Analysis of influencing factors associated with the time between cataract surgery and Nd:YAG laser posterior capsulotomy.

PURPOSE: To retrospectively analyze the clinical data of large samples of YAG laser posterior capsulotomy, and to explore the influencing factors of time from cataract surgery to YAG laser capsulotomy (TFCSTLC), so as to provide reference for the occurrence and treatment of real-world posterior capsular opacification (PCO). METHODS: 1093 patients (1093 eyes) with PCO who underwent YAG laser posterior capsulotomy from 2014 to 2019 in the largest eye center of northwest China were analyzed retrospectively. The gender, age, systemic complications, material, and design of intraocular lens (IOL) and TFCSTLC were recorded. The test and Wilcoxon rank sum test were applied to analyze and compare the average TFCSTLC values under different factors, and the relationship between each factor and TFCSTLC was analyzed by multiple linear regression. RESULTS: The average TFCSTLC was 19.2 (range, 7.9 ∼ 31.2) months. There were significant statistical differences in TFCSTLC among the implanted single focus versus multifocal IOLs (P < 0.001), diabetic versus non-diabetic patients (P < 0.001), high myopia versus non-high myopia patients (P = 0.003). Multiple linear regression analysis demonstrated that TFCSTLC was negatively correlated in patients with diabetes mellitus versus with no history of diabetes mellitus (coefficient, -5.36; 95% confidence interval [CI], -8.30 to -2.41; P < 0 .001), and multifocal IOL versus a single focus IOL implanted (coefficient, -5.56 ; 95% CI, -9.01 to -2.11; P = 0.002). CONCLUSIONS: TFCSTLC may be affected by many factors in the real world. The YAG laser posterior capsulotomy time was sooner in patients with a history of diabetes mellitus and multifocal IOL implanted.

The prophylactic effect of betaxolol 0.5% versus brimonidine 0.2% on IOP elevation after Nd:YAG laser posterior capsulotomy.

CLINICAL RELEVANCE: Posterior capsule opacification is a common late complication of cataract surgery. Posterior capsule opening with Nd:YAG laser, which is the standard treatment, may cause transient elevation of intraocular pressure (IOP). BACKGROUND: To evaluate the efficacy of betaxolol 0.|5% compared to brimonidine 0.2%, in prevention of intraocular pressure increase after Nd:YAG Laser posterior capsulotomy. METHODS: In a double masked randomised clinical trial, 38 eyes from 38 pseudophakic patients over 21 years of age who had significant posterior capsule opacification after phacoemulsification were randomly assigned to receive either betaxolol 0.|5% (18 eyes) or brimonidine 0.|2% (20 eyes) one hour before Nd:YAG Laser posterior capsulotomy.| Exclusion criteria were: glaucoma or history of glaucoma surgery, active uveitis, active ocular infection, pregnancy, unstable cardiovascular condition and severe asthma and lung diseases. Intraocular pressure was measured by Goldmann applanation tonometry, 1 hour before applying the laser and 4 hours after the laser application. RESULTS: There was no statistically significant difference between the two groups regarding the baseline mean IOP and the 4-hour post-laser mean IOP. There was a statistically significant decrease in the 4-hour post-laser mean IOP as compared to the baseline mean IOP in each group. The mean IOP change in the betaxolol group, was -2.39 ± 1.79 mm Hg and in the brimonidine group was -4.25 ± 2.20 mm Hg. The difference was statistically significant (P = 0.007). None of the patients experienced clinically significant IOP increase (≥5 mm Hg) in either group. CONCLUSION: Use of a single topical dose of betaxolol 0.5% and brimonidine 0.2%, 1 hour before laser treatment, can prevent significant acute IOP increase after Nd:YAG laser posterior capsulotomy, and betaxolol may provide a new alternative for prophylactic use.

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.

SPONTANEOUS CLOSURE OF A MACULAR HOLE RESULTING FROM YAG LASER CAPSULOTOMY IN A 13-YEAR-OLD GIRL.

PURPOSE: To describe the novel finding of spontaneous resolution of a full-thickness macular hole resulting from YAG laser capsulotomy in a 13-year-old girl with previous history of retinal detachment repair and cataract surgery. METHODS: A 13-year-old girl who had developed a macular hole after YAG laser was noted to have spontaneous resolution of the macular hole at 2-week follow-up visit with concurrent increase in visual acuity. Institutional review board was not applicable for this case. RESULTS: Spontaneous resolution of a YAG laser-induced macular hole in a pediatric patient. CONCLUSION: This is a novel report in a pediatric patient of spontaneous resolution of a full-thickness macular hole induced by YAG laser capsulotomy. If a macular hole is noted after YAG capsulotomy, consideration should be given to initial close observation rather than surgical intervention as spontaneous resolution may occur.

Intraocular lens tilt and decentration after Nd:YAG laser posterior capsulotomy: Femtosecond laser capsulorhexis versus manual capsulorhexis.

PURPOSE: To compare intraocular lens (IOL) tilt and decentration after Nd:YAG laser posterior capsulotomy in eyes that had femtosecond laser-assisted capsulotomy versus manual capsulorhexis. SETTING: Ekol Eye Hospital, Izmir, Turkey. DESIGN: Retrospective case series. METHODS: Intraocular lens decentration and angle of tilt were measured using a Scheimpflug camera before and 1 month after Nd:YAG capsulotomy. RESULTS: Eighteen eyes had a femtosecond laser-assisted capsulotomy and 25 eyes a manual capsulorhexis. The mean age was 58.2 years ± 10.2 (SD) (range 44 to 69 years) and 60.6 ± 8.3 years (range 45 to 70 years), respectively. Before capsulotomy, the angle of tilt and decentration at both meridians did not differ significantly between the 2 groups (P > .05). After capsulotomy, the angle of tilt was significantly decreased in both groups (femtosecond: vertical 1.5 degrees and horizontal 1.2 degrees; manual: vertical 1.1 degrees and horizontal) and decentration was significantly increased (femtosecond: vertical 0.085 mm and horizontal 0.096 mm; manual: vertical 0.2 mm and horizontal 0.2 mm) at both meridians (P < .05). After capsulotomy, all tilt and decentration parameters were significantly different between the 2 groups (P < .05) except decentration on the horizontal meridian (P = .669). CONCLUSIONS: Nd:YAG posterior capsulotomy performed after femtosecond laser-assisted capsulotomy resulted in better mechanical stability of the IOL. This suggests that a femtosecond laser-created capsulotomy better maintains a proper IOL position. Although the differences were statistically significant, the tilt and decentration values were small and might not be clinically significant.

Posterior capsule opacification rate after phacoemulsification in pediatric cataract: Hydrophilic versus hydrophobic intraocular lenses.

PURPOSE: To compare the rate of posterior capsule opacification (PCO) of hydrophilic acrylic intraocular lenses (IOLs) and hydrophobic acrylic IOLs in pediatric cataract surgery. SETTING: Sadguru Netra Chikitsalaya, Chitrakoot, India. DESIGN: Retrospective case series. METHODS: The medical records of children who had uneventful cataract surgery with acrylic IOL implantation from 2010 to 2016 and a follow-up of at least 1-year were reviewed. The patients had implantation of a hydrophilic IOL (Ocuflex ANU6 IOL) or a hydrophobic IOL (AcrySof SA60AT). The main outcome measure was the PCO rate at the last follow-up. RESULTS: The study comprised 103 eyes (80 children). The mean age was 8.2 years ± 4 (SD) in the hydrophilic group (51 eyes) and 6.9 ± 4 years in the (52 eyes) hydrophobic group (P = .1). The mean follow-up was 38.8 months and 39.4 months, respectively. When the posterior capsule was left intact, 39.3% of eyes in the hydrophilic group and 13.4% of eyes in the hydrophobic group developed PCO (P = .03). When primary posterior capsulotomy (PPC) and anterior vitrectomy were performed, 4.3% and 6.8%, respectively, developed PCO (P = .69). Kaplan-Meier survival plots with stratification for type of procedure (ie, PPC and anterior vitrectomy) showed a survival (ie, no PCO formation at 5-year follow-up) rate of 95.4% in the hydrophobic group and 88.8% in the hydrophilic group. CONCLUSION: Hydrophilic acrylic IOLs and hydrophobic acrylic IOLs implanted in the bag had comparable visual and surgical outcome and an equal rate of PCO formation when PPC and anterior vitrectomy were performed.

The Clinical Relationship of Anterior Capsular Tears and Vertical Spacing in the Femtosecond Laser Capsulotomy Procedure.

PURPOSE: To evaluate the frequency of anterior capsule tears and capsule edge irregularities in femtosecond laser anterior capsulotomy, including the effect of optimized vertical spacing settings. METHODS: Three thousand eight hundred thirty-four cases were examined and grouped according to the femtosecond laser capsulotomy settings using manufacturer default settings with a vertical spacing of 10, 15, and 20 µm. Capsulotomy edge irregularities and anterior capsule tears were recorded intraoperatively. RESULTS: The anterior capsule tear rates for the 10, 15, and 20 µm groups were 0.79%, 0.35%, and 0.09%, respectively. The capsule edge irregularity rates for the 10, 15, and 20 µm groups were 6.25%, 1.13%, and 1.15%, respectively. The treatment times for the 10, 15, and 20 µm groups were 1.6, 0.7, and 0.8 second, respectively. The risk reduction of anterior capsule tears positively correlated with the 15 and 20 µm group settings. The anterior capsule tear rate difference between the 10 and 20 µm group settings was statistically significant. Capsule edge irregularity rates were reduced in the 15 and 20 µm group settings. Eye movement was monitored in the 20 µm group and was observed in 9 of 13 patients with capsule edge irregularities. CONCLUSIONS: Anterior capsule tear rates are low with femtosecond laser cataract surgery. The rate can be further reduced with optimization of the settings, including an increase in vertical spacing. [J Refract Surg. 2019;35(5):280-284.].

Haptic fracture and dislocation of polyimide intraocular lens after neodymium: YAG laser capsulotomy: A case report.

RATIONALE: We report a case of haptic fracture of polyimide intraocular lens (IOL) and its dislocation after neodymium:YAG (Nd:YAG) laser capsulotomy. To the best of our knowledge, this is the first report of both the fracture and dislocation of the IOL after laser posterior capsulotomy. PATIENT CONCERNS: A 78-year-old male was referred to our clinic with a history of decreased visual acuity after Nd:YAG laser posterior capsulotomy in the right eye. A dislocated IOL was observed on slit lamp examination. DIAGNOSIS: On slit-lamp examination, dislocated IOL with intact anterior capsulorrhexis margin was observed in the right eye. INTERVENTIONS: We removed the dislocated IOL and fixed a 3-piece IOL (Acrysof MN60AC, Alcon Laboratories, Inc) in the ciliary sulcus under retrobulbar anesthesia. OUTCOMES: After the operation, the observed uncorrected distance visual acuity (UCVA) was 20/20 and the measured intraocular pressure (IOP) was 18 mmHg; the IOL was fixed in the ciliary sulcus. LESSONS: Three-piece, silicone-polyimide haptics in IOLs can get fractured after Nd:YAG laser capsulotomy. Thus, it is suggested that sufficient haptic dilation should be ensured while performing Nd:YAG laser capsulotomy in patients with polyimide haptics. Moreover, a small-sized capsulotomy is likely to be helpful in such patients.

Efficacy and safety of primary posterior capsulotomy in combined phaco-vitrectomy in rhegmatogenous retinal detachment.

OBJECTIVE: To evaluate the efficacy and safety of posterior capsulotomy by analyzing the long-term visual outcomes in patients with rhegmatogenous retinal detachment (RD), who underwent combined phaco-vitrectomy with or without primary posterior capsulotomy. METHODS: A retrospective longitudinal cohort analysis was performed by using data of rhegmatogenous RD patients undergoing combined phaco-vitrectomy. Patients were divided into two groups; Group A (68 eyes of 68 patients) with capsulotomy, and Group B (39 eyes of 39 patients) without capsulotomy. We reviewed the best-corrected visual acuity (BCVA), incidence of posterior capsule opacification (PCO), clinical features at the diagnosis of rhegmatogenous RD, and intraoperative or postoperative complications following posterior capsulotomy. RESULTS: The modified BCVA measured by the logarithm of the minimum angle of resolution at initial diagnosis and 3, 6, and 12 months after surgery was 0.67 in Group A versus 0.85 in Group B (p = 0.258), 0.40 in Group A versus 0.50 in Group B (p = 0.309), 0.27 in Group A versus 0.45 in Group B (p = 0.055), and 0.21 in Group A versus 0.47 in Group B (p = 0.014), respectively. In subgroup with macula-on RRD, Group A exhibited better visual outcomes compared to Group B at 6(0.17 versus 0.40 [p = 0.037]) and at 12 months(0.14 versus 0.39 [p = 0.030]). The incidence of PCO in Group B was higher than Group A(28.2% versus 4.4% (p < 0.001)). There were no complications associated with posterior capsulotomy. CONCLUSIONS: A primary posterior capsulotomy during combined phaco-vitrectomy using a 23-gauge vitreous cutter was a safe and effective surgical procedure in patients with RRD patients for preventing postoperative intraocular lens-related PCO.

Advanced glaucoma following Nd:YAG capsulotomy: a case report.

BACKGROUND: We present a case of aphakic pupil block caused by vitreous prolapse into the anterior chamber following Nd:YAG capsulotomy. CASE PRESENTATION: This resulted in advanced glaucoma in a young patient, which presented a significant clinical management challenge. CONCLUSIONS: Ultimately, at the time of writing, her intraocular pressure and uveitis were well controlled, however the long-term outcome remains uncertain, given the uncompromising natural history of her complicated ocular condition.

Does Nd:YAG Capsulotomy Increase the Risk of Retinal Detachment?

Laser capsulotomy is accepted as a standard and effective treatment for posterior capsule opacification. It is generally believed that neodymium:YAG (Nd:YAG) capsulotomy is related to an increased risk of retinal detachment (RD). The aim of this study was to evaluate the association between Nd:YAG capsulotomy and risk for developing RD. A PubMed and Medline search was conducted using the terms "retinal detachment" and "Nd:YAG laser capsulotomy." Of the articles retrieved by this method, all publications in English and abstracts of non-English publications were reviewed. The literature analysis presented no convincing evidence supporting the association between Nd:YAG capsulotomy and increased risk for developing RD. The existing discrepancy between some studies might be related to inadequate group sizes, short observation period, and co-existing disorders. We also reviewed the possible risk factors for RD after Nd:YAG capsulotomy and found no association with preceding surgical approach, existing posterior vitreous detachment, and intraocular lens design. Myopic patients should be treated with caution, as it cannot be concluded that Nd:YAG capsulotomy does not increase RD rate in this cohort. Treatment energy should be as low as possible, as high energy levels and anterior hyaloid damage might increase the chance for RD development. Cataract surgery itself is a potential RD risk factor, particularly after intraoperative capsule complications.

Decentration and Tilt of Intraocular Lens after Posterior Capsulotomy.

PURPOSE: To assess the effect of posterior capsular opacification (PCO) and Neodymium-doped:Yttrium Aluminium Garnet (Nd:YAG) laser capsulotomy on tilt and decentration of intraocular lens (IOL) at vertical and horizontal meridians. METHODS: The study included 64 eyes of 64 patients. IOL decentration and tilt were measured using a Scheimpflug camera before and 1 month after Nd:YAG capsulotomy. Corrected distance visual acuity (CDVA) and manifest refraction were also determined. Between-group differences of IOL position change and the effect of Nd:YAG laser capsulotomy were analyzed. RESULTS: In the PCO group, before capsulotomy, CDVA was significantly lower than that after capsulotomy and of the control group values (p = 0.001 for both). No significant difference was observed in CDVA between the control group and the PCO group after capsulotomy (p = 0.854). Before capsulotomy, the angle of tilt and decentration at both meridians was significantly higher than that in the control group (tilt: p < 0.001; for both decentrations: p = 0.001, p = 0.003, respectively). A significant decrease was observed in the angle of tilt at both meridians (horizontal p = 0.001, vertical p = 0.001) from before to after capsulotomy in the PCO group. Although decentration was increased after capsulotomy, no significant position change was observed (horizontal p = 0.350, vertical p = 0.107). The angle of tilt and decentration at both meridians was significantly higher in the PCO group after capsulotomy compared to the control group (p < 0.001 for all). CONCLUSIONS: PCO is associated with not only axial displacement, but also tilt and decentration of IOL at the vertical and horizontal meridians. Laser capsulotomy decreased IOL tilt but had no effect on decentration. However, these changes did not significantly change the visual acuity between the control group and the PCO group after capsulotomy.

Safety of femtosecond laser-assisted primary posterior capsulotomy immediately after cataract surgery.

PURPOSE: To evaluate the safety and feasibility of a new femtosecond laser-assisted method for posterior capsule opacification (PCO) prevention. SETTING: University Eye Hospital Bochum, Bochum, Germany. DESIGN: Prospective randomized intraindividual case series. METHODS: Eyes scheduled for bilateral cataract surgery between April 2015 and January 2016 were enrolled in the study. In 1 eye, routine manual cataract surgery with intraocular lens (IOL) implantation was performed with a primary posterior laser capsulotomy as the last step in the procedure. For the laser treatment, the posterior capsule between the anterior hyaloid surface and the posterior optic surface of the IOL was identified with integrated 3-dimensional spectral-domain optical coherence tomography. In the fellow eye, routine manual cataract surgery without posterior capsulotomy was performed. Follow-up examinations were done 1 week, 2 months, and 6 months after surgery. The main outcome measures were feasibility of the procedure and between-group difference in visual acuity, macular thickness, laser flare, intraocular pressure (IOP), and PCO. RESULTS: Fifty-six eyes were included. No differences in cataract density (P = .2), axial length (P = .8), or amount of ultrasound energy used (P = .55) were found between the groups. In all cases, it was possible to identify and target the posterior capsule. In 1 case, a minimal attachment of a half-hour length was seen. No significant between-group differences in visual acuity, macular thickness, laser flare, or IOP were seen. CONCLUSION: The described off-label use of primary posterior laser capsulotomy was a safe, feasible technique in preventing PCO over a 6-month follow-up.

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

PURPOSE: The purpose of our study is to assess the changes in macular thickness (MT) in diabetic and non-diabetic patients and to research effects of topical ketorolac (Acular®, Allergan, Irvine, CA) on MT change after neodymium:yttrium aluminum garnet (Nd:YAG) laser capsulotomy. MATERIAL AND METHODS: This study involved 88 eyes of 88 patients diagnosed as posterior capsule opacification (PCO). Patients were divided into four groups according to presence of diabetes mellitus (DM) and drugs used after capsulotomy. Group 1: Patients with DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy (22 patients). Group 2: Patients with DM using 0.5% ketorolac (Acular®) and 0.1 Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy (20 patients). Group 3: Patients without DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) (22 patients). Group 4: Patients without DM using 0.5% ketorolac (Acular®) and 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) (24 patients). A plus-shaped capsulotomy was performed using VISULAS® YAGIII (Carl Zeiss) laser microscope. MT measurement with Cirrus SD-OCT (Carl Zeiss Opthalmic System Inc., Model 400, Dublin, CA, Software 5) were done. Measurements were done before laser, and on the first day, first week, first month, third month and sixth month after laser capsulotomy. We compared the four groups for MT change during 6 months. RESULTS: Group 1 involving patients with DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy had increased MT at the first week, and the first, third, and sixth month after laser (p < 0.001). Group 3 involving patients without DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) had increased MT at the first week, and at the first and third month, there was no statistically significant difference at the sixth month (p > 0.05). There was no statistically significant increase in MT during the follow-up period in group 2 involving patients with DM using 0.5% ketorolac (Acular®) and 0.1 Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy and group 4 involving patients without DM using 0.5% ketorolac (Acular®) and 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) (p > 0.05). CONCLUSION: An increase in MT can be observed after Nd:YAG laser capsulotomy, especially in diabetic patients. Adding topical ketorolac (Acular®, Allergan, Irvine, CA) to topical Fluorometholon (FML®, Allergan, Irvine, CA) therapy after YAG laser capsulotomy can prevent this increase.

Fracture and dislocation of a glass intraocular lens optic as a complication of neodymium:YAG laser posterior capsulotomy: Case report and literature review.

UNLABELLED: An 83-year-old man presented with a 1-year history of blurry vision in his left eye. Bilateral cataract surgery and ciliary sulcus posterior chamber intraocular lens (IOL) implantation had been performed 11 years earlier. The corrected distance visual acuity (CDVA) was 20/60 in the left eye. Slitlamp examination revealed moderate posterior capsule opacification. Neodymium:YAG laser posterior capsulotomy was performed and complicated by IOL fracture and immediate dislocation of optic fragments into the anterior chamber. An IOL exchange was performed, and the damaged IOL was removed in 7 pieces. A 3-piece acrylic IOL was suture fixated to the posterior iris. Pathologic analysis showed that the damaged IOL was made of glass supported by a polyimide frame. Twelve months after the IOL exchange, the CDVA was 20/60. FINANCIAL DISCLOSURE: Dr. Ahmed is a consultant to Alcon Laboratories, Inc., Abbott Medical Optics, Inc., and Bausch & Lomb. Dr. Mamalis is a consultant to Anew Optics, Inc., and Medennium, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Accidental macular hole following neodymium:YAG posterior capsulotomy.

INTRODUCTION: Posterior capsular opacification (PCO) is the commonest complication of cataract surgery, occurring in up to one-third of patients in a period of five years. The treatment of choice is the Neodymium:YAG laser posterior capsulotomy. This treatment can be associated with several complications, some of them severe. A rare complication of this procedure is the accidental induced macular hole. CASE OUTLINE: A 54-year-old female patient was referred to our Department because of a severe loss of vision and a central scotoma at the right eye. The patient underwent a Nd:YAG posterior capsulotomy 2 days ago, for a PCO. The fundus examination at presentation revealed a round retinal defect in the macular region, a massive inferior preretinal hemorrhage and a mild vitreous hamorrhage. A 6-months follow-up of the case, including retinography and fluorescein angiography, is presented. CONCLUSION: Although the Nd:YAG laser capsulotomy is a safe, noninvasive, and effective outpatient procedure to improve vision hindered by PCO, it must be recognized that it carries a low but definite risk of serious complications. Physicians and patients should be aware of these rare but severe complications regarding this otherwise safe procedure. Fortunately, most of the complications related to this procedure are transient and can be managed by proper medication.

Descemet membrane detachment after Nd: YAG laser capsulotomy in a patient with fuchs dystrophy.

PURPOSE: Descemet membrane detachment (DMD) is uncommon. It most frequently occurs as a complication of intraocular surgery. The aim of this study was to report a case of DMD after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy in a patient with Fuchs dystrophy. METHODS: We describe the case of an 89-year-old man suffering from Fuchs dystrophy, who underwent cataract surgery on his left eye. Three years later, the patient presented with posterior capsule opacification, which was treated using Nd:YAG laser capsulotomy. The day after the procedure, the patient came back for emergency treatment because of an acute reduction in his vision caused by a DMD. RESULTS: Fifteen days after an initial treatment involving the injection of air into the anterior chamber coupled with ocular paracentesis, clinical examination revealed a significant improvement in visual acuity, reduction in corneal edema, and reattachment of Descemet membrane. These findings were confirmed using anterior segment optical coherence tomography. CONCLUSIONS: To our knowledge, this is the first reported case of DMD after Nd:YAG laser capsulotomy.