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Bucur J, Werner L, Kohnen T. Carbon bursts inside a small aperture intraocular lens after Nd:YAG laser capsulotomy. Am J Ophthalmol Case Rep 2024; 36:102129. [PMID: 39156904 PMCID: PMC11327537 DOI: 10.1016/j.ajoc.2024.102129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/20/2024] [Accepted: 07/12/2024] [Indexed: 08/20/2024] Open
Abstract
Purpose The IC-8® Apthera™ (AcuFocus Inc.™, Irvine, California, USA) is the first small aperture intraocular lens (IOL) to receive FDA approval for presbyopia correction in the summer of 2022. It is a single-piece hydrophobic acrylic monofocal lens, which is placed in the capsular bag. In its center it carries a black circular mask (FilterRing™) with a diameter of 3.23 mm consisting of polyvinylidene fluoride and carbon black nanoparticles. In the center of this mask sits a 1.36 mm wide aperture. Thanks to this pinhole effect the IC-8® serves as an extended-depth-of-focus (EDOF) IOL and can be used in presbyopia correction.This report describes the case of a patient with an IC-8® implant who underwent Nd:YAG laser capsulotomy for posterior capsule opacification (PCO). The post laser checkup showed a dark central optical change within the IOL and the patient described optical phenomena as well as blurred central vision, which is why he received IOL exchange. The explanted IC-8® was sent to the Intermountain Ocular Research Center at the University of Utah for further analysis. Observations A 56-year-old male underwent cataract surgery with implantation of a non-diffractive EDOF-IOL on the right and the IC-8® small aperture IOL on the left eye. On the left eye, the patient had received penetrating keratoplasty seven years prior to the cataract operation due to posttraumatic corneal scarring. The early checkups after cataract surgery showed a corrected distance visual acuity (CDVA) in the left eye of +0.1 logMAR in the first month. About 5 months after the operation, PCO was first described on the left eye leading to a decrease in visual acuity to +0.4 logMAR (CDVA). Due to PCO, Nd:YAG laser capsulotomy was conducted 5 months after the cataract operation on the left eye. 12 shots were applied at 2.7 mJ. The following appointments showed a continuously reduced visual acuity of +1.3 logMAR (uncorrected) on the left eye and the patient described blurry and 'swirled' central vision. By slightly tilting his head and thus not using the center of his optic axis, he would be able to see sharper. Slit lamp examination showed a small optical change inside the IC-8® IOL not resembling a pit but believed to be a small pocket of air. Due to the ongoing symptoms as well as the reduced VA, the seemingly damaged small aperture IOL was exchanged for a three-piece hydrophobic acrylic monofocal lens, which was also placed in the posterior chamber. The explanted IC-8® was sent to the Intermountain Ocular Research Center at the University of Utah for further analysis. Results from gross and light microscopic analysis showed that the change caused by the Nd:YAG laser application consisted of a localized optical area containing carbon black nanoparticles used for the circular mask within the IOL. Conclusions and importance When dealing with PCO and performing Nd:YAG laser capsulotomy in eyes with an IC-8® IOL implant, the laser shots should be applied either inside the aperture or outside of the black circular mask of the IOL. Otherwise, the Nd:YAG laser can lead to bursts of carbon nanoparticles within the IOL which may cause optical phenomena as well as decreased visual acuity possibly resulting in an IOL exchange.
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Affiliation(s)
- Julian Bucur
- Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany
| | - Liliana Werner
- John A. Moran Eye Center, Intermountain Ocular Research Center, University of Utah, Salt Lake City, USA
| | - Thomas Kohnen
- Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany
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Borkenstein AF, Borkenstein EM. Neodymium-doped yttrium aluminum garnet (Nd: YAG) laser treatment in ophthalmology: a review of the most common procedures Capsulotomy and Iridotomy. Lasers Med Sci 2024; 39:167. [PMID: 38954050 DOI: 10.1007/s10103-024-04118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 06/24/2024] [Indexed: 07/04/2024]
Abstract
Nowadays, lasers are used in various medical fields. Ophthalmology was the first medical specialty to utilize lasers in patient treatment and still remains the leading medical field that uses laser energy for both therapeutic and diagnostic purposes. The neodymium: yttrium-aluminum-garnet (Nd: YAG) laser is one of the most common lasers used in ophthalmology. It is a solid-state laser with a wavelength of 1064 nm that works on the principle of photodisruption. Since its introduction in ophthalmology over 40 years ago, it has found various applications, mainly for procedures where cutting or disruption of ocular tissue is required. Compared to surgical alternatives, the use of Nd: YAG lasers on ocular tissue is minimally invasive. In this review, we focus on the two most common ophthalmic applications of Nd: YAG laser - laser peripheral iridotomy and posterior capsulotomy. The history of the techniques, current trends, potential complications, and the prognosis for future use is discussed.
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Affiliation(s)
- Andreas F Borkenstein
- Borkenstein and Borkenstein, Private Practice at Privatklinik Kreuzschwestern Graz, Ophthalmology, Kreuzgasse 35, Graz, 8010, Austria.
| | - Eva-Maria Borkenstein
- Borkenstein and Borkenstein, Private Practice at Privatklinik Kreuzschwestern Graz, Ophthalmology, Kreuzgasse 35, Graz, 8010, Austria
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Zeng Z, Giap BD, Kahana E, Lustre J, Mahmoud O, Mian SI, Tannen B, Nallasamy N. Evaluation of Methods for Detection and Semantic Segmentation of the Anterior Capsulotomy in Cataract Surgery Video. Clin Ophthalmol 2024; 18:647-657. [PMID: 38476358 PMCID: PMC10929120 DOI: 10.2147/opth.s453073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Background The capsulorhexis is one of the most important and challenging maneuvers in cataract surgery. Automated analysis of the anterior capsulotomy could aid surgical training through the provision of objective feedback and guidance to trainees. Purpose To develop and evaluate a deep learning-based system for the automated identification and semantic segmentation of the anterior capsulotomy in cataract surgery video. Methods In this study, we established a BigCat-Capsulotomy dataset comprising 1556 video frames extracted from 190 recorded cataract surgery videos for developing and validating the capsulotomy recognition system. The proposed system involves three primary stages: video preprocessing, capsulotomy video frame classification, and capsulotomy segmentation. To thoroughly evaluate its efficacy, we examined the performance of a total of eight deep learning-based classification models and eleven segmentation models, assessing both accuracy and time consumption. Furthermore, we delved into the factors influencing system performance by deploying it across various surgical phases. Results The ResNet-152 model employed in the classification step of the proposed capsulotomy recognition system attained strong performance with an overall Dice coefficient of 92.21%. Similarly, the UNet model with the DenseNet-169 backbone emerged as the most effective segmentation model among those investigated, achieving an overall Dice coefficient of 92.12%. Moreover, the time consumption of the system was low at 103.37 milliseconds per frame, facilitating its application in real-time scenarios. Phase-wise analysis indicated that the Phacoemulsification phase (nuclear disassembly) was the most challenging to segment (Dice coefficient of 86.02%). Conclusion The experimental results showed that the proposed system is highly effective in intraoperative capsulotomy recognition during cataract surgery and demonstrates both high accuracy and real-time capabilities. This system holds significant potential for applications in surgical performance analysis, education, and intraoperative guidance systems.
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Affiliation(s)
- Zixue Zeng
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Binh Duong Giap
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Ethan Kahana
- Department of Computer Science, University of Michigan, Ann Arbor, MI, USA
| | | | - Ossama Mahmoud
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Shahzad I Mian
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Bradford Tannen
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Nambi Nallasamy
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
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Keles A, Karaman SK. Intraocular pressure increase after Nd:YAG laser capsulotomy and anterior segment optical coherence tomography analysis. Lasers Med Sci 2023; 39:13. [PMID: 38135858 DOI: 10.1007/s10103-023-03958-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
This study is to determine whether post-procedure intraocular pressure (IOP) increase is associated with the anterior chamber angle in cases of Neodymium: yttrium-aluminum garnet (Nd: YAG) laser capsulotomy. The study included 51 eyes with posterior capsule opacification. Initial IOP values of the patients were compared with IOP values without intraocular pressure-lowering administration at the end of the 1st hour, 1st day, 3rd day, and 7th day after Nd:YAG laser capsulotomy. The anterior segment angle configuration was evaluated using anterior segment optical coherence tomography analysis without dilatation before the procedure. The anterior chamber angle (ACA) and angle opening distances of 500 and 750 μm (AOD500 and AOD750) in the nasal and temporal quadrants were examined. The mean pre-laser IOP value only increased significantly at 1st hour post-laser (13.02 ± 3.02 mmHg vs 14.16 ± 4.07 mmHg, p = 0.016). In eyes with ACA below 40° in both the nasal and temporal quadrants, mean IOP increased significantly at 1st hour post-laser (p = 0.025 and p = 0.032, respectively), while it was not significant in eyes with ACA above 40° (p > 0.05). No correlation was found between ACA, AOD500, and AOD750 values and IOP changes at the first hour (p > 0.05). Except for the first hour after Nd:YAG laser capsulotomy, no significant increase in IOP was observed. This elevation was higher in eyes with ACA less than 40°. In patients with a narrow ACA, first-hour follow-up may be beneficial in terms of susceptibility to increased IOP.
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Affiliation(s)
- Ali Keles
- Department of Ophthalmology, Faculty of Medicine, Bilecik Seyh Edebali University, 11230, Bilecik, Turkey.
| | - Suleyman Korhan Karaman
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Icoz M, Tarım B, Icoz SGG. The effect of Nd:YAG Laser applied in the posterior capsule opacification on retinal and choroidal structures. Photodiagnosis Photodyn Ther 2023; 43:103653. [PMID: 37295662 DOI: 10.1016/j.pdpdt.2023.103653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE To assess the effect of neodymium:yttrium-aluminum-garnet (Nd-YAG) laser procedure on the choroid and retina in patients who developed posterior capsular opacification (PCO) after cataract surgery. METHODS In this study, 32 eyes of 30 patients who underwent Nd:YAG laser treatment for PCO were evaluated. Visual acuity (VA), intraocular pressure (IOP), central macular thickness (CMT) with optical coherence tomography device (OCT), ganglion cell layer (GCL), inner plexiform layer (IPL), retinal nerve fiber layer (RNFL) and subfoveal choroidal thickness (SCT) were measured. Choroidal vascular index (CVI) was calculated from HD line images obtained by spectral domain OCT with the software Image J. RESULTS The mean age of the patients participating in the study was 60.1 ± 8.9 years. There was no significant difference in IOP, CMT, RNFL, GCL, IPL and SCT values in all comparisons before and after laser (p>0.05 for all values). While Nd:YAG laser pretreatment CVI was 63.2 ± 3.2%, it was 66.8 ± 2.9% at 1 week and 67.1 ± 2.6% at 1 month after laser treatment. A significant difference was detected in the comparison of pre-laser CVI and post-laser 1 week and 1 month CVI (p<0.05 for all values). DISCUSSION CVI was found to be significantly higher in the post-laser period in patients who underwent Nd:YAG laser. As far as the author knows, this study is the first research in the literature to evaluate this relationship. CVI can be used to evaluate choroidal vascular changes after Nd:YAG laser.
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Affiliation(s)
- Mehmet Icoz
- Department of Ophthalmology, Yozgat City Hospital, Erdoğan Akdağ Mah., Viyana Cad., 66100 Merkez, Yozgat, Turkey.
| | - Bilge Tarım
- Department of Ophthalmology, Ankara City Hospital, Ankara, Turkey
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Urfalıoglu S, Özdemir G, Güler M, Daghan B, Öz F. The evaluation of the effect of Nd-YAG capsulotomy on posterior ocular vascular structures by Optical coherence tomography angiography. Photodiagnosis Photodyn Ther 2023; 42:103323. [PMID: 36773755 DOI: 10.1016/j.pdpdt.2023.103323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/28/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND We aimed to examine the changes in retinal, choroidal and optic nerve head vascular structures after Nd-YAG laser application due to posterior capsule opacification after cataract surgery by Optical coherence tomography angiography (OCTA). METHODS Fifteen eyes of 15 patients who have posterior capsule opasification and underwent Nd-YAG laser capsulotomy were included in the study. OCTA imagings of patients were made before and one hour, one week and one month later after the laser procedure. RESULTS No significant change was determined before and after capsulotomy in macular thickness measurements, flow areas and vessel densities (all p > 0.05). Optic nerve head vessel densities and flow areas didn't differ preoperatively and postoperatively (p > 0.05). CONCLUSIONS Nd-YAG laser capsulotomy for posterior capsule opacification has no detectable effect on macular and optic nerve flows and vessel densities.
