compare the Nd:YAG capsulotomy rate of the three piece acrylic/PMMA AcrySof MA series lens with the one piece acrylic AcrySof SA series lens.

METHODS

434 eyes of 329 patients who had cataract extraction and implantation of one of four types of intraocular lenses (IOLs) were evaluated for rate of Nd:YAG capsulotomy. 176 eyes received the acrylic AcrySof MA30AC IOL, 71 eyes the acrylic AcrySof MA60AC IOL, 45 eyes the acrylic AcrySof SA30AL IOL, and 142 eyes the acrylic AcrySof SA60AT IOL.

RESULTS

The rates of Nd:YAG capsulotomy with the three piece IOL (MA30AC/MA60AC) and the one piece IOL (SA30AL/SA60AT) were 1.2% and 2.1% at 6 months, 2.8% and 5.9% at 12 months, and 3.6% and 7.5% at 24 months, respectively. The incidence of Nd:YAG capsulotomy was higher in patients who received the one piece IOL (p=0.01, log rank test). There was no difference in Nd:YAG capsulotomy rates when comparing lens optic size, age, sex, history of pars plana vitrectomy, and diabetes mellitus.

CONCLUSIONS

This study shows a greater incidence of Nd:YAG capsulotomy in patients who receive one piece acrylic AcrySof lenses when compared to those who receive three piece acrylic AcrySof lenses.

Three-year follow-up of posterior capsule opacification with two different silicone intraocular lenses

PURPOSE

To compare posterior capsule opacification (PCO) after cataract surgery with implantation of two silicone intraocular lenses (IOLs) with different designs.

METHODS

We carried out a prospective, clinical study of 116 patients randomized to standardized phacoemulsification with implantation of CeeOn Edge (n = 57) or SI40NB (n = 59) IOLs. The follow-up period was 3 years. To evaluate PCO morphologically, digital images were obtained and analysed using evaluation of posterior capsule opacification computer software (epco). The neodymium:YAG (Nd:YAG) capsulotomy rate was recorded.

RESULTS

At 2 and 3 years, the eyes with SI40NB IOLs had significantly more PCO than those with the CeeOn Edge IOLs (p = 0.00014 and p = 0.002). Nine Nd:YAG capsulotomies were performed in the SI40NB group and none in the CeeOn Edge group. This difference was statistically significant (p = 0.003). In some patients a regression of PCO was noticed and confirmed using epco. Statistically less PCO was noted when the capsulorhexis rim was placed so that it covered all 360 degrees of the optic of the IOL.

CONCLUSIONS

A clinically and statistically significant difference in PCO development between CeeOn Edge and SI40NB IOLs at 2 and 3 years postoperatively was found. These findings support earlier studies indicating that a sharp edge of the optic is a more important factor in IOL design than IOL material in the prevention of PCO.

Accommodation after Nd: YAG capsulotomy in patients with accommodative posterior chamber lens 1CU

PURPOSE

After initial encouraging results with the accommodative 1CU posterior chamber lens (PCIOL), we investigated the rate, the postoperative time point of posterior capsular opacification (PCO) necessitating YAG capsulotomy and the accommodative range after Nd: YAG capsulotomy in patients with 1CU-PCIOL.

PATIENTS AND METHODS

This prospective clinical study included 65 patients who underwent phacoemulsification and implantation of the accommodative 1CU-PCIOL with postoperative follow-up from 3 to 24 months. Postoperative examination was performed 3, 6 and 12 months after surgery, then before and 6 weeks after Nd: YAG capsulotomy. Measurements included: the best corrected distance visual acuity, distance refraction, near visual acuity (Birkhauser charts in 35 cm) obtained with best distance correction, accommodative range measured by subjective near point with an accodommometer and defocusing with a visual acuity fall to 0.4.

RESULTS

Both best corrected distance visual acuity (1.1+/-0.1) and near visual acuity with best distance correction (0.4+/-0.1) remained stable over the follow-up period until 12 months postoperatively. The accommodative range determined by near point was stable (mean 2.0+/-0.5 D). Also, the defocusing range remained stable over 12 months (1.8+/-0.4 D). A clinically relevant posterior capsule opacification with a significant decrease of visual acuity (0.4+/-0.2) and a need for Nd: YAG capsulotomy was diagnosed in 12 patients between 15 and 22 (mean 20+/-4, median 20) months postoperatively. All capsulotomies were performed without complication. Six weeks after capsulotomy, best corrected distance visual acuity was improved (1.1+/-0.1), near visual acuity with best distance correction was 0.4+/-0.1 and the accommodative range determined by near point was 1.95+/-0.6 D and by defocusing was 1.88+/-0.47 D. Six weeks after capsulotomy, measurements of the accommodative range did not show any statistical difference to the 12-month results before the occurrence of PCO (P>0.5).

CONCLUSIONS

A clinically relevant PCO with a significant decrease of visual acuity necessitating Nd: YAG capsulotomy occurred mainly after 15 postoperative months in patients with 1CU. Our results indicate that Nd: YAG capsulotomy may not affect the accommodation ability of the 1CU. Nevertheless, long-term studies are needed to further analyze the accommodative properties.

Acute angle-closure glaucoma caused by vitreous prolapse after neodymium:YAG posterior capsulotomy

We report the second known case of acute angle-closure glaucoma from vitreous prolapse after neodymium:YAG (Nd:YAG) laser posterior capsulotomy in a patient with a posterior chamber intraocular lens (IOL). This is the first reported case to result in corneal decompensation that required penetrating keratoplasty. The rare complication of vitreous prolapse was unusual in this patient because of the presence of a posterior chamber IOL, a small 4.0 mm capsulotomy opening, and low (26 mJ) Nd:YAG laser energy.