Angle-closure glaucoma associated with vitreous prolapse after neodymium-doped yttrium-aluminum-garnet laser posterior capsulotomy

ABSTRACT Capsulotomy with neodymium-doped yttrium--aluminum-garnet (Nd:YAG) laser is an effective treatment for posterior capsule opacification following cataract surgery. A wide opening of the posterior capsule associated with the ruptured anterior hyaloid can cause anterior chamber vitreous prolapse. Two patients who developed angle-closure glaucoma associated with vitreous prolapse following Nd:YAG laser posterior capsulotomy were successfully treated with antiglaucoma medication and peripheral iridotomies. Patient identification for potential risk factors and a careful postoperative follow-up are essential to avoid these serious complications.

Comparison of early clinical outcomes between SuperCap and direct anterior approaches for total hip arthroplasty / 中国骨伤

OBJECTIVE@#To compare the short-term clinical efficacy of SuperCap approach and direct anterior approach in total hip arthroplasty.@*METHODS@#Clinical data of 70 patients who underwent minimally invasive SuperCap approach and DAA THA in January 2016 to June 2017 were retrospective analyzed. These patients were divided into two groups:SuperCap approach group(SuperCap group) and direct anterior approach group(DAA group). There were 15 males and 15 females in SuperCap group, aged from 45 to 71 years old, and the follow-up time ranged from 24 to 30 months. There were 24 males and 16 females in Group B, aged from 51 to 76 years and the follow-up time ranged from 24 to 36 months. Hemoglobin level of the 3rd day after operation, transfusion rate, acetabular abduction angle, anteversion angle and creatine kinase level of the 3rd day after operation, Harris score of 3 months and the last time, VAS score of 1 week and the last time were recorded and compared. Complications were recorded at the final follow-up.@*RESULTS@#All patients were followed up, the follow-up time of SuperCap group ranged from 24 to 30 months, that of DAA group ranged from 24 to 36 months. No significant differences were found in hemoglobin level on the 3rd day after operation, transfusion rate, Harris score or VAS score between two group (P>0.05). There was no significant difference in Harris score between 3 months after operation and the final follow-up in both groups (P>0.05). There were no significant difference in VAS scores of 6 weeks after operation and on the final follow-up neither(P>0.05). The level of creatine kinase in SuperCap group was significant lower than that in DAA group(P<0.05). Until the final follow-up, there was no significant difference in the incidence of complications between the two groups(P>0.05).@*CONCLUSION@#The clinical effect of minimally invasive SuperCap approach after total hip arthroplasty is comparable to that of DAA approach with less soft tissue injury. Patients can recover rapidly after operation and it is a safe and effective surgical approach for surgeons with short learning curve.

Vacuum rhexis � A novel capsulorhexis technique for white cataracts

Capsulorhexis in white intumescent cataract is often associated with extension leading to radial tears or biradial extension 揂rgentinian flag sign� and associated complications. We describe a novel technique of managing this situation. Vacuum rhexis is performed with a 24 G bent cannula attached to a 10-ml syringe. The flap is lifted and then caught using 24 G cannula. The suction is manually controlled by the surgeon, and the rhexis is completed using circumferential movement. The chamber stability is well maintained as there is no leakage, and the bent tip gives excellent fulcrum for movement. The advantage of this technique is that a single port is used for maintaining the chamber stability and it needs no special surgical instruments. Vacuum rhexis is a novel surgical technique used for performing successful continuous curvilinear capsulorhexis (CCC) of adequate size in white and intumescent cataracts, with a consistent and predictable outcome.

Recommendations for management of peripheral retinal degenerations

Some degenerations involving the peripheral retina can result in a rhegmatogenous retinal detachment. Currently, there are no clear guidelines for retinal screening and/or management of these peripheral retinal degenerations in patients with or without recent onset posterior vitreous detachment or in those prior to refractive surgery or intraocular procedures. This article aims to provide a set of recommendations for the screening and management of peripheral retinal degenerations based on a common consensus obtained from an expert panel of retinal specialists.

Intraocular lens-blocking technique for intraocular foreign body removal

The aim of this study was to describe a novel technique for intraocular foreign body (IOFB) removal. Phacoemulsification was performed in all patients, followed by a complete microincision vitrectomy to free all tissues surrounding the IOFB. A three?piece intraocular lens (IOL) was placed in the capsular bag, and an opening was made in the upper center of the capsule. The IOFB was removed and lifted to the anterior chamber through the capsular opening and IOL edge. The IOFB was confined to the anterior chamber by the IOL, and then easily extracted through the main corneal incision. The technique was adopted in six eyes of six patients. All IOFBs were removed successfully in all patients without intraoperative or postoperative complications. The IOL?blocking technique is a useful approach for IOFB removal.