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Affiliation(s)
- Selma Urfalıoglu
- Department of Ophthalmology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Avsar Campus, Onikisubat, Kahramanmaras 46100, Turkiye.
| | - Gökhan Özdemir
- Department of Ophthalmology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Avsar Campus, Onikisubat, Kahramanmaras 46100, Turkiye
| | - Mete Güler
- Department of Ophthalmology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Avsar Campus, Onikisubat, Kahramanmaras 46100, Turkiye
| | - Betül Daghan
- Department of Ophthalmology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Avsar Campus, Onikisubat, Kahramanmaras 46100, Turkiye
| | - Furkan Öz
- Department of Ophthalmology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Avsar Campus, Onikisubat, Kahramanmaras 46100, Turkiye
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Moshirfar M, Basharat NF, Seitz TS, Peterson CM, Stapley SR, Ziari M, Bundogji N, Ronquillo YC, Hoopes PC. Refractive Changes After Nd:YAG Capsulotomy in Pseudophakic Eyes. Clin Ophthalmol 2023; 17:135-143. [PMID: 36644604 PMCID: PMC9833321 DOI: 10.2147/opth.s395605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose To analyze refractive changes after neodymium: yttrium-aluminum-garnet (Nd:YAG) posterior capsulotomy in pseudophakic eyes. Patients and Methods Patients who underwent Nd:YAG capsulotomy after cataract surgery from January 2013 to April 2022 were included in this retrospective study. Sphere, cylinder, spherical equivalent (SE), axis, and corrected distance visual acuity (CDVA) were compared pre- and postoperatively in 683 eyes of 548 patients at one month (n = 605 eyes) and one year (n = 211 eyes). Patients with both one-month and one-year follow-ups (n = 133) were also compared. Eyes were stratified into single-piece (n = 330), three-piece (n = 30), and light adjustable lenses (LALs) (n = 16). Pre- and postoperative measurements were analyzed within each group. Results Cylinder was significantly decreased at one-month (difference: 0.042±0.448 D, p = 0.006) and one-year (difference: 0.101±0.455 D, p = 0.003) compared to preoperative measurements. No significant change in sphere or axis was observed at follow-up visits (p > 0.05). CDVA significantly improved at both time points (p < 0.05). No significant change in any parameters between the one-month and one-year groups was observed (p > 0.05). There was significant improvement in CDVA in the single and three-piece lens groups (p < 0.0001 and p = 0.026, respectively), with no change in the LAL group (p > 0.05). Conclusion There were no changes in sphere, axis, or spherical equivalent after Nd:YAG capsulotomy. However, cylindrical error and CDVA were significantly better after the procedure. Lens type did not impact refractive parameters postoperatively.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, 84020, USA,John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA,Utah Lions Eye Bank, Murray, UT, USA,Correspondence: Majid Moshirfar, Hoopes Vision Research Center, 11820 S, State Street Suite #200, Draper, UT, 84020, Tel +1-801-568-0200, Fax +1-801-563-0200, Email
| | - Noor F Basharat
- University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Tanner S Seitz
- Midwestern University Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | | | - Seth R Stapley
- Midwestern University Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Melody Ziari
- University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Nour Bundogji
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Phillip C Hoopes
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, 84020, USA
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Tan Y, Zhang J, Li W, Jin G, Luo L, Liu Z. Refraction Shift After Nd:YAG Posterior Capsulotomy in Pseudophakic Eyes: A Systematic Review and Meta-analysis. J Refract Surg 2022; 38:465-473. [PMID: 35858199 DOI: 10.3928/1081597x-20220516-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To explore ocular refraction shift after Neodymium: yttrium aluminum garnet (Nd:YAG) posterior capsulotomy in pseudophakic eyes. METHODS A systematic literature search was performed in the PubMed, Embase, and Cochrane Library databases until November 10, 2021. Studies on the evaluation of changes in spherical equivalent (SE), cylindrical error (CE), or anterior chamber depth (ACD) after Nd:YAG laser capsulotomy were included in the meta-analysis. The review was registered in the international platform of registered systematic review and meta-analysis protocols (INPLASY202120059). RESULTS A total of 805 eyes from 18 studies were included in the final analysis. The pooled mean differences in SE from baseline to postoperative follow-up points were not significant (1 hour: 0.04 diopters [D], 95% CI: -0.13 to 0.21, P = .644; 1 week: 0.04 D, 95% CI: -0.12 to 0.20, P = .640; 1 month: 0.05 D, 95% CI: -0.06 to 0.16, P = .349). There was no significant difference between baseline CE and any subsequent visit (1 week: 0.14 D, 95% CI: -0.06 to 0.33, P = .172; 1 month: 0.17 D, 95% CI: -0.04 to 0.38, P = .108). No statistical difference in ACD from baseline was observed either (1 hour: 0.01 mm, 95% CI: -0.07 to 0.09, P = .846; 1 week: -0.12 mm, 95% CI: -0.24 to 0.01, P = .079; 1 month: -0.06, 95% CI: -0.14 to 0.01, P = .110). CONCLUSIONS Neither ocular refraction nor ACD changed within 1 month after laser capsulotomy, suggesting laser capsulotomy did not affect ocular refraction in short-term observation. [J Refract Surg. 2022;38(7):465-473.].
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Refractive Changes Following Premature Posterior Capsulotomy Using Neodymium:Yttrium–Aluminum–Garnet Laser. J Pers Med 2022; 12:jpm12020272. [PMID: 35207760 PMCID: PMC8874370 DOI: 10.3390/jpm12020272] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 12/03/2022] Open
Abstract
We aimed to determine the timing of neodymium:yttrium–aluminum–garnet (Nd:YAG) laser capsulotomy on corrected-distance visual acuity (CDVA), intraocular pressure (IOP), and spherical equivalent (SE) in patients with posterior capsular opacification (PCO). There were 59 patients with unilateral PCO and a history of Nd:YAG laser capsulotomy enrolled and further divided into the early Nd:YAG group (timing < 12 months, n = 25) and late Nd:YAG group (timing > 12 months, n = 34) depending on the elapsed months from phacoemulsification to Nd:YAG laser capsulotomy. The primary outcomes were CDVA, IOP, and SE before (immediately before Nd:YAG laser capsulotomy) and after (weeks one and four after the laser treatment). The independent t test was applied to analyze the difference in CDVA, IOP, and SE between the two groups, while the generalized estimating equation with Bonferroni adjustment was conducted to evaluate the effect of all the parameters on the change in SE with adjusted odds ratio (aOR) and 95% confidence interval (CI). The CDVA showed significant improvement in both the early Nd:YAG group (p = 0.005) and the late Nd:YAG group (p = 0.001), and hyperopic change occurred in both the early Nd:YAG group (p = 0.003) and the late Nd:YAG group (p = 0.017). The early Nd:YAG group revealed more significant hyperopic change compared with the late Nd:YAG group four weeks after Nd:YAG treatment (p < 0.001), which was still significant after multivariable analysis (aOR: 0.899, 95% CI: 0.868–0.930, p = 0.011). In addition, a deeper ACD (aOR: 0.764, 95% CI: 0.671–0.869, p = 0.019) was significantly correlated with hyperopic change. In conclusion, Nd:YAG laser capsulotomy performed within one year after cataract surgery may lead to significant hyperopic change, in which the ACD alteration affects the hyperopic shift significantly.
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Hirt B, Worma MB, Wojcik LR, Lacerda BSD, Moreira LB, Ferenczy PAVH. Alteração refracional após capsulotomia posterior com laser Nd:YAG. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tariq M, Iqbal K, Inayat B, Rehman MU, Zaheer W, Shahid MA, Ahmed M, Abbas K. 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. Cureus 2021; 13:e16242. [PMID: 34373805 PMCID: PMC8346227 DOI: 10.7759/cureus.16242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Moneeb Tariq
- Orthopedics, Layton Rehmatullah Benevolent Trust (LRBT) Free Eye Hospital, Lahore, PAK
| | - Kashif Iqbal
- Ophthalmology, Layton Rehmatullah Benevolent Trust (LRBT) Free Eye Hospital, Lahore, PAK
| | - Bilal Inayat
- Orthopedics, Layton Rehmatullah Benevolent Trust (LRBT) Free Eye Hospital, Lahore, PAK
| | - Munib-Ur Rehman
- Ophthalmology, Khwaja M Safdar Medical College, Sialkot, PAK
| | - Waqas Zaheer
- Ophthalmology, Layton Rehmatullah Benevolent Trust (LRBT) Free Eye Hospital, Lahore, PAK
| | - Malik A Shahid
- Orthopedics, Layton Rehmatullah Benevolent Trust (LRBT) Free Eye Hospital, Lahore, PAK
| | - Moiz Ahmed
- Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK.,Medicine and Surgery, Sindh Medical College, Karachi, PAK
| | - Kiran Abbas
- Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Lu B, Xu H, Wang C, Yan Q, Wang X. Influence of the "Inverted U Method" Nd: YAG Laser Posterior Capsulotomy on Anterior Segment Parameters, Decentration and Tilt of Intraocular Lens in Patients after Phaco-vitrectomy. Semin Ophthalmol 2021; 36:88-93. [PMID: 33734918 DOI: 10.1080/08820538.2021.1884267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate the effects of the "inverted U method" Nd:YAG laser posterior capsulotomy on anterior segment parameters, decentration and tilt of intraocular lens (IOLs) and visual acuity in posterior capsular opacification (PCO) patients after combined phaco-vitrectomy. METHODS Seventy-six patients (76 eyes) were enrolled in this study, who were diagnosed as PCO and underwent "inverted U method" Nd:YAG laser posterior capsulotomy. All patients had undergone previous combined phaco-vitrectomy for rhegmatogenous retinal detachment. The parameters including IOL decentration, angle of IOL tilt, anterior chamber angle (ACA), anterior chamber depth (ACD), anterior chamber volume (ACV), central corneal thickness (CCT), keratometry, pupil size, axial length (AL), intraocular pressure (IOP), refractive status, corrected distance visual acuity (CDVA), objective scattering index (OSI) and Chinese version of Visual Function 14 (VF-14) index were obtained before and 3 months after capsulotomy. RESULTS After capsulotomy, the tilt angle and decentration of the IOLs at both vertical (tilt: p = .004, decentration: p = .029) and horizontal meridian (tilt: p = .001, decentration: p = .017) were significantly decreased, ACA increased (p = .015), CDVA (p = .000), VF-14 score (p = .000) and OSI (p = .000) were significantly improved. There were a significant decrease in cylindrical error (p = .001) and a myopic shift in spherical error (p = .001) after the capsulotomy. No significant differences in ACD, ACV, CCT, keratometry, pupil size, AL and IOP were detected (p > .05 for all). CONCLUSION The "inverted U method" Nd: YAG laser posterior capsulotomy decreases tilt and decentration of the IOL, increases ACA and causes no change in ACD, ACV, CCT and IOP in patients after phaco-vitrectomy. These changes make a decrease in cylindrical error and a myopic shift in spherical error. Laser capsulotomy significantly improves visual acuity.
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Affiliation(s)
- Bo Lu
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, Liaoning Province China
| | - Haoyan Xu
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, Liaoning Province China
| | - Chunxia Wang
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, Liaoning Province China
| | - Qichang Yan
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, Liaoning Province China
| | - Xinling Wang
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, Liaoning Province China
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Raulinajtys-Grzybek M, Grabska-Liberek I, Opala A, Słomka M, Chrobot M. Budget impact analysis of lens material on the posterior capsule opacification (PCO) as a complication after the cataract surgery. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:19. [PMID: 32549794 PMCID: PMC7296914 DOI: 10.1186/s12962-020-00214-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Over 300,000 cataract operations are performed in Poland every year, and the most common, late complication of cataract removal surgery is posterior capsule opacification (PCO). The risk of PCO depends on the lens material. Hydrophobic acrylic lenses cause PCO less frequently as lymphatic endothelial cells show lower affinity for the surface of the lens made of silicone. The objective of this study is to assess the economic impact of using hydrophobic acrylic lenses compared to using hydrophilic acrylic lenses for cataract treatment in the Polish inpatient and outpatient settings. Methods A budget impact analysis (BIA) compared the economic outcomes associated with using hydrophobic acrylic lenses versus using hydrophilic lenses for patients undergoing cataract surgery. The BIA predicted annual expenses in the following scenarios: performing Nd:YAG to treat PCO within 2 and 3 years after implantation of hydrophobic or hydrophilic acrylic lenses for different lens structure. Data used to assess the frequency of PCO was determined in systematic literature review. Costs of current and predicted interventions were estimated based on average data from 19 Polish hospitals. Prices of health services were taken from official public tariff lists. Results The use of a hydrophobic lens significantly limits the number of complications after cataract surgery relative to a hydrophilic lens. As hydrophobic lenses have a higher unit price their use increases the cost of treatment which currently is not reflected by adequate difference in price of the service. Total annual National Health Fund (NHF) expenses for 3-year follow-up model range from 139.1 million EUR to 143.1 million EUR depending on the lens structure, due to the cost of complications. Conclusions BIA indicates the possibility of introducing surcharge for the use of hydrophobic lenses, which could increase the frequency of their use and reduce the number of complications after cataract surgery. It was estimated that total NHF expenses reach the minimum value for the surcharge at the level of 9 EUR. The surcharge of 14 EUR is the maximum value that does not increase the initial NHF expenses.
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Affiliation(s)
| | - Iwona Grabska-Liberek
- Department of Ophthalmology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Aleksandra Opala
- Department of Ophthalmology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marta Słomka
- Department of Neurochemistry, Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
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Tazouta M, Auchere C, Marty PA, Parienti J, Degoumois A, Billotte C, Quintyn JC, Lux AL. [Combined vitrectomy-lensectomy surgery with bag-in-the-lens or lens in the bag implantation: comparison of final visual acuity]. J Fr Ophtalmol 2020; 43:298-304. [PMID: 32087983 DOI: 10.1016/j.jfo.2019.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Combined vitrectomy-lensectomy surgery is a safe and effective procedure. Nevertheless, it is frequently complicated by posterior capsule opacification and the formation of posterior synechiae. These complications can be avoided by placing a "bag in the lens" (BIL) implant. The objective of this study is to compare the visual acuity gain (VA) after combined vitrectomy-lensectomy surgery between a group implanted with the BIL technique and a group with implantation in the bag (LIB). MATERIAL AND METHODS We included in the study all vitrectomy-lensectomy procedures for epiretinal membrane and vitreomacular traction performed between May 2013 and July 2016 at the Hospital and University Center of Caen. We compared the VA gain between the BIL group and the LIB group six months after surgery. RESULTS A total of 33 patients were included in the study, consisting of 28 eyes in the BIL group and 8 eyes in the LIB group. The mean VA gain in the BIL group was -0.52 LogMAR (P<0.0001) and -0.56 LogMAR (P=0.0047) for the LIB group. The difference between the two groups was not significant (P=0.74). CONCLUSION The use of the BIL technique during vitrectomy-lensectomy allows visual recovery as good as implantation within the capsular bag. In addition, this implant has the advantage of significantly reducing the occurrence of posterior synechiae and preventing anterior and posterior capsular proliferation.
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Affiliation(s)
- M Tazouta
- Service d'ophtalmologie, Hôpital Côte de Nacre, avenue Côte de nacre, 14000, Caen, France
| | - C Auchere
- Service d'ophtalmologie, Hôpital Côte de Nacre, avenue Côte de nacre, 14000, Caen, France
| | - P A Marty
- Service d'ophtalmologie, Hôpital Côte de Nacre, avenue Côte de nacre, 14000, Caen, France
| | - J Parienti
- Service de Biostatistiques, Hôpital Côte de Nacre, avenue Côte de nacre, 14000, Caen, France
| | - A Degoumois
- Service d'ophtalmologie, Hôpital Côte de Nacre, avenue Côte de nacre, 14000, Caen, France
| | - C Billotte
- Service d'ophtalmologie, Hôpital Côte de Nacre, avenue Côte de nacre, 14000, Caen, France
| | - J C Quintyn
- Service d'ophtalmologie, Hôpital Côte de Nacre, avenue Côte de nacre, 14000, Caen, France; Normandie Univ, UNICAEN, CHU de Caen Normandie, Unité de recherche UMR-S 1075 Inserm-UNICAEN, 14000 Caen, France.
| | - A L Lux
- Service d'ophtalmologie, Hôpital Côte de Nacre, avenue Côte de nacre, 14000, Caen, France
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Fakhrutdinova AF, Siplivy VI, Fedoruk NA, Bolshunov AV, Gamidov AA. [Retinal changes after laser interventions on anterior segment of the eyeball]. Vestn Oftalmol 2019; 135:122-129. [PMID: 31215543 DOI: 10.17116/oftalma2019135021122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Laser surgery of the cornea, iris, angle of the anterior chamber and other parts of anterior segment of the eye sees wide application in clinical practice. The adverse effects it can cause in the anterior segment are well known and understood. At the same time, changes the treatment method can cause in the posterior segment of the eye - primarily, in macular area of the cornea, which is of great importance, have not been studied sufficiently. Purpose of the review - to consolidate previously published data on changes in the retina after laser intervention on the anterior segment of the eye.
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Affiliation(s)
- A F Fakhrutdinova
- Moscow Municipal Polyclinic #219, 47 Jana Rainisa Blvd., Moscow, Russian Federation, 125373
| | - V I Siplivy
- I.M. Sechenov First Moscow State Medical University, Department of Ophthalmology, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991
| | - N A Fedoruk
- Research Institute of Eye Diseases, 11, A, Rossolimo St., Moscow, Russian Federation, 119021
| | - A V Bolshunov
- Research Institute of Eye Diseases, 11, A, Rossolimo St., Moscow, Russian Federation, 119021
| | - A A Gamidov
- Research Institute of Eye Diseases, 11, A, Rossolimo St., Moscow, Russian Federation, 119021
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Parajuli A, Joshi P, Subedi P, Pradhan C. Effect of Nd:YAG laser posterior capsulotomy on intraocular pressure, refraction, anterior chamber depth, and macular thickness. Clin Ophthalmol 2019; 13:945-952. [PMID: 31239636 PMCID: PMC6559220 DOI: 10.2147/opth.s203677] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/15/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose: To see the effect of Nd:YAG laser capsulotomy on intraocular pressure (IOP), refraction, best-corrected visual acuity (BCVA), anterior chamber depth (ACD), and macular thickness. Methodology: The authors conducted a prospective, descriptive study on pseudophakic eyes with posterior capsule opacification who underwent Nd:YAG laser capsulotomy. BCVA, IOP, spherical equivalent (SE), macular thickness, and ACD were noted preoperatively, at 1 hr postoperatively and at 1-month follow-up. Patients were divided into two groups based on energy used (Group I ≤50 mJ, Group II >50 mJ). None of the patients received prophylactic antiglaucoma medications either before or after the procedure. Results: There were 96 eyes of 83 patients. Mean total energy levels were 26.64±12.92 mJ in Group I and 81.96±32.10 mJ in Group II. BCVA at 1 hr and 1 month postoperatively improved significantly in both the groups compared to preoperative BCVA (P<0.001). There was no significant change in SE compared to preoperative values in both the groups. The ACD continued to increase significantly in both the groups at both 1 hr and 1-month follow-up. In Group I, IOP increased at 1 hr postoperatively (P=0.023) and declined to preoperative levels at 1 month. In Group II, IOP increased at 1 hr postoperatively (P<0.001) and did not return to preoperative levels at 1-month follow-up (P=0.003). Likewise, macular thickness increased at 1 hr in both groups (P<0.001). In Group I, macular thickness decreased significantly to preoperative level at 1 month whereas in Group II, it remained significantly high at 1-month follow-up (P=0.006). There was no case with serious rise in IOP or cystoid macular edema. Conclusion: Statistically significant increment in IOP and macular thickness occurs after Nd:YAG laser capsulotomy which however may not necessitate the use of any medications.
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Affiliation(s)
| | | | - Prabha Subedi
- Cataract and Refractive Surgery, Mechi Eye Hospital, Jhapa, Nepal
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Khan MA, Khan MT, Rehman AU, Idris M, Khan MA. FREQUENCY OF ACUTE RISE OF INTRAOCULAR PRESSURE FOLLOWING YAG LASER POSTERIOR CAPSULOTOMY. GOMAL JOURNAL OF MEDICAL SCIENCES 2018. [DOI: 10.46903/gjms/16.04.1964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background: Posterior capsular opacification (PCO) is the most frequent complication of cataract surgery. The objective of this study was to determine the frequency of acute rise of intraocular pressure (IOP) following Neodymium-Yttrium Aluminum Garnet (Nd:Yag) laser posterior capsulotomy. Materials & Methods: This cross-sectional study was conducted in the Department of Ophthalmology, HMC, Peshawar, Pakistan, from July-December 2016. Sample size was 325 selected by consecutive sampling technique. Inclusion criteria were all patients having significant PCO after uneventful cataract surgery with intra ocular lens implant. Demographic variables were sex, age groups and age in years. Research variable was presence of acute rise of IOP following Yag laser capsulotomy. Pre-laser assessment included slit lamp examination and recording of IOP with Goldmann applanation tonometer by a single ophthalmologist. IOP was measured 3 hours after Nd: Yag laser capsulotomy. Rise in IOP was labeled when IOP was ≥5 mmhg from baseline. Mean ±SD was used to express quantitative variables like age. Categorical variables were analyzed as frequency and percentage. Goodness-of-fit was applied to compare the frequency of acute rise in IOP between sample and population. SPSS-20 was used for data entry and its analysis. Results: Out of 325 patients, 170(52.3%) were men and 155(47.7%) were women. The mean age of the sample was 44.92 ±23.843 years. A total of 107(32.9%) patients were 20-39 years old whereas 218(67.1%) were 40-70 years. IOP was raised in 61 (18.8%) patients while in 264(81.2%) patients it was not raised. The frequency of acute rise in IOP after Yag laser capsulotomy was significantly different in sample compared to population. Conclusion: Men were more than women, especially of old age. The frequency of acute rise in IOP after Yag laser capsulotomy was significantly different in sample compared to population.
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Maxwell A, Suryakumar R. Long-term effectiveness and safety of a three-piece acrylic hydrophobic intraocular lens modified with hydroxyethyl-methacrylate: an open-label, 3-year follow-up study. Clin Ophthalmol 2018; 12:2031-2037. [PMID: 30349186 PMCID: PMC6188169 DOI: 10.2147/opth.s175060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Clareon® is a new hydrophobic acrylic optic biomaterial designed for enhanced clarity and greater resistance to glistening. The present study evaluated the effectiveness and safety of a three-piece hydrophobic, monofocal intraocular lens (IOL) Model MA60NM, made of this new optic material. Methods In this prospective, multicenter, open-label study, eligible patients aged ≥60 years, underwent a unilateral implantation with IOL Model MA60NM following phacoemulsification. Patients were followed-up for up to 3 years after implantation. Visual outcome and serious adverse events (SAEs, cumulative and persistent) were compared to ISO grid rates (BS EN ISO 11979-7:2006). The primary effectiveness variable was Best Spectacle-Corrected Visual Acuity (BSCVA) at 1-year postoperative follow-up. In addition, posterior capsular opacification (PCO) was assessed qualitatively and graded by slit lamp exam on a 5-point scale at all visits. Results Overall, 179 and 138 patients completed the 1-year and 3-year postoperative follow-up, respectively. The BSCVA outcomes were better with IOL Model MA60NM than the ISO grid rates with 95.5% of patients at 1 year and 94.2% of patients at 3 years having achieved a BSCVA of 20/40 or better vs 92.5% in ISO grid. The incidence of cumulative or persistent SAEs was lower after Model MA60NM implantation than the ISO grid reference. The incidence of clinically significant PCO was 1.1% at the 1-year and 2.2% at the 3-year visit. Posterior capsulotomy rate was 1.1% at 1 year and 1.4% at 3 years. Conclusion The three-piece hydrophobic, monofocal IOL Model MA60NM was effective for the visual correction of aphakia and successfully met all the safety parameters as defined by the ISO criteria. PCO and posterior capsulotomy rates were low over the 3-year follow-up period. This study provides evidence and supports the long-term safety and effectiveness of the new optic biomaterial Clareon®.
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El-Haddad NSEDM. The impact of Nd: YAG laser posterior capsulotomy by the use of “the circular pattern with vitreous strand cut” technique on anterior chamber parameters. Lasers Med Sci 2018; 34:353-357. [DOI: 10.1007/s10103-018-2602-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/23/2018] [Indexed: 11/30/2022]
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Monteiro T, Soares A, Leite RD, Franqueira N, Faria-Correia F, Vaz F. Comparative study of induced changes in effective lens position and refraction after Nd:YAG laser capsulotomy according to intraocular lens design. Clin Ophthalmol 2018; 12:533-537. [PMID: 29593378 PMCID: PMC5863715 DOI: 10.2147/opth.s156703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate and compare the changes in refraction and effective intraocular lens (IOL) position between a plate-haptic IOL and a c-loop single-piece IOL after neodymium-doped yttrium aluminium garnet (YAG) laser posterior capsulotomy. Methods In a prospective study, anterior chamber depth and subjective refraction were measured in 110 pseudophakic eyes from 110 patients, before and 1 month after YAG laser capsulotomy. Patients were divided into 2 groups according to the IOL design: group 1 (plate-haptic acrylic hydrophilic AT LISA tri 839MP®) and group 2 (c-loop acrylic hydrophobic single-piece AcrySof® SA60AT). Lens position was obtained through optical coherence biometry (Biograph WaveLight OB820®). Results YAG laser capsulotomy was performed 37.8±9.8 months after surgery in group 1 and 40.6±8.6 months in group 2 (p=0.125). Significant changes were found in the lens effective position after treatment in the 2 groups. The YAG posterior capsulotomy led to a change of anterior chamber depth in group 1 from 4.03±0.32 mm to 3.86±0.34 mm (p=0.02) and in group 2 from 4.03±0.37 mm to 4.14±0.45 mm (p=0.025). After YAG laser posterior capsulotomy, no significant changes were observed in mean spherical equivalent, sphere or cylinder for both groups (p>0.05). Conclusion YAG laser posterior capsulotomy can induce a significant change in the IOL position according to the IOL type; however, the refractive change after treatment is clinically insignificant.
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Affiliation(s)
- Tiago Monteiro
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - Andreia Soares
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal
| | | | - Nuno Franqueira
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal
| | - Fernando Faria-Correia
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - Fernando Vaz
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal
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Kim JS, Choi JY, Kwon JW, Wee WR, Han YK. Comparison of two Nd:YAG laser posterior capsulotomy: cruciate pattern vs circular pattern with vitreous strand cutting. Int J Ophthalmol 2018; 11:235-239. [PMID: 29487812 DOI: 10.18240/ijo.2018.02.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/31/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the effects and safety of neodymium: yttrium-aluminium-garnet (Nd:YAG) laser posterior capsulotomy with vitreous strand cutting. METHODS A total of 40 eyes of 37 patients with symptomatic posterior capsular opacity (PCO) were included in this prospective randomized study and were randomly subjected to either cruciate pattern or round pattern Nd:YAG posterior capsulotomy with vitreous strand cutting (modified round pattern). The best corrected visual acuity (BCVA), intraocular pressure (IOP), refractive error, endothelial cell count (ECC), anterior segment parameters, including anterior chamber depth (ACD) and anterior chamber angle (ACA) were measured before and 1mo after the laser posterior capsulotomy. RESULTS In both groups, the BCVA improved significantly (P<0.001 for the modified round pattern group, P=0.001 for the cruciate pattern group); the IOP and ECC did not significantly change. The ACD significantly decreased (P<0.001 for both) and the ACA significantly increased (P=0.001 for the modified round pattern group and P=0.034 for the cruciate group). The extent of changes in these parameters was not significantly different between the groups. CONCLUSION Modified round pattern Nd:YAG laser posterior capsulotomy is an effective and safe method for the treatment of PCO. This method significantly changes the ACD and ACA, but the change in refraction is not significant. Modified round pattern Nd:YAG laser posterior capsulotomy can be considered a good alternative procedure in patients with symptomatic PCO.
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Affiliation(s)
- Jin-Soo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jung Yeol Choi
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 07061, Korea
| | - Ji-Won Kwon
- Department of Ophthalmology, Seonam University College of Medicine, Myongji Hospital, Goyang 10475, Korea
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Young Keun Han
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 07061, Korea
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Kossack N, Schindler C, Weinhold I, Hickstein L, Lehne M, Walker J, Neubauer AS, Häckl D. German claims data analysis to assess impact of different intraocular lenses on posterior capsule opacification and related healthcare costs. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2017; 26:81-90. [PMID: 29416961 PMCID: PMC5794811 DOI: 10.1007/s10389-017-0851-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/26/2017] [Indexed: 12/31/2022]
Abstract
Aim Cataract extraction is one of the most frequent surgeries in Germany. In most cases, the clouded natural lens is replaced by a hydrophobic or hydrophilic acrylic intraocular lens (IOL) implant. The most common long-term complication after cataract surgery is the development of a posterior capsule opacification (PCO). Although no precise real world data are available, published evidence suggests a lower risk for PCO development for hydrophobic acrylic IOLs compared to hydrophilic acrylic IOLs. Therefore, in the present study we assessed real world data on the impact of different IOL material types on the incidence of post-operative PCO treatment. Subject and methods In this retrospective study, we included 3,025 patients who underwent cataract extraction and implantation of either an acrylic hydrophobic or hydrophilic IOL in 2010. We assessed clinical outcomes and direct costs in a 4-year follow-up period after cataract surgery from a statutory health insurance (SHI) perspective in Germany. Results PCO that required capsulotomies occurred significantly (p < 0.0001) less frequent in patients who had received a hydrophobic IOL (31.57% of 2,078 patients) compared to the group with hydrophilic IOL implants (56.6% of 947 patients) and costs per patient for postoperative treatment in a 4-year follow-up were 50.03 € vs. 87.81 € (i.e. 75% higher in the latter group, p < 0.0001). Conclusion Considering the high prevalence of cataract, the economic burden associated with adverse effects of cataract extraction is of great relevance for the German SHI. Hydrophobic lenses seem to be superior regarding both medical and economic results.
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Affiliation(s)
- Nils Kossack
- WIG2 Institute for Health Economics and Health System Research, Leipzig, Germany
| | - Christian Schindler
- WIG2 Institute for Health Economics and Health System Research, Leipzig, Germany
| | - Ines Weinhold
- WIG2 Institute for Health Economics and Health System Research, Leipzig, Germany
| | | | | | - Jochen Walker
- InGef Institut für angewandte Gesundheitsforschung, Berlin, Germany
| | | | - Dennis Häckl
- WIG2 Institute for Health Economics and Health System Research, Leipzig, Germany
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Resident-performed neodymium:YAG laser posterior capsulotomy. Can J Ophthalmol 2017; 52:324-330. [PMID: 28774511 DOI: 10.1016/j.jcjo.2016.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the outcomes of resident-performed Nd:YAG laser posterior capsulotomy. DESIGN Combined retrospective and prospective study. PARTICIPANTS Patients (N = 301) who underwent Nd:YAG capsulotomy by ophthalmology residents at Rassoul Akram Hospital, Tehran, Iran. METHODS Assessment of visual outcomes and complications and the results of second- and third-year residents. RESULTS In the retrospective arm, 131 eyes of 129 patients were enrolled. Mean best-corrected visual acuity (BCVA) improved significantly from 1.15 ± 0.26 to 0.54 ± 0.39 logMAR (p < 0.001). Mean intraocular pressure (IOP) before capsulotomy and at the final visit was 13.1 ± 2.34 mm Hg and 13.6 ± 2.17 mm Hg, respectively (P = 0.30). Retinal detachment occurred in 2 eyes (1.5%). No case of intraocular lens decentration or endophthalmitis was detected. In the prospective arm on 173 eyes of 172 patients, mean pre-YAG BCVA was 1.14 ± 0.25 logMAR and increased to 0.51 ± 0.37 logMAR after surgery (p < 0.001). There was no significant difference between pre-laser IOP measurements compared with the 1-month IOP measurements (P = 0.32). The postoperative changes in mean BCVA and IOP between the second- and third-year residents were not significant; however, the applied laser power, the number of laser spots, rate of incomplete capsulotomies, and the amount of total and central laser-induced IOL pits were significantly higher among the second-year residents. CONCLUSIONS Resident-performed capsulotomy appears to be effective with a low complication profile. Despite the lower levels of surgical skills, second-year residents could achieve good visual outcomes. The laser parameters and IOL-related complications improved with increasing surgical experience.
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Shetty NK, Sridhar S. Study of Variation in Intraocular Pressure Spike (IOP) Following Nd- YAG Laser Capsulotomy. J Clin Diagn Res 2016; 10:NC09-NC12. [PMID: 28208899 DOI: 10.7860/jcdr/2016/21981.9037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Posterior Capsular Opacifications (PCO) is a frequent complication of cataract surgery following posterior chamber intraocular lens implantation. Nd -Yag laser capsulotomy is the treatment of choice for PCO and is known to be associated with complications like Raised Intraocular Pressure (IOP), Intraocular lens pitting, intraocular lens cracks, cystoid macular oedema, retinal detachment, corneal burns. Raised IOP is the most common complication and prescribing anti-glaucoma drugs post capsulotomy is a common practise. Our study helps us to anticipate the post procedural IOP rise in specific patients and treat only selected group of patients with anti- glaucoma medications. AIM To study and correlate the effect of energy used and number of shots with post procedural IOP spike following Nd-YAG laser capsulotomy cases. MATERIALS AND METHODS All patients with PCO presenting to Ophthalmology Out Patient Department at Sri Siddhartha Medical College between November 2014 to November 2015 were included. All the patients with glaucoma, uveitis and high myopia were excluded from the study. Data relevant to history, ocular examination and IOP were recorded. RESULTS Significant correlation of IOP spike with the number of Nd- YAG Laser shots delivered was found by One-way ANOVA Post-Hoc Tukeys Test. The p-value was significant for shots more than 40, provided the energy was restricted to 20 mJ and below. Correlation of energy with IOP spike was not significant as found by One-way ANOVA, Post-Hoc Tukey test. Predictability of 2 hours post-procedure IOP regarding persistent IOP rise was significant. CONCLUSION It was observed that all pseudophakic patients may not require anti-glaucoma medication pre, or post Nd YAG laser capsulotomy. Only patients who required more than 40 shots during the procedure would need a close observation and if persistent rise is documented, ocular hypotensives may be advised.
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Affiliation(s)
- Niharika K Shetty
- Associate Professor, Department of Ophthalmology, Sri Siddhartha Medical College and Hospital , Tumakuru, Karnataka, India
| | - Sriya Sridhar
- Post Graduate, Department of Ophthalmology, Sri Siddhartha Medical College and Hospital , Tumakuru, Karnataka, India
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Lin HZ, Lee YC. Neovascular glaucoma following Nd:YAG laser capsulotomy in a patient with diabetes and syphilitic uveitis. Tzu Chi Med J 2016; 28:76-78. [PMID: 28757727 PMCID: PMC5442896 DOI: 10.1016/j.tcmj.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 11/29/2022] Open
Abstract
A diabetic woman had been suffering from progressively blurry vision in the right eye for 1 year after cataract surgery. Slit lamp examination revealed bilateral band keratopathy with quiescent anteriorchamber reaction, an intumescent cataract in the left eye, and dense posterior capsular opacity in the right eye. Capsulotomy was performed, but this led to neovascular glaucoma. Because of a refractory elevation in intraocular pressure, trabeculectomy with mitomycin C treatment, vitrectomy with panretinal photocoagulation, and intravitreal injection of bevacizumab were performed. A positive rapid plasma reagin test and a positive Treponema pallidum hemagglutination assay led to the impression of syphilitic uveitis, and the patient was treated with intravenous penicillin for 2 weeks. The visual acuity of the right eye was 0.1 at the 12th-month follow up. This case shows that neovascular glaucoma may present as a complication of capsulotomy in uveitic/diabetic eyes.
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Affiliation(s)
- Hong-Zin Lin
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan
| | - Yuan-Chieh Lee
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan.,Institute of Medical Science, Tzu Chi University, Hualien, Taiwan
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Bhargava R, Kumar P, Phogat H, Chaudhary KP. Neodymium-yttrium aluminium garnet laser capsulotomy energy levels for posterior capsule opacification. J Ophthalmic Vis Res 2015; 10:37-42. [PMID: 26005551 PMCID: PMC4424716 DOI: 10.4103/2008-322x.156101] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 05/12/2014] [Indexed: 11/16/2022] Open
Abstract
Purpose: To study factors affecting laser energy levels required for neodymium: yttrium aluminium garnet (Nd: YAG) laser capsulotomy and to evaluate whether any correlation exists between applied laser energy levels and complications. Methods: The present study examined 474 consecutive patients for a number of factors including age, type of posterior capsule opacification (PCO), material and fixation of intraocular lens (IOL) and complication rates, versus energy levels used for Nd: YAG laser capsulotomy. Results: Mean patient age was 55.6 ± 8.7 years and mean follow up period was 22.9 ± 4.5 months. IOL biomaterial (KW ANOVA; P = 0.173) and patient's age (P = 0.246) did not significantly influence total laser energy requirement for capsulotomy. However, total laser energy levels were significantly higher (KW ANOVA; P < 0.001) with fibro-membranous and fibrous subtypes of PCO. Complications such as IOL pitting, intraocular pressure (IOP) elevation, uveitis, retinal detachment (RD) and cystoid macular edema (CME) were significantly more common when higher energy levels was used. The mean total energy in patients with RD was 77.7 ± 17.7 mJ as compared to 43.4 ± 26.9 mJ in the rest of the cohort. RD was more common in patients with higher axial length [n = 7 (63%)] (P < 0.001). Conclusion: Type of PCO significantly influenced laser energy levels required for capsulotomy, whereas IOL biomaterial and fixation did not. Complications such as IOL pitting, uveitis, IOP elevation, RD and CME was significantly more common when total laser energy was higher. It is recommended that the lowest possible single pulse laser energy be used for capsulotomy to minimize complications.
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Affiliation(s)
- Rahul Bhargava
- Department of Ophthalmology, Laser Eye Clinic, Noida, Uttar Pradesh, India
| | - Prachi Kumar
- Department of Pathology, Santosh Medical College and Hospital, Ghaziabad, India
| | - Hemant Phogat
- Department of Ophthalmology, Santosh Medical College and Hospital, Ghaziabad, India
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Yılmaz U, Küçük E, Ulusoy DM, Özköse A, Ataş M, Demircan S, Yuvacı I. 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. Cutan Ocul Toxicol 2015; 35:58-61. [PMID: 25799211 DOI: 10.3109/15569527.2015.1017579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
| | | | | | - Ayşe Özköse
- b Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Mustafa Ataş
- b Kayseri Training and Research Hospital , Kayseri , Turkey
| | | | - Isa Yuvacı
- b Kayseri Training and Research Hospital , Kayseri , Turkey
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Kim BJ, Kim JH, Kim SJ, Han YS, Park JM, Chung IY. Two Cases of WIOL-CF® IOL Dislocation after Nd:YAG Laser Capsulotomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.3.443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Byung Jae Kim
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ji Hye Kim
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Seong Jae Kim
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Yong Seop Han
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Jong Moon Park
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - In Young Chung
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
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Karahan E, Er D, Kaynak S. An Overview of Nd:YAG Laser Capsulotomy. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2014; 3:45-50. [PMID: 25738159 PMCID: PMC4346677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It has been revealed that posterior capsule opacification (PCO) is the most common delayed complication of cataract surgery. On the other hand, Nd:YAG laser capsulotomy is accepted as standard treatment for PCO. Although, Nd:YAG laser capsulotomy is a noninvasive and safe treatment it carries risk of some complications. Using less total energy and performing smaller capsulotomies are effective choices to decrease complications after Nd:YAG capsulotomy. The purpose of this review is to look through the complications associated with Nd:YAG laser capsulotomy, and the effect of capsulotomy size and used total energy on such complications.
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Affiliation(s)
- Eyyup Karahan
- Egepol Hospital, Department of Ophthalmology, Izmir, Turkey
| | - Duygu Er
- Dokuz Eylul University, Department of Ophthalmology, Izmir, Turkey
| | - Suleyman Kaynak
- Dokuz Eylul University, Department of Ophthalmology, Izmir, Turkey
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