Cystoid macular oedema following neodymium:YAG laser capsulotomy a prospective study

Topical steroid alone vs a combination with a posterior segment NSAID after Nd-YAG capsulotomy: Is the posterior segment NSAID really necessary?

Purpose:

To compare the effect of topical 1% prednisolone acetate and 0.09% bromfenac versus topical 1% prednisolone acetate alone on macular thickness following Nd: YAG laser capsulotomy.

Materials and Methods:

About 150 eyes with posterior capsule opacification following were included. All patients were treated with Nd: YAG laser posterior capsulotomy. Patients were randomly divided into two groups of 75. Group 1-Patients received: Topical 1% prednisolone acetate and Topical 0.09% bromfenac. Group 2-Patients received: Topical 1% prednisolone acetate alone. Outcome measures by an independent observer were BCVA by Snellen chart, IOP by NCT, and Central Macular Thickness (CMT) by Macular OCT. All patients were examined before the procedure, 1 h after the procedure, at 1 week, and at 6 weeks.

Statistics:

1. Quantitative variables: Mann-Whitney Test and Wilcoxon ranked sum test. 2. Qualitative variables: Chi-square test. A P value of < 0.05 was considered statistically significant.

Results:

Mean IOP increase in both groups is statistically significant at 1 h and later decreases back to nonsignificant levels at 1 week and 6 weeks. No significant change in mean CMT was seen in the duration of 6 weeks neither in Group 1 nor Group 2.

Conclusion:

Prophylactic antiglaucoma medications are not recommended in patients undergoing Nd: YAG laser capsulotomy. No evidence of cystoid macular edema was recorded till the end of 6 weeks follow-up.

Long-term changes in subfoveal choroidal thickness and central macula thickness after Nd:YAG laser capsulotomy

PURPOSE

To evaluate changes in central macula thickness (CMT), subfoveal choroid thickness (SCT), and intraocular pressure (IOP) before and after neodymium:yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy.

METHODS

42 eyes of 42 patients who underwent Nd:YAG laser capsulotomy were included in this prospective study. CMT, SCT, and IOP were evaluated preoperatively and at postoperative week 1 and postoperative months 1, 3, 6, and 12.

RESULTS

CMT was 238.1 ± 27.6 μm (mean ± SD) preoperatively, then 239.7 ± 29.8, 241.3 ± 28.7, 242.7 ± 27.2, 238.8 ± 23.7, and 238.3 ± 21.7 μm at postoperative week 1 and months 1, 3, 6, and 12, respectively. SCT was 263.3 ± 21.6 μm preoperatively, and 265.5 ± 24.8, 266.2 ± 25.7, 267.1 ± 26.3, 269.1 ± 24.2, and 269.9 ± 21.4 μm at postoperative week 1 and months 1, 3, 6, and 12, respectively. There were no significant differences between preoperative and postoperative results for CMT, SCT, or IOP (all p > 0.05).

CONCLUSION

Although there were slight changes in choroid thickness in the long term, treatment of posterior capsule opacification with a low-energy Nd:YAG laser is a safe procedure that increases visual acuity without creating a significant increase in IOP, CMT, and SCT.

[Posterior capsule opacification]

Posterior capsule opacification (PCO) is the most common complication after cataract surgery, with an incidence of 30%. It tends to be considered a normal event in the natural history of cataract surgery. Better understanding of its pathophysiology and advancement of intraocular lens material and design along with the improvement of phacoemulsification technique have contributed to decrease the incidence of PCO. Although treatment by Nd: YAG laser posterior capsulotomy is quick and non-invasive, the opening of the posterior capsule may be associated with numerous complications. Prevention remains the best measure for controlling this pathology.

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

To compare the effect of Nd:YAG laser capsulotomy and primary posterior continuous capsulorhexis (PPCC) combined with phacoemulsification on macular thickness using optical coherence tomography (OCT) in adults. This prospective comparative interventional study included 32 eyes of 30 patients who underwent Nd:YAG laser capsulotomy and 33 eyes of 33 patients who underwent cataract surgery with PPCC. Detailed ocular examinations, including macular thickness measurements by OCT, were performed in all patients preoperatively and postoperatively on the 1st day, 1st week, and 1st, 3rd and 6th months. No significant differences were found in macular thickness between the two groups in preoperative and postoperative follow-up. No cystoid changes were observed in OCT during the postoperative period in both groups. Nd:YAG laser capsulotomy and PPCC combined with cataract surgery are safe and effective procedures that are not associated with an increase in macular thickness.

Use of Nd:YAG laser capsulotomy

Surgery for cataract removal has become successively refined such that posterior capsular opacification is the most common problem presenting after modern cataract extraction. Various techniques and treatments exist to manage patients with posterior capsular opacification using Nd:YAG capsulotomy. There are many possible variations in initial assessment, pre-laser treatments, laser techniques, and follow-up routines. The literature on the use of Nd:YAG laser for capsulotomy was reviewed and interpreted. This article presents the currently available knowledge in a format that allows the practitioner to tailor an evidence-based protocol for treating patients with symptomatic posterior capsule opacification.

The role of light scatter in the degradation of visual performance before and after Nd:YAG capsulotomy

The aim of this study was to determine whether capsulotomy size influences visual performance. Snellen visual acuity and forward light scatter (light scattered towards the patient's retina, but out of the focussed retinal image) measurements using simple computer graphics based on van den Berg's technique were used to measure visual performance. Twelve patients were studied: 4 had small central capsulotomies through undilated pupils and 8 had wide capsulotomies through dilated pupils. The two groups were matched for age and pre-laser Snellen acuity. Following treatment, both groups had equal improvements in Snellen acuity. There was only a significant (p < 0.001) improvement in forward light scatter readings in the group who received wide capsulotomies. Measurements of forward light scatter are more sensitive than Snellen acuity testing in demonstrating loss of visual performance in patients with media opacities. It is recommended that pupils are dilated prior to Nd:YAG capsulotomy if forward light scatter from capsule remnants and the consequent glare disability are to be minimised.