Application of posterior capsulotomy in cataract surgery combined with silicone oil removal for diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical effect of posterior capsulotomy in diabetic retinopathy with silicone oil removal combined with cataract surgery.<p>METHODS: A retrospective analysis that collected clinical data of 83 cases(83 eyes)diagnosed as diabetic retinopathy and silicone oil filled eyes with cataract and treated in our hospitalfrom January 2019 to February 2020. They were randomly divided into two groups. The experimental group consisted 41 eyes received silicone oil removal and posterior capsulotomy combined with cataract surgery; The rest 42 eyes were in control group, who received silicone oil removal combined with cataract surgery. At 6mo after surgery, the best corrected visual acuity, posterior capsular opacification, and floaters were evaluated between the two groups to confirm the advantages of posterior capsulotomy in combined cataract surgery with silicone oil removal for diabetic retinopathy.<p>RESULTS: At 6mo after surgery, the best corrected visual acuity in experimental group was better than control group(<i>P</i><0.05); There were significant differences between the two groups in the posterior capsular opacification, and floaters,experimental group is lower than control group(<i>P</i><0.05). There was no significant difference in intraocular pressure compared to preoperative between the two groups, and no significant difference in retinal detachment, vitreous hemorrhage and intraocular lens deviationafter operation(<i>P</i>>0.05). <p>CONCLUSION: Posterior capsulotomy is safe and reliable in the application of silicone oil removal combined with cataract surgery for diabetic retinopathy, and can effectively avoid the occurrence of posterior capsular opacification.

Clinical analysis of combined microsurgery for nanophthalmic patients with uncontrolled intraocular pressure after peripheral iridectomy / 中华显微外科杂志

Objective:To evaluate the efficacy and safety of limited pars plana vitrectomy(LPPV), pressure-controlled phacoemulsification(PCP), intraocular lens implantation(IOL), and posterior capsulotomy (PC) in treatment of nanophthalmic glaucoma eyes which intraocular pressure(IOP) were still out of control after peripheral iridectomy.Methods:All 24 patients(29 eyes) with nanophthalmic glaucoma whose IOP failed to be reduced after peripheral iridectomy and needed LPPV plus PCP plus IOL plus PC were recruited from July 2017 to April 2021. The age of these patients was(44.6±11.0) years old. Preoperative and postoperative IOP, best corrected visual acuity(BCVA), anterior chamber depth(ACD) and number of glaucoma medications were recorded by chart review and compared by using paired t-test or Wilcoxon signed rank-sum test. P<0.05 was considered as statistical significant. IOP could be controlled in normal range(≥5 mmHg and≤21 mmHg), without both of disease progression and serious complications were regarded as the success criteria of the operation. Surgical success rate was evaluated. Surgery-associated complications were recorded. Results:The average follow-up time was(11.52±12.44) months. After the microsurgery, IOP decreased from(33.12±9.25) mmHg to(14.23±3.44) mmHg( P<0.01); The ACD increased from(1.23±0.46) mm to(2.86±0.62) mm, and the median number of glaucoma medications dropped from 3(3,4) to 3(0,3) at final follow-up visit( P<0.05). There were no significant differences in BCVA( P=0.196) and the degrees of angle closure(AC) ( P=0.478) before and after operation. The total surgical success rate was 86.2%(25/29) at the final follow-up visit. Two eyes suffered from local choroidal detachment which recovered within 2 weeks with medical treatment. Conclusion:LPPV plus PCP plus IOL plus PC is a safe and effective novel surgical procedure in the treatment of nanophthalmic glaucoma patients with uncontrolled IOP after peripheral iridectomy. It could significantly decrease IOP, increase the depth of ACD, reduce the number of glaucoma medications and maintain BCVA. It can be considered as a first choice for the surgical management for patients with a such condition.

Alteração refracional após capsulotomia posterior com laser Nd: YAG / Change on refraction after Nd: YAG laser posterior capsulotomy

RESUMO Objetivo: Identificar se há mudança refracional significativa após realização de capsulotomia posterior com laser Nd:YAG em olhos pseudofácicos. Métodos: Estudo retrospectivo com análise de prontuários de pacientes atendidos em um hospital com diagnóstico de opacificação de cápsula posterior do cristalino tratada com capsulotomia posterior com laser Nd:YAG no período de outubro de 2019 a março de 2021. A comparação entre a refração antes e após o procedimento foi realizada calculando-se o equivalente esférico. Também foi avaliada a mudança da acuidade visual, aferida por LogMAR. Resultados: Foram analisados 90 prontuários, totalizando 140 olhos, de pacientes submetidos à capsulotomia posterior com laser Nd:YAG. O equivalente esférico médio pré-procedimento foi de -0,07±0,89D, mínimo de -3,0D e máximo de +2,5D, mediana (intervalo interquartil) de 0,0D (-0,50D a +0,375D). A média pós-procedimento foi de -0,18±0,86D, mínimo de -3,5D e máximo de +2,25D, mediana (intervalo interquartil) de -0,125D (-0,50D a 0,0D). com p<0,0082. Dos 140 olhos, 66 sofreram miopização e 37 hipermetropização. A média de alteração do equivalente esférico geral foi de -0,12±0,51D, mínimo de -2,50D e máximo de +1,25D, mediana (intervalo interquartil) de 0,0D (-0,375D a +0,125D). Ao se comparar a diferença entre o equivalente esférico antes e após o procedimento do grupo de olhos que sofreu miopização (n=66) ou hipermetropização (n=37), separadamente, ambos obtiveram p<0,0001. Ao se compararem todos os olhos que sofreram alguma alteração refracional (n=103), foi encontrado p=0,008. A acuidade visual média pré-procedimento foi de 0,23±0,32, mínimo de 0,0 e máximo de 2,3. Pós-procedimento, a média foi de 0,06±0,13, mínimo de -0,12 e máximo de 0,7, com p<0,0001. Conclusão: A capsulotomia posterior com laser Nd:YAG gerou melhora significativa da acuidade visual nos pacientes do estudo, porém também gerou alteração refracional significativa após o procedimento, tanto para miopização (a mais frequente), quanto para hipermetropização.

ABSTRACT Objective: To identify if there is a significant change on refraction after Nd:YAG laser posterior capsulotomy in pseudophakic eyes. Methods: A retrospective study with analysis of medical records of patients treated at a hospital, with diagnosis of opacification of posterior lens capsule treated with Nd:YAG laser posterior capsulotomy, from October 2019 to March 2021. The comparison of refraction before and after the procedure was performed by calculating the spherical equivalent. Changes in visual acuity (VA), measured by LogMAR, were also evaluated. Results: A total of 90 medical records (140 eyes) of patients submitted to Nd:YAG laser posterior capsulotomy were analysed. The mean pre-procedure spherical equivalent was -0.07±0.89D, minimum of -3.0D and maximum of +2.5D, median (interquartile range) of 0.0D (-0.50D to +0.375D). The post-procedure mean was -0.18±0.86D, minimum of -3.5D and maximum of +2.25D, median (interquartile range) of -0.125D (-0.50D to 0.0D), with p <0.0082. Of the 140 eyes, 66 underwent myopia and 37 hyperopia, the mean change in the general spherical equivalent was -0.12±0.51D, minimum -2.50D and maximum +1.25D, median (interquartile range) of 0.0D (-0.375D to +0.125D). When comparing the difference between the spherical equivalent before and after the procedure of the group of eyes that underwent myopia (n=66) or hyperopia (n=37), separately, both obtained p<0.0001. When comparing all eyes that suffered any change on refraction (n=103), the p value was 0.008. The mean pre-procedure visual acuity was 0.23±0.32, minimum of 0.0 and maximum of 2.3. After the procedure, the mean was 0.06±0.13, minimum of -0.12 and maximum of 0.7, p<0.0001. Conclusion: Nd:YAG laser posterior capsulotomy significantly improved visual acuity of patients in this study; however, it also led to a significant change on refraction after the procedure, both for myopization, which was more frequent, and for hyperopization.

Iris-registration capsulotomy marking for the implantation of Toric intraocular lens / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the accuracy of Toric intraocular lens(IOL)alignment and visual outcome using the femtosecond laser-assisted capsulotomy markings(FLACM)versus a conventional slitlamp-assisted manual marking(SAMM)procedure. <p>METHODS: Totally 50 patients required cataract surgery and Toric IOL implantation were assigned to the FLACM group(25 eyes)or the SAMM group(25 eyes). The uncorrected distant visual acuity(UCDVA), best corrected distant visual acuity(BCDVA), residual astigmatism(RA), IOL rotation, MTF Total were measured 1mo after surgery. <p>RESULTS: The UCDVA(LogMAR)was significantly lower in the FLACM group than in the SAMM group 1mo postoperatively(0.15±0.09 <i>vs</i> 0.22±0.11, <i>P</i><0.05). The RA and IOL rotation were significantly lower in the FLACM group than in the SAMM group(0.30±0.18D <i>vs</i> 0.64±0.28D, <i>P</i><0.05; 3.64°±1.68° <i>vs</i> 5.40°±3.44°, <i>P</i><0.05). There was no statistical difference between the two groups in the BCDVA and MTF total value(<i>P</i>>0.05). The UCDVA(LogMAR)was positive correlative to the RA(<i>r</i>=0.350, <i>P</i><0.05)and IOL rotation(<i>r</i>=0.369,<i> P</i><0.05), and was negative correlative to the MTF total value(<i>r</i>= -0.290, <i>P</i><0.05); the RA was positive correlative to the IOL rotation(<i>r</i>=0.431, <i>P</i><0.05). <p>CONCLUSION: The accuracy of the axis alignment was significantly higher in the FLACM group, which results in lower residual astigmatism and better visual outcome.

Evaluation of quality of life and visual acuity after posterior capsulotomy with neodymium: YAG laser in adults / Avaliação da qualidade de vida e da acuidade visual após capsulotomia com Neodymium: YAG laser em adultos

Abstract Purpose: To determine the impact of neodymium:YAG (Nd:YAG) laser posterior capsulotomy on quality of life and visual acuity in adults. Methods: A prospective study that included patients over 65 years old with clinical indications for Nd: YAG laser capsulotomy. On the day of the procedure, corrected distance visual acuity tests, slit-lamp examination and posterior capsule opacification (PCO) photo documentation were performed, followed by application of the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). The PCO rate was evaluated with Evaluation of Posterior Capsule opacification (EPCO 2000) software. Four weeks after the posterior capsulotomy, corrected distance visual acuity was measured, and the NEI-VFQ-25 was applied again. Complications were also reported. Results : Sixty eyes from 45 patients were enrolled in the study. The mean age was 71.51 ± 6.38 years (65 to 93). Comparing the results before and after the Nd:YAG laser capsulotomy, there was a statistically significant improvement in quality of life according to the NEI-VFQ-25 (p<0.001) and in visual acuity (p=0.0). The mean score in NEI-VFQ-25 Questionnaire before capsulotomy was 62.07 ± 20.90 (16.81-95.90) and after was 83.95±19.49 (20.68 - 100.0). The mean CDVA before the procedure was 0.75 ± 0.35 LogMAR (0.1-1.3) and after was 0.21 ± 0.20 LogMAR (0.0-1.3). The mean PCO rate measured by the EPCO software was 0.688 ± 0.449. There was a positive correlation between the EPCO score and the total score of quality of life after Nd: YAG laser capsulotomy (r=0.845, p=0.00). Damage to intraocular lens was the only complication observed in six eyes (10%). Conclusion: Nd: YAG laser capsulotomy, in addition to improving visual acuity, is able to improve quality of life.

Resumo Objetivo: Determinar o impacto da capsulotomia posterior com laser de neodímio: YAG (Nd: YAG) na qualidade de vida e na acuidade visual em adultos. Métodos: Estudo prospectivo que incluiu pacientes acima de 65 anos com indicação clínica para capsulotomia com laser de Nd: YAG. No dia do procedimento, foram realizados testes de acuidade visual corrigida, exame com lâmpada de fenda e fotodocumentação da opacificação da cápsula posterior (OCP), seguido da aplicação do National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). A taxa de OCP foi avaliada utilizando o software de avaliação de opacificação de cápsula posterior (EPCO 2000). Quatro semanas após a capsulotomia posterior, a acuidade visual corrigida foi medida, e o NEI-VFQ-25 foi aplicado novamente. Complicações também foram relatadas. Resultados: Sessenta olhos de 45 pacientes foram incluídos no estudo. A idade média foi de 71,51±6,38 anos (65 to 93). Comparando os resultados antes e após a capsulotomia com laser Nd: YAG, houve melhora estatisticamente significante na qualidade de vida de acordo com o NEI-VFQ-25 (p <0,001) e na acuidade visual (p = 0,0). A média do escore total do questionário NEI-VFQ-25 pré capsulotomia foi de 62.07 ± 20.90 (16.81-95.90) e pós foi de 83.95 ±19.49 (20.68 - 100.0). A AVCC antes do procedimento foi 0.75 ± 0.35 LogMAR (0.1-1.3) e após foi 0.21 ± 0.20 LogMAR (0.0-1.3). A taxa média de OCP medida pelo software EPCO foi de 0,688 ± 0,449. Houve correlação positiva entre o escore EPCO e o escore total de qualidade de vida após a capsulotomia com laser de Nd: YAG (r = 0,845, p = 0,00). O dano à lente intraocular foi a única complicação observada em seis olhos (10%). Conclusão: A capsulotomia com laser Nd: YAG, além de melhorar a acuidade visual, é capaz de melhorar a qualidade de vida.

Factors Affecting IOP Changes Following Neodymium: Yttrium Aluminum GARNET (Nd:YAG) Capsulotomy

Introduction: Transient intraocular pressure rise is acommonly observed phenomenon following Nd:YAGcapsulotomy. However, IOP change is considered to bedependent on multiple factors. Study aimed to assess factorsdetermining the IOP change following Nd:YAG capsulotomy.Material and Methods:A total of 150 adult patients, scheduledto undergo Nd:YAG laser capsulotomy for management ofposterior chamber opacification (PCO) were enrolled. Age,gender, time since cataract surgery, PCO grade, IOP, topicalhypotensive use was noted in all the cases. Amount of energyused in Nd:YAG procedure was recorded. Postoperative IOPchange was noted immediately, 1 hr and 3 hr postoperativeintervals. Rise >5 mm was considered clinically significant.Independent samples ‘t’-test, Chi-square test and binarylogistic regression were used. Data analysis was performedusing SPSS 15.0 software.Results: Mean age of patients was 60±11.3 years. Majoritywere females (59.3%). Majority of patients had Grade I andII of PCO (64%), 5-10 years duration since cataract surgery(79.3%) and topical hypotensive use was done(58%).Preoperative mean IOP was 15.99±2.72 mmHg. Energyused was 55.7±52.7 mJ. A total of 19 (12.7%) patients hadIOP rise >5 mm. On univariate analysis, Grade III or abovePCO, higher level of total energy use and low hypotensive usewere found to be significantly associated with IOP rise. Onmultivariate assessment, low hypotensive use and high energyuse were found to be significantly associated with clinicallysignificant IOP rise (p<0.05).Conclusions: Low energy and prophylactic topicalhypotensives were protective against IOP rise.

Objective evaluation of vision quality in pseudophakic patients with posterior capsular opacification using double-pass retinal imaging / Avaliação objetiva da qualidade da visão em pacientes pseudofácicos com opacificação capsular posterior pelo método de dupla passagem de luz

ABSTRACT Purpose: The purpose of this study was to objectively assess the optical vision quality of patients before and after Nd:YAG capsulotomy for posterior capsular opacification using a double-pass retinal imaging system. Methods: We retrospectively analyzed the data from 26 pseudophakic eyes with posterior capsular opacification that underwent Nd:YAG capsulotomy. The objective scatter indices, modulation transfer function cutoff frequencies, Strehl ratios, and logMAR corrected distance visual acuities were assessed before and after YAG capsulotomy with a double-pass retinal imaging system (OQAS II, Visiometrics, Spain). We also analyzed data from a subgroup of 10 patients with pre-YAG corrected distance visual acuity of 0.10 logMAR (20/25) or better. Results: Vision quality indices improved in all 26 eyes, resulting in a statistically significant improvement in the corrected distance visual acuity (p=0.007), objective scatter index (p=0.001), modulation transfer function cutoff frequency (p=0.001), and Strehl ratio (p=0.020). The overall mean improvements included 0.12 ± 0.04 logMAR for corrected distance visual acuity, 2.84 ± 0.76 for objective scatter index, 12.29 ± 2.77 for modulation transfer function cutoff frequency, and 0.06 ± 0.03 for Strehl ratio. Our sub-analysis of 10 eyes with 0.10 logMAR (20/25) corrected distance visual acuity or better also showed a statistically significant improvement in the mean objective scatter index (0.76 ± 16; p=0.001), resulting in approximately 35% decrease in intraocular light scatter. Conclusions: The objective vision quality measurements as assessed by the double-pass retinal imaging system showed a significant improvement after YAG capsulotomy. This suggests that the objective scatter index improves after YAG capsulotomy, even in eyes with pre-YAG 0.10 logMAR (Snellen 20/25) corrected distance visual acuity or better.

RESUMO Objetivo: Avaliar objetivamente a qualidade da visão óptica antes e depois da capsulotomia com Nd: YAG, obtida por imagem pelo metodo de dupla passagem de luz em pacientes com opacificação capsular posterior. Método: Análise retrospectiva de 26 olhos pseudofácicos com opacificação capsular posterior visualmente significativa, que foram submetidos à capsulotomia de Nd: YAG. O índice de dispersão objetiva, a função de transferência de modulação, a relação de Strehl e a acuidade visual à distância corrigida foram avaliados antes e após a capsulotomia com YAG usando o dupla passagem de luz (OQAS II, Visiometrics, Espanha). Também foi analisado um subgrupo de pacientes com acuidade visual à distância corrigida pré-YAG de 0,10 logMAR (20/25) ou melhor. Resultados: Os índices de qualidade da visão melhoraram em todos os 26 olhos, resultando em uma melhora estatisticamente significativa na acuidade visual à distância corrigida (p=0,007), índice de dispersão objetiva (p=0,001), função de transferência de modulação (p=0,001) e relação de Strehl (p=0,020). A melhora média na acuidade visual à distância corrigida foi de 0,12 ± 0,04 logMAR, no índice de dispersão objetiva foi de 2,84 ± 0,76, no função de transferência de modulação foi de 12,29 ± 2,77 e na razão de Strehl foi de 0,06 ± 0,03 em todos os olhos. Sub-análise de 10 olhos com 0.10 logMAR (20/25) acuidade visual à distância corrigida ou melhor também mostrou uma melhora estatisticamente significativa no índice de dispersão objetiva (p=0,001). A melhora média no OSI foi de 0,76 ± 16, uma diminuição de 35% na dispersão da luz intraocular. Conclusões: A qualidade da visão avaliada pelo dupla passagem de luz mostra uma melhora significativa nas medidas objetivas da qualidade da visão após a capsulotomia do YAG. O índice de dispersão objetiva melhora após a capsulotomia YAG, mesmo em olhos com acuidade visual à distância corrigida pré-YAG de 0,10 logMAR (Snellen 20/25) ou melhor.

Techniques of anterior capsulotomy in cataract surgery

Optimal outcomes of a cataract surgery largely depend on the successful performance of an anterior capsulotomy. It is one of the most important steps of modern cataract surgery which reduces the risk of capsular tears and ensures postoperative stable intraocular lens (IOL). Anterior capsulotomy is considered ideal if it is round, continuous, well-centered, and overlaps the implanted IOL around its circumference. If any of these features is missing, it can be a cause of impedance for desired surgical and visual outcomes. Manual can opener and manual capsulorhexis are the routine standard techniques employed for manual extracapsular cataract extraction and phacoemulsification, respectively. Recent increasing use of femtosecond laser cataract surgery has allowed cataract surgeons to obviate inherent inaccuracies of manual anterior capsulotomy techniques. There is an ongoing quest to find an ideal, risk free, and surgeon-friendly technique of anterior capsulotomy that can be employed for surgery in all types of cataracts.

Effects of ND YAG Laser Capsulotomy on Intra ocular Pressure and Macular Thickness

AIM- This study was aimed to find the changes in macular thickness and intra-ocular pressure overtime after ND-YAG laser capsulotomy. Methods: 100 pts fulfilling the inclusion criteria were included in the study and underwent a detailed ophthalmic examination. Pts IOP and macular thickness was measured by goldmann applanation tonometery and ocular coherence tomography (OCT) respectively before performing the procedure. Each patient was called for follow up on day 1, 1 week, 4 weeks, 8 weeks and 12 weeks. During all the follow up visits complete eye examination, IOP measurement, and macular thickness measurement were noted. Results: For this study, a total of 100 eyes of 100 patients (54 males, 46 females) aged 18to 80 years (mean age 51.98±14.01 years) fulfilling the inclusion and exclusion criteria were enrolled in the study.IOP was significantly higher at all the follow-up intervals among those in whom >40 mJ energy was used as compared to those in whom <40 mJ energy was used Mean change in macular thickness was found to be significantly higher at day 1 and week 1 among those in whom >40 mJ energy was used as compared to those in whom <40mJ energy was used. However, at subsequent follow-up intervals, the difference was not significant statistically. Conclusion: Nd-YAG laser capsulotomy results in increased IOP and macular thickness which sustains upto a substantial period.Rise in IOP following Nd:YAG laser posterior capsulotomy is correlated with the amount of energy used.Change in macular thickness following Nd:YAG laser posterior capsulotomy is weakly/mildly correlated with the amount of energy used during the initial follow-up, however, subsequently it does not show a correlation with amount of energy used.

Application of femtosecond laser technology in the management of subluxated lens / 南方医科大学学报

OBJECTIVE@#To evaluate the application of femtosecond laser technology in the management of subluxated lens.@*METHODS@#We retrospectively analyzed the data of the patients with subluxated lens undergoing femtosecond laser- assisted surgery at the Cataract Center of Guangzhou Aier Eye Hospital between March, 2017 and May, 2019. The LenSx femtosecond laser-assisted cataract surgery system was used to perform capsulotomy and lens fragmentation. According to the patients' eye condition, anterior vitrectomy was performed and capsular retractors was used. After phacoemulsification, I/A and insertion of the tension rings, the intraocular lens (IOL) was implanted into the capsular bag. The perioperative data, complications, visual acuity and intraocular pressure after the operation were recorded, and the stability of the capsular bag and IOLs were assessed.@*RESULTS@#We analyzed the data of 25 cases (29 eyes) of subluxated lens, including 16 (16 eyes; 55.17%) as the result of traumatic lens subluxation, 5 (9 eyes; 31.03%) of Mafan syndromes, 1 case (1 eye; 3.45%) of high myopia and 3 cases (3 eyes; 10.34%) of unknown causes. Thirteen 13 eyes (44.83%) showed mild subluxation, 7 (24.14%) had moderate subluxation, and 9 (31.03%) had severe subluxation. Femtosecond laser- assisted capsulorhexis, lens fragmentation and phacoemulsification were successfully completed for 29 eyes, of which 28 eyes (96.55%) retained the complete capsular bag and with successful implantation of the capsular tension devices and IOLs. Nine eyes (31.03%) were treated with anterior segment vitrectomy; iris hooks were used for 2 eyes (6.90%) and capsular bag hooks for 9 eyes (31.03%). The best corrected visual acuity was significantly improved in 29 eyes after operation ( < 0.05). At 1 month after the surgery, 26 eyes (89.66%) showed stably centered IOLs, 2 eyes (6.90%) showed slight tilt of the IOLs, and 3 eyes (10.34%) had anterior capsular contraction. The intraoperative complications included subconjunctival hemorrhage (75.87%), incomplete capsulotomy (17.24%) and contracted pupils (13.79%).@*CONCLUSIONS@#The application of femtosecond laser assisted technology enhances the surgical safety and effectiveness for subluxated lens, facilitates the choice of individualized surgical options, and promotes maximum recovery of the patients' visual function.

Comparison of visual quality following different methods of YAG laser posterior capsulotomy for posterior capsular opacification / 中华实验眼科杂志

Objective To evaluate and compare the subjective and objective visual quality of YAG laser posterior capsulotomy.Methods A series of case observation study was designed.Twenty-eight patients (38 eyes)underwent Nd:YAG laser posterior capsulotomy in the Eye Hospital of Wenzhou Medical University were retrospectively collected from 2015 to 2016.Patients were divided into circular capsulotomy group (20 patients 23 eyes) and cruciate capsulotomy group (12 patients 15 eyes) based on the capsulotomy technique (round incision of posterior capsule or cross incision of posterior capsule).The uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were examined before and 2 weeks after operation,the intraocular pressure was also measured before operation,1 hour after operation and 2 weeks after operation.The Strehl ratio (SR),modulation transfer function (MTF) cut-off,objective scatter index (OSI),OQAS values (OVs) were analyzed by Two-channel visual quality analysis system OQAS Ⅱ at 1 h and 2 weeks after operation.The changes of intraocular scattering and visual quality at 1 h and 2 weeks after operation with different posterior capsulotomy methods were compared and analyzed.Results At 2 weeks after operation,the UCVA was 0.18±0.15 and 0.16±0.14,and the BCVA was 0.10±0.10 and 0.10±0.11,respectively in the circular capsulotomy group and cruciate capsulotomy group,which was higher than those before operation (all at P＜0.05),but there was no significant difference in UCVA and BCVA between the two groups (all at P＞0.05).There was no significant difference in intraocular pressure between the two groups at 1 hour and 2 weeks after operation (both at P＞0.05).In the circular capsulotomy group,the incidence of black shadow drift was 39.1％ and 30.4％ respectively at 1 hour and 2 weeks after operation,which was higher than that in the cruciate capsulotomy group (6.7％ and 6.7 ％),with no significant differences between the two groups (P =0.065,0.177).No significant difference were found in the incidence of black shadow drift before eyes between the two groups (P＞0.05),and there was no significant differences in the OQAS parameters OSI,MTF,SR,OV100％,OV20％ and OV9％ between the two groups (all at P＞0.05).Conclusions After Nd:YAG laser capsulotomy,the incidence of black shadow drift in the cruciate capsulotomy group is lower than that in the circular capsulotomy group.There is no significant difference in the visual acuity,intraocular pressure,intraocular scattering and visual quality parameters between circular posterior capsulotomy and cross posterior capsulotomy.

Comparison of the Neodymium-doped Yttrium Aluminum Garnet Capsulotomy Rate with Viscoimplantation and the Hydroimplantation Intraocular Lens Technique

PURPOSE: To investigate the rate of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy in the hydroimplantation intraocular lens (IOL) technique. METHODS: This retrospective study was comprised of 6,192 eyes in 3,790 patients who underwent surgery from January 2013 to September 2017 and then were followed up for at least 1 year. The eyes of these patients were divided into two groups: either viscoimplantation or hydroimplantation. The follow-up examinations were carried out on the 1st day, 4th day, 1st month, and 3 months to 1 year postoperatively. The Nd:YAG capsulotomy rates were evaluated by the different IOL implantation techniques and IOL materials. RESULTS: The mean follow-up duration of the patients was in the viscoimplantation group 14.85 ± 2.43 and 15.05 ± 1.93 months in the hydroimplantation group. The Nd:YAG capsulotomy rate was significantly lower in the hydroimplantation group compared with the viscoimplantation group for the entire hydrophilic IOL model (p < 0.001). In addition, the Nd:YAG rate was lower in the hydroimplantation group that used a hydrophilic IOL than it was in the viscoimplantation group, which used a hydrophobic IOL. CONCLUSIONS: The hydroimplantation technique reduced the Nd:YAG capsulotomy rate.

The Changes of Anterior Chamber Depth and Refractive Errors after Phacovitrectomy with Posterior Capsulotomy

PURPOSE: To evaluate the changes in anterior chamber depth (ACD) and refractive error after combined phacovitrectomy with posterior capsulotomy using a vitrectomy probe. METHODS: In 20 eyes of 20 patients who underwent combined phacovitrectomy with posterior capsulotomy using a vitrectomy probe, the ACD was measured with Scheimpflug imaging (Pentacam®, OCULUS Optikgeräte GmbH, Wetzlar, Germany) preoperatively and postoperatively. We compared the preoperative desired refraction and postoperative refraction using an autokeratorefractometor. RESULTS: The preoperative ACD was 2.58 ± 0.248 mm; the ACD significantly increased in 1 month postoperatively to 3.65 ± 0.475 mm (p < 0.001), and it was maintained as 3.70 ± 0.452 mm (p = 0.213) at 3 months postoperatively. The preoperative target spherical equivalent was −0.60 ± 0.809 diopters (D). Myopic shifting was noticed at 1 month postoperatively as −1.45 ± 1.252 D, and it changed between 1 month and 3 months postoperatively (−1.48 ± 1.235 D at 3 months postoperatively was not statistically significant). There was no increased intraocular pressure or intraocular lens-related complication. CONCLUSIONS: Phacovitrectomy with posterior capsulotomy using a vitrectomy probe might be a useful way to stabilize the axial position of an intraocular lens without constriction of the capsular bag. However, using this procedure, the surgeon must consider the possibility of myopic shifting in the postoperative refractive error.

Comparison of different surgical approaches for pediatric cataracts: complications and rates of additional surgery during long-term follow-up

OBJECTIVES: To compare long-term postoperative complications of pediatric cataract surgery with primary intraocular lens (IOL) implantation associated with posterior capsulotomy (PC) and anterior vitrectomy (AV) between patients treated with a corneal or pars plicata/pars plana approach. METHODS: Children who underwent cataract surgery with in-the-bag primary IOL implantation were divided into two groups according to PC and AV surgical approach: a corneal approach (group 1) and a pars plicata/pars plana approach (group 2). Only patients with a follow-up duration of more than two years were included. Long-term surgical outcomes were retrospectively reported. RESULTS: The mean follow-up period was 10.00±3.13 years. No cases of glaucoma or retinal detachment were reported. The mean age at surgery was 34.57±22.66 months. Forty-six children were included (27 eyes in group 1 and 29 eyes in group 2). The most frequent postoperative complication was corectopia, followed by visual axis opacification. Both complications occurred more frequently in group 1 (p<0.001). After cataract surgery, the rate of additional surgeries in group 1 was 51.9%, while in group 2, the rate was 27.6% (p=0.1132). CONCLUSION: The pars plicata/pars plana approach with PC and vitrectomy with primary in-the-bag IOL implantation for pediatric cataracts is a safe procedure.

Precision pulse capsulotomy in phacoemulsification: Clinical experience in Indian eyes

Purpose: To evaluate the surgical outcome of precision pulse capsulotomy (PPC) in phacoemulsification surgery. Methods: One hundred twenty-three eyes of 99 consecutive patients who underwent phacoemulsification with PPC through a 2.8 mm clear corneal incision were prospectively studied at a tertiary care centre. The size, shape of capsulotomy and intraoperative capsulotomy, and surgery-related complications were noted. Visual outcome, IOL stability, and signs of capsular opacification/contraction were evaluated at 3 and 6 months. Results: The mean age of patients was 49.5 ± 7.77 years. Complete, circular capsulotomy averaging 5.5 mm diameter was achieved in 117 of 123 eyes. In seven eyes, we experienced complications like capsulorhexis tear (n = 6) and inadvertent iris capture (n = 1). Probe malfunction occurred in six cases. Stable intracapsular intraocular lens (IOLs) fixation and centration was achieved in all eyes. None of the eyes had any significant posterior capsular opacification or capsular contraction at 3 and 6 months. In one eye anterior capsular opacification at the capsulotomy edge was noted at 6 months. Conclusion: PPC is a useful device for achieving a perfectly round capsulorrhexis. However, it has a learning curve and chances of skip areas in capsulorhexis, capsular tag, and its extension should be kept in mind. Special care should be taken in initial cases and while operating on eyes with poorly dilating pupil and mature cataracts.