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ABSTRACT: Background: Posterior capsule opacification (PCO) is the most common cause of vision reduction following successful cataract surgery. It is a dynamic process caused by the migration and proliferation of residual lens epithelial cells on the posterior capsule, leading to visual impairment. The standard treatment for PCO is neodymium: yttrium–aluminum–garnet (Nd: YAG) laser capsulotomy. This study aims to compare the efficacy and safety of Bimatoprost 0.03% and Brimonidine 0.2% in preventing intraocular pressure (IOP) elevation post-Nd: YAG laser capsulotomy. Materials and Methods: This study was conducted over a year at the Government Medical College, Jammu. 400 patients with PCO post extracapsular cataract extraction were randomly divided into two groups. Group A received 1 drop of Bimatoprost 0.03% and Group B received 1 drop of Brimonidine 0.2%, both administered 1 hour before Nd: YAG laser capsulotomy. Intraocular pressure was measured using Goldmann applanation tonometry before treatment and at intervals of 1 hour, 3 hours, 24 hours, 3 days, and 7 days post-treatment. Results: The mean age of patients was approximately 65 years with no significant difference between groups. The baseline IOP was similar across both groups. At 1 hour post-capsulotomy, Group A showed a mean IOP increase of 2.2 mmHg, while Group B showed an increase of 3.6 mmHg. At 24 hours, the IOP in Group A returned to baseline levels, whereas Group B still exhibited a slight elevation. No significant adverse effects were reported in either group. Conclusion: Bimatoprost 0.03% is more effective in preventing IOP elevation post Nd: YAG laser capsulotomy compared to Brimonidine 0.2%. It also demonstrated a faster return to baseline IOP levels with fewer side effects. This suggests that Bimatoprost may be a preferable prophylactic treatment for managing post-capsulotomy IOP spikes. [ABSTRACT FROM AUTHOR]

Purpose To study the outcomes and complications of Nd: YAG laser capsulotomy in patients with uveitis. Methods This study retrospectively evaluated outcomes of Nd: YAG laser capsulotomy in 260 eyes of 260 patients with uveitis. The main indications for performing capsulotomy were a visually significant posterior capsule opacification (PCO) and inability to visualize the posterior segment. The presence of 5 or

Feyzahan Uzun, Emre Aydın, Hasan Akgöz, Mehmet Gökhan Aslan Recep Tayyip Erdogan University, School of Medicine, Department of Ophthalmology, Rize, TurkeyCorrespondence: Feyzahan Uzun, Recep Tayyip Erdoğan University, School of Medicine, Department of Ophthalmology, Rize, Turkey, Tel +90 464 212 30 09, Email feyzahan.ekici@erdogan.edu.trBackground: Inflammation plays a significant role in the proliferation, migration, and differentiation of lens epithelial cells after cataract surgery, clinically manifested as posterior capsule opacification (PCO). This condition is typically treated with neodymium: yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy. Our objective is to evaluate the association between blood-derived inflammatory markers and the development of clinically significant PCO necessitating treatment with laser capsulotomy.Materials and Methods: We conducted a retrospective review of charts for all patients who underwent Nd:YAG laser capsulotomy in our department between January 2021 and December 2022. The study included 70 patients who diagnosed with clinically significant PCO requiring treatment with Nd:YAG laser capsulotomy following cataract surgery, as well as 70 pseudophakic controls with no signs of PCO. Complete blood cell count parameters were obtained from medical records and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were calculated.&#x00A0Results: The mean age of the Nd:YAG laser capsulotomy and control group was 71.83± 8.46 and 72.27± 9.98 years, respectively. The preoperative NLR scores for the Nd:YAG laser capsulotomy group (mean rank = 34.43) were statistically significantly higher than those of the control group (mean rank = 25.41) (p = 0.044). However, after adjusting for preoperative measurements, no statistically significant differences were observed between the groups for the other parameters.Conclusion: Preoperative NLR scores were higher in patients who developed clinically significant PCO requiring treatment with Nd:YAG laser capsulotomy. This finding suggests that patients with elevated systemic inflammation may be at an increased risk of developing PCO following cataract surgery. Further research is needed to evaluate the role of systemic inflammation in the pathogenesis of PCO.Keywords: cataract, inflammation, nd:YAG laser capsulotomy, neutrophil-to-lymphocyte ratio, posterior capsular opacification

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.

Purpose: To report a challenging case of corneal descemetocele following Nd:YAG laser capsulotomy for posterior capsule opacification in a patient with Steven Johnson syndrome (SJS). Observations: A single-eye 52 year-old man, with a history of Steven Johnson syndrome, presented with severe eye pain and profound vision reduction in his left eye two days after undergoing Nd:YAG laser capsulotomy using the standard Abraham contact lens. A corneal descemetocele was identified and subsequently confirmed by anterior segment optical coherence tomography. He was promptly treated with the application of a therapeutic contact lens and sustained antibiotic regimen (preservative-free fluoroquinolone drops every 4 hours for 6 weeks) until healing of the corneal epithelium. Throughout the following eight weeks AS-OCT showed favorable anatomical and functional outcomes, achieving a substantial spontaneous healing. Conclusions and Importance: Corneal descemetocele may occur after Nd:YAG laser capsulotomy in patients with Steven Johnson syndrome. This case strengthens the critical importance of a careful preoperative assessment and meticulous postoperative management in high-risk patients, such as those with Steven Johnson syndrome, even after seemingly routine and safe ophthalmic procedures.

Stephen A LoBue,1 Curtis R Martin,1 Krysta K Benson,1 Krystle B Trosclair,2 Christopher L Shelby,1 Wyche T Coleman III1 1Department of Ophthalmology, Willis-Knighton Medical Center, Shreveport, LA, USA; 2Department of Graduate Medical Education, Statistics, Willis-Knighton Medical Center, Shreveport, LA, USACorrespondence: Wyche T Coleman III, Department of Ophthalmology, Willis-Knighton Medical Center, Bert Kouns Industrial Loop, Suite 116, Shreveport, LA, 71118, USA, Tel +1-318-212-5901, Email wychetcoleman@gmail.comPurpose: To determine the effect of early Nd:YAG (neodymium:yttrium-aluminum-garnet) laser capsulotomy on objective and subjective visual quality in symptomatic trifocal intraocular lens (IOL) patients.Methods: A single-center, prospective study examined symptomatic patients after bilateral cataract extraction with trifocal IOL implantation. A ten-question survey was conducted one month after surgery. Study endpoints included the assessment of monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), contrast sensitivity (CS), and subjective visual quality before and after Nd:YAG capsulotomy prior to 4 months after cataract surgery.Results: A total of 38 eyes from 21 patients were included with a TFAT00 (n = 23) or TFAT30-60 (n = 15). Overall satisfaction with the IOL was 8.55 ± 1.77 (range 5– 10). A Nd:YAG capsulotomy was performed at 55 ± 26 days. Monocular UDVA and UNVA > 20/25 before Nd:YAG were 53.0% and 42.0%, which improved post-Nd:YAG to 63.0% and 66.0%, respectively (P = 0.41, P = 0.051). Binocular UDVA and UNVA > 20/25 before Nd:YAG were 82.0% and 63.0%, which increased to 97% and 97%, respectively (P < 0.05, P < 0.001). CS increased in all post-Nd:YAG capsulotomies (P < 0.01). The presence of glare was documented at 74% pre-Nd:YAG, which decreased to 41% post-Nd:YAG (P < 0.01). Glare which limited activities was documented at 24%, which decreased to 5% post-Nd:YAG (P = 0.21).Conclusion: Early treatment of posterior capsule opacities in mild to moderately dissatisfied trifocal IOL patients may be beneficial in improving CS, visual quality, and reducing the presence and severity of dysphotopsias.Keywords: trifocal IOL, posterior capsule opacification, Nd:YAG laser capsulotomy, visual performance, dysphotopsias, symptomatic patients

Abstract Introduction Posterior capsular opacification (PCO) is the most common complication of cataract surgery. In this study, we develop a model to quantitatively predict the probability of Nd:YAG laser capsulotomy for vision-threatening PCO to improve the life quality of postoperative patients. Methods A registry analysis of cataract procedures performed between the years 2010 and 2021. Following the screening of 16,802 patients (25,883 eyes), 9768 patients (eyes) were enrolled. The cohort was randomly divided into two groups: training (n = 6838) and validation (n = 2930). To identify relevant risk factors, univariate, multivariate, and Least Absolute Shrinkage and Selection Operator (LASSO) algorithm Cox regression analysis were employed, and a nomogram was created to demonstrate the prediction result. Results At 5 years, the overall cumulative incidence of Nd:YAG laser capsulotomy was 12.0% (1169/9768). The following variables were included in the prediction model: sex [hazard ratio (HR) = 1.53, 95% CI 1.32–1.76], age (HR = 0.71, 95% CI 0.56–0.88), intraocular lens (IOL) material (HR = 2.65, 95% CI 2.17–3.24), high myopia (HR = 2.28, 95% CI 1.90–2.75), and fibrinogen (HR = 0.79, 95% CI 0.72–0.88). In the validation cohort, the area under the curve (AUC) of 1-, 3-, and 5-year predictions for Nd:YAG laser capsulotomy were 0.702, 0.691, and 0.688, respectively. For a subgroup of patients with high myopia, the protective effect of hydrophobic IOL disappeared (HR = 0.68, 95% CI 0.51–1.12, P = 0.127). Conclusion This model could predict the probability of Nd:YAG laser capsulotomy for vision-threatening PCO after cataract surgery by taking into account factors such as age, gender, IOL material, high myopia, and fibrinogen. Meanwhile, implantation of a hydrophobic IOL in individuals with high myopia did not demonstrate a protective impact against vision-threatening PCO.

Introduction: Posterior capsular opacification (PCO) is the most common complication of cataract surgery. In this study, we develop a model to quantitatively predict the probability of Nd:YAG laser capsulotomy for vision-threatening PCO to improve the life quality of postoperative patients. Methods: A registry analysis of cataract procedures performed between the years 2010 and 2021. Following the screening of 16,802 patients (25,883 eyes), 9768 patients (eyes) were enrolled. The cohort was randomly divided into two groups: training (n = 6838) and validation (n = 2930). To identify relevant risk factors, univariate, multivariate, and Least Absolute Shrinkage and Selection Operator (LASSO) algorithm Cox regression analysis were employed, and a nomogram was created to demonstrate the prediction result. Results: At 5 years, the overall cumulative incidence of Nd:YAG laser capsulotomy was 12.0% (1169/9768). The following variables were included in the prediction model: sex [hazard ratio (HR) = 1.53, 95% CI 1.32–1.76], age (HR = 0.71, 95% CI 0.56–0.88), intraocular lens (IOL) material (HR = 2.65, 95% CI 2.17–3.24), high myopia (HR = 2.28, 95% CI 1.90–2.75), and fibrinogen (HR = 0.79, 95% CI 0.72–0.88). In the validation cohort, the area under the curve (AUC) of 1-, 3-, and 5-year predictions for Nd:YAG laser capsulotomy were 0.702, 0.691, and 0.688, respectively. For a subgroup of patients with high myopia, the protective effect of hydrophobic IOL disappeared (HR = 0.68, 95% CI 0.51–1.12, P = 0.127). Conclusion: This model could predict the probability of Nd:YAG laser capsulotomy for vision-threatening PCO after cataract surgery by taking into account factors such as age, gender, IOL material, high myopia, and fibrinogen. Meanwhile, implantation of a hydrophobic IOL in individuals with high myopia did not demonstrate a protective impact against vision-threatening PCO. [ABSTRACT FROM AUTHOR]

In this retrospective case series, we investigated factors associated with posterior capsule aperture (PCA) reclosure following neodymium-yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy. The study encompassed patients who underwent cataract surgery with intraocular lens (IOL) implantation or a combined vitrectomy, cataract surgery, and IOL implantation between 2009 and 2022. PCA reclosure was observed in 22 eyes of 17 patients: 45% (10 eyes) underwent the triple procedure, and 55% (12 eyes) received cataract surgery with IOL implantation. In our clinic, 14% of patients were given IOLs with a 4% water content, while 73% (13 eyes) of those experiencing PCA reclosure had IOLs with a 4% water content. The mean interval between Nd:YAG capsulotomies was notably shorter than that between the initial cataract surgery and the first Nd:YAG laser capsulotomy. We also identified five stages of PCA reclosure progression. In conclusion, IOL water content may be linked to PCA reclosure, and the time to recurrence is shorter with each successive reclosure. Further research is needed to verify these findings and uncover additional contributing factors. [ABSTRACT FROM AUTHOR]

Aim: To retrospectively evaluate the effectiveness of the capsular vacuuming technique in reducing posterior capsule opacification (PCO). Methods: Group 1 of the study consisted of 2752 eyes of 2752 patients with a cataract who had undergone phacoemulsification and IOL implantation surgery with anterior, equatorial, and posterior capsular polishing between January 2010 and December 2014. Group 2 consisted of 2761 eyes of 2761 patients with a cataract who had undergone phacoemulsification and IOL implantation surgery with anterior, equatorial, and posterior capsular polishing as well as posterior capsular vacuuming between January 2010 and December 2014. Results: The mean patient age was 63.45 ± 12.23 years (range, 43–89) in Group 1 and 64.02 ± 13.36 years (range, 40–91) in Group 2. The two groups did not significantly differ with respect to age, sex, preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) measurements (p > 0.05). At the 5-year follow-up, 253 eyes (9.19%) in Group 1 developed PCO requiring Nd:YAG laser capsulotomy, whereas 24 eyes (0.86%) in Group 2 developed PCO requiring Nd:YAG laser capsulotomy (p < 0.001). During capsular vacuuming, posterior capsule rupture was observed in the shape of a hole in only 2 eyes in Group 2. But the IOLs were implanted in the capsular bag in all eyes in both groups. Conclusion: PCO is the most common complication of cataract surgery; therefore, surgical technique is important in preventing PCO formation. We recommend posterior capsular vacuuming together with anterior, equatorial, and posterior capsular polishing, as this method significantly reduced the PCO rate. [ABSTRACT FROM AUTHOR]

In this retrospective case series, we investigated factors associated with posterior capsule aperture (PCA) reclosure following neodymium-yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy. The study encompassed patients who underwent cataract surgery with intraocular lens (IOL) implantation or a combined vitrectomy, cataract surgery, and IOL implantation between 2009 and 2022. PCA reclosure was observed in 22 eyes of 17 patients: 45% (10 eyes) underwent the triple procedure, and 55% (12 eyes) received cataract surgery with IOL implantation. In our clinic, 14% of patients were given IOLs with a 4% water content, while 73% (13 eyes) of those experiencing PCA reclosure had IOLs with a 4% water content. The mean interval between Nd:YAG capsulotomies was notably shorter than that between the initial cataract surgery and the first Nd:YAG laser capsulotomy. We also identified five stages of PCA reclosure progression. In conclusion, IOL water content may be linked to PCA reclosure, and the time to recurrence is shorter with each successive reclosure. Further research is needed to verify these findings and uncover additional contributing factors.

Roland Ling,1 Eva-Maria Borkenstein,2 Andreas F Borkenstein2 1The Medical Eye Clinic, Royal Devon and Exeter Hospital, Exeter, UK; 2Privatklinik der Kreuzschwestern Graz, Private Practice Borkenstein & Borkenstein, Graz, AustriaCorrespondence: Andreas F BorkensteinPrivatklinik der Kreuzschwestern Graz, Private Practice Borkenstein & Borkenstein, Graz 8010, AustriaTel +43 316 331 3880Email crustalith@gmx.atObjective: The objective of this study was to assess the rate of posterior capsule opacification (PCO), under “real-life” conditions, as measured by rates of Nd:YAG laser intervention, rather than from a controlled study from which patients with conditions predisposing to PCO have been excluded.Methods and Analysis: This was a retrospective, multicenter study in an unselected consecutive cohort of patients undergoing surgery for senile cataract. Patients aged 18 years and older, previously implanted with the CT LUCIA 611P IOL, were contacted at 12, 18 and 24 months to ascertain if they had received Nd:YAG laser treatment. There was an additional assessment at 36 months at the Austrian centre.Results: A total of 200 patients were recruited at two centers. Laser capsulotomy rates were 4.5% at 1 year and 10% by year 2 and 12% by year 3. Three Nd:YAG capsulotomies, carried out at other external centers, were performed for reasons other than PCO, including astigmatism, epiretinal membrane and ARMD. If these patients are excluded, the true rate of Nd:YAG carried out for PCO at 1 year was 3.5% and at 2 years was 8.5%.Conclusion: It is critical to ensure that Nd:YAG capsulotomies are being performed only for the correct clinical reason. Carrying out unnecessary procedures places the patient at risk of adverse events, is a cost to the healthcare system, and is likely to have no direct visual benefit for the patient. In PCO studies, it should be a requirement to document the fibrosis grade to confirm that Nd:YAG capsulotomy was correctly indicated.Keywords: Nd:YAG laser capsulotomy, PCO, cataract, CT LUCIA 611P

BackgroundMicrospherophakia (MSP) is a rare ocular condition, the lens surgery of which is complicated by both insufficient zonules and undersized capsule.MethodsThis study included MSP eyes managed with phacoemulsification combined with supra-capsular and scleral-fixated intraocular lens implantation (SCSF-IOL) and made the comparison with those treated by transscleral-fixated modified capsular tension ring and in-the-bag intraocular lens implantation (MCTR-IOL).ResultsA total of 20 MSP patients underwent SCSF-IOL, and 17 patients received MCTR-IOL. The postoperative best corrected visual acuity was significantly improved in both groups (P < 0.001), but no difference was found between the groups (P = 0.326). The IOL tilt was also comparable (P = 0.216). Prophylactic Nd:YAG laser posterior capsulotomy was performed 1 week to 1 month after the SCSF-IOL procedure. In the SCSF-IOL group, two eyes (10.00%) needed repeated laser treatment and one eye (5.00%) had a decentered capsule opening. Posterior capsule opacification was the most common complication (6, 35.29%) in the MCTR group. No IOL dislocation, secondary glaucoma, or retinal detachment was observed during follow-up.ConclusionsSCSF-IOL is a viable option for managing MSP and is comparable with the MCTR-IOL. Nd:YAG laser posterior capsulotomy was necessary to prevent residual capsule complications after the SCSF-IOL procedure.

This article, published in the journal Clinical & Experimental Optometry, describes a case of bilateral full thickness central intraocular lens defect following Nd:YAG laser capsulotomy. The patient, a 48-year-old male, had previously undergone cataract surgery in both eyes and experienced a gradual loss of vision. After undergoing the laser procedure, the patient's vision deteriorated further. Examination revealed significant damage to the central part of the intraocular lens in both eyes. The article discusses the complications that can arise from Nd:YAG laser capsulotomy and emphasizes the importance of proper training and technique to prevent vision-threatening complications. [Extracted from the article]

Purpose: To report a case of iris epithelium detachment following Nd:YAG laser capsulotomy. Observations: We describe the case of an 81 year old woman who developed hyphema and detachment of the iris epithelium following standard Nd:YAG laser capsulotomy. The detachment was readily visualized using anterior segment OCT. The hyphema was managed with topical atropine and steroids. The detachment itself was left untreated. Conclusions and importance: No persisting subjective complaints or effect on visual function were noted. To our knowledge, this complication represents a novel observation.

Introduction: Posterior capsular opacification is a common complication after cataract surgery. Neodynium Yttrium Aluminium Garnet laser capsulotomy is still the preferred treatment for posterior capsular opacification. This study was done to determine the use of Brimonidine eye drop in preventing the rise of intraocular pressure post-Neodynium Yttrium Aluminium Garnet laser capsulotomy. Methods: A descriptive cross-sectional study was conducted in Lumbini eye institute and research center, Bhairahawa, Nepal, in 200 eyes with posterior capsular opacification using Brimonidine from Feb 1, 2019, to July 30, 2019. The Institutional Review Committee approved the study with approval number 0237. A convenient sampling method was used. Pre-capsulotomy best-corrected visual acuity, slit-lamp examination of the anterior segment, and dilated fundus examination were done. Intraocular pressure was measured with Goldmann Applanation Tonometer. Post capsulotomy patients were evaluated after one hour, two hours, and two weeks for intraocular pressure and any complications. The statistical analysis was done using Statistical Package of Social Sciences version 20.0 statistical analysis software. The descriptive statistical analysis of the study was done after the collection of the data. Results: Mean age of patients at presentation was 61.61±SD 1.09. The mean intraocular pressure following Neodynium Yttrium aluminum garnet laser capsulotomy using brimonidine at 1 hour was 12.73±3.3 mmHg.and two hours was 11.98±3.2 mmHg. The mean energy per pulse was 2.3±SD 0.3 mJ. The mean duration of posterior capsular opacification from cataract surgery was 22.28 weeks. Conclusions: Neodynium Yttrium Aluminium Garnet laser capsulotomy had lower intraocular pressure after the Brimonidine eye drop procedure. The maximum mean reduction in intraocular pressure was observed after two hours.

AIM:To investigate the influences of Nd:YAG laser capsulotomy with different size on visual acuity(VA), intraocular pressure(IOP), refraction, anterior chamber depth(ACD), and macular thickness(MT)in patients with posterior capsular opacification(PCO). METHODS: In this retrospective, constantly study, 41 eyes of 41 patients treated with Nd:YAG laser posterior capsulotomy for PCO were divided into 2 groups according to the different incision sizes of capsulotomy: the patients received capsulotomy with the incision diameter less than or equal to 3.5mm were enrolled into group 1, while those received operation with incision diameter more than 3.5mm went to group 2. All patients were followed up before Nd:YAG laser capsulotomy, 1wk, 1 and 3mo after Nd:YAG laser capsulotomy, and the best-corrected visual acuity(BCVA), refraction, IOP, ACD, and MT were compared between two groups. RESULTS: In both groups, BCVA were significantly improved postoperatively compared with base line(PP>0.05). The diopter(SE)of the two groups were not significantly different before and after operation(P>0.05). Intraocular pressure in group 2 was higher than those in group1 at 1wk(t=-2.609, P=0.013). ACD decreased significantly at 1wk postoperatively(PP>0.05). Both groups had increased macular thickness lightly at 1wk postoperatively, but with no statistical significance(P>0.05), and there was no significant difference between the two groups at 1wk, 1 and 3mo postoperatively(P>0.05). CONCLUSION: The increase in intraocular pressure is more pronounced when the size of posterior capsulotomy was larger. However, the changes of BCVA, ACD, refraction, MT are not related with the incision size of posterior capsulotomy.

Purpose: The aim of this study was to compare wavefront aberrations before and after Nd:YAG capsulotomy in multifocal intraocular lens (MfIOL) and monofocal (MoIOL) pseudophakic eyes with posterior capsule opacification (PCO). Materials and methods: Wavefront aberrations were measured using a ARK-10000 topographer before and after Nd:YAG capsulotomy in eyes that underwent MfIOL or MoIOL implantation and developed PCO. Total and higher-order aberrations (HOAs) values were evaluated as root mean square (RMS). Results: The study included 64 eyes with MfIOLs (64 patients) and 72 with MoIOLs (72 patients) that developed PCO. Total RMS values before and 1 month after Nd:YAG capsulotomy were 0.863 ± 0.27 and 0.504 ± 0.24 in the MFIOL group and 0.862 ± 0.31 and 0.466 ± 0.26 in the MoIOL group, respectively. Total RMS values did not differ significantly between the groups before (p = 0.914) or 1 month after Nd:YAG laser capsulotomy (p = 0.357), but decreased significantly after Nd:YAG capsulotomy compared to baseline in both the MfIOL (p = 0.027) and MoIOL (p = 0.012) groups. HOA values before and 1 month after Nd:YAG capsulotomy were 0.546 ± 0.23 and 0.364 ± 0.19 in the MfIOL group and 0.500 ± 0.21 and 0.346 ± 0.18 in the MoIOL group, respectively. HOA values did not differ significantly before (p = 0.828) or after Nd:YAG capsulotomy (p = 0.111), while both groups showed significant reduction in HOAs after Nd:YAG capsulotomy (MfIOL: p = 0.021, MoIOL: p = 0.027). Conclusions: Nd:YAG capsulotomy reduces total and HOAs to the same extent in eyes with both MfIOLs and MoIOLs, with no significant impact of the IOL design. [ABSTRACT FROM AUTHOR]

We aimed to survey whether the timing of neodymium:yttrium–aluminum–garnet (Nd:YAG) laser capsulotomy would alter the corneal endothelial morphology and density. A retrospective cohort study was conducted, and 48 patients with unilateral posterior capsular opacity (PCO) and Nd:YAG laser capsulotomy performance were enrolled. The participants were divided into the early Nd:YAG group (timing ≤ 12 months, n = 20) and late Nd:YAG group (timing > 12 months, n= 28) depending on elapsed months between phacoemulsification and Nd:YAG laser capsulotomy. Endothelial cell density (ECD), coefficient of variant (CV), hexagonality (HEX), and central corneal thickness (CCT) between the two groups were collected. A generalized estimate equation was conducted to evaluate the corneal endothelial parameters between the two groups with an adjusted odds ratio (aOR) and 95% confidence interval (CI). The CDVA was improved after treatment in both groups (both p < 0.001). Chronically, ECD in the early group was significantly decreased one week after treatment (2221.50 ± 327.73/mm2 vs. 2441.55 ± 321.80/mm2, p < 0.001), which recovered to 2369.95 ± 76.37/mm2 four weeks after the treatment but was still lower than the preoperative status (p < 0.001). In addition, the HEX percentage showed a significant reduction at four weeks after treatment (p = 0.028). The ECD in the early group was significantly lower than that in the late group (aOR: 0.167, 95% CI: 0.079–0.356, p = 0.003) in both week 1 (p < 0.001) and week 4 (p = 0.004) after laser treatment. In conclusion, the early application of Nd:YAG laser capsulotomy within one year after cataract surgery may be the reason for postoperative ECD decrement without known etiology.

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. [ABSTRACT FROM AUTHOR]

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®. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate patients prediagnosed with capsular block syndrome (CBS) using slit-lamp adapted anterior segment optical coherence tomography (SL-OCT) prospectively. Materials and Methods: The eyes of the patients with decreased vision following phacoemulsification and intraocular lens (IOL) implantation prediagnosed as capsular block syndrome were included. Following ophthalmological examination with pupillary dilation, SL-OCT imaging was performed. Results: The study included 17 eyes of 17 cases with late onset CBS. The mean period of time between cataract operation and CBS diagnosis was 66.5± 31.6 months (range 5 to 120 months). The interspace between posterior surface of the IOL and posterior capsule was hyporeflective in six cases and hyperreflective in other cases. The mean posterior displacement of posterior capsule was 1.02 ± 0.74 mm (ran ge 0.35 to 2.17 mm) at the deepest location. Except for three cases all were treated with Neodymium:YAG (Nd:Y AG) laser posterior capsulotomy. Conclusion: Late-onset CBS can be seen years after phacoemulsification surgery and is thought to be occurred by the liquefied retained cortical material. Also, this condition may be misdiagnosed as IOL opacification. SL-OCT is a useful and supportive method in the demonstration and differential diagnosis of CBS. [ABSTRACT FROM AUTHOR]

• Posterior capsule opacification (PCO) is the most common long-term complication of cataract surgery. • The current treatment of PCO is Nd:YAG laser capsulotomy. • It has been shown that Nd:YAG laser capsulotomy performed after routine cataract surgery can affect the corneal endothelium. • There is a higher rate of endothelial loss after Nd:YAG capsulotomy in eyes with keratoplasty compared to normal eyes, and an increase in CV value, which is an indicator of endothelial morphology. To investigate the safety of Nd:YAG laser capsulotomy in eyes with Penetrating Keratoplasty (PK) and its impact on corneal endothelium as well as graft survival. Thirty patients who underwent Nd: YAG laser capsulotomy after PK and 30 pseudophakic control eyes were included in this prospective study. Endothelial cell density (ECD), hexagonality (HEX), coefficient of variation (CV), central corneal thickness (CCT), and the change of these values during follow-up measured at the 1st hour, first week, and first month after the laser and the data were compared between groups. The mean time passed between the PK procedure and the subsequent YAG laser procedure was i.e. of YAG laser after PK was 30.5 ± 15.2 months (range 6 to 57 months). Baseline ECD was 1648.2 ± 669.77 cells/mm² in the PK group and 2008.27 ± 347.42 cells/mm² in the control group. In the first month, ECD was 1545.2 ± 639.35 cells/mm² in the PK group and 1979 ± 350.95 in the control group. The loss was significantly higher in PK group (-103 ± 153.67 cells/mm²) (6.25%) compare to the control group (-28.73 ± 82.31 cells/mm²) (1.44%) (p = 0.024). A significant increase in CV was observed in the PK group, and not in the control group (p = 0.008, p = 0.255, respectively). There were no significant changes in HEX and CCT values in either group. Nd:YAG laser provides a significant increase in visual acuity in first month in patients with PK with no significant harmful effect on graft transparency. Endothelial cell density measurements during follow-up will be beneficial. [ABSTRACT FROM AUTHOR]

Background The aim was to investigate the effects of neodymium-doped yttrium aluminum garnet laser capsulotomy on the main numerical parameters of the anterior segment with Pentacam in patients with opacification of the posterior capsule. Methods Thirty eyes of 30 patients (19 male, mean age 66.9 ± 8.1 years) with visually significant posterior capsular opacification were enrolled. Patients had undergone phacoemulsification surgery with three-piece intraocular lens (Sensar, AMO, USA) implantation. Full ocular examination was performed before and after capsulotomy. Intraocular pressure (Goldmann applanation tonometry) and refractive changes were measured. Pentacam measurements of the patients before and one week and one month after capsulotomy were obtained. Results Mean visual acuity (logMAR) improved pre-operatively (0.50 ± 0.36) to one week (0.04 ± 0.07) and one month after capsulotomy (0.03 ± 0.06; p < 0.001). Mean spherical and cylindrical powers were 0.50 ± 0.98 DS and -1.61 ± 1.00 DC before the procedure and 0.10 ± 0.80 DS and -0.92 ± 0.66 DC at one month, respectively. There was a significant decrease in cylindrical errors (p = 0.001) and a myopic shift in spherical errors (p = 0.01) after the procedure. Mean anterior chamber depth (ACD) was 4.26 ± 0.63 mm before the procedure, 3.73 ± 0.56 mm at one week and 3.75 ± 0.56 mm at one month. The decrements in anterior chamber depth were significant (p < 0.001). The mean of the anterior chamber angle measurements was 43.41 ± 6.87 degrees before the procedure, increased to 45.56 ± 7.01 degrees at one week and decreased to 44.56 ± 6.13 degrees at one month. The increments in anterior chamber angle at the first week of the procedure were significant (p = 0.01). Mean central corneal thickness was 549.60 ± 41.70 μm before the procedure, increased to 551.40 ± 39.72 μm at one week and decreased to 542.30 ± 35.48 μm at one month. The decrements in central corneal thickness were significant (p = 0.048). Conclusion Mean anterior chamber depth decreased by approximately 0.5 mm after capsulotomy. This decrement in anterior chamber depth might be a clue for associated complications, such as unwelcome refractive errors, changes at intraocular lens position, post-procedure intraocular pressure increases and acute glaucoma. [ABSTRACT FROM AUTHOR]

Background: The aims of this study were to determine the 5-year incidence of posterior capsule opacification (PCO) requiring Nd:YAG laser capsulotomy in a representative mixed cohort of cataract patients, to determine risk factors for PCO and to investigate possible association with growth of human lens epithelial cells (HLEC) in vitro. Methods: Pieces of the anterior lens capsule and adhering HLEC were obtained at cataract surgery and cultured individually. After one and two weeks respectively, cultured cells were stained with carboxy-fluorescein diacetate succinimidyl ester (CFDA SE), after which image processing software was used to determine the area of the confluent cell layer. The 5-year incidence of Nd:YAG laser capsulotomy in this cohort was determined through medical records and by mail or telephone interviews. For statistic analyses Mann–Whitney U-test, Fisher’s exact test and binary logistic regression were used. Results: Data on treatment/no treatment for PCO was obtained from 270 patients with a median follow-up time of 57 months (range 50–64 months). The three-year cumulative incidence of PCO was 5.2% and the cumulative 5-year incidence was 11.9%. Patients who had undergone Nd:YAG laser capsulotomy were significantly younger (median 71 years) than patients who did not receive treatment for PCO (median 75 years, p = 0.022). Logistic regression demonstrated that apart from younger age, follow-up time and type of intraocular lens (IOL) were associated with risk of PCO, with hydrophilic 1-piece IOLs conferring a higher risk than hydrophobic acrylic 1-piece or 3-piece IOLs (adjusted OR = 9.4, 95% CI 2.5-35.7, p = 0.001). Of the 270 patients from whom information could be retrieved regarding PCO treatment, in vitro cell culture could be established and quantified from 185 patients. No significant difference in cell growth in vitro was shown between patients subsequently requiring/not requiring Nd: YAG laser capsulotomy. Conclusions: The cumulative 5-year incidence of 11.9% is comparable or slightly higher than reported in other recent studies. The type of IOL was the most important risk factor for PCO in this study, whereas intrinsic proliferative capacity of the individual’s lens epithelial cells seems to be less important for subsequent PCO development. [ABSTRACT FROM AUTHOR]

Purpose: To compare the safety and efficacy of two Nd: YAG laser capsulotomy techniques. Methods: In this prospective comparative interventional case series, 60 eyes of 57 patients with posterior capsular opacification were enrolled. Thirty eyes were selected to undergo a cruciate capsulotomy (Cross group) and the other 30 eyes were selected to undergo a circular capsulotomy (Circular group). Main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), amount of energy used, mean macular thickness (MMT), and floater symptoms. Results: The amount of energy used was significantly higher in the Circular group than in the Cross group ( p < 0.001). BCVA and IOP were not significantly different between the two groups at baseline or follow-up. MMT was significantly higher in the Circular group than in the Cross group at one day after the laser procedure ( p = 0.032). MMT was not significantly different between groups at one week, one month, and three months ( p > 0.05). The number of patients with floater symptoms was significantly higher in the Circular group than in the Cross group at one week and one month ( p < 0.05). Conclusion: Both the cross-like and circular Nd:YAG laser capsulotomy techniques induce similar visual and IOP changes. The circular technique is associated with a higher amount of energy used, more floater symptoms, and has a greater effect on macular thickness at one day after laser capsulotomy. [ABSTRACT FROM AUTHOR]

Background: This study evaluated anterior hyaloid damage (AHD), AHD-related Nd:YAG laser parameters, and retinal complications in subjects that underwent Nd:YAG laser posterior capsulotomy for cataracts. Methods: In this prospective, cross-sectional study, 277 pseudophakic eyes of 216 patients treated with Nd:YAG laser capsulotomy for posterior capsule opacification were enrolled. Pulse number, pulse energy, and total energy were noted for each eye. All procedures were performed with a sense of anterior hyaloid protection. Anterior hyaloid faces were assessed during procedure and 1 day after the procedure. Eyes with biomicroscopically invisible anterior hyaloid face were excluded from statistical analysis. Eyes with and without AHD were compared according to Nd:YAG laser parameters. Retinal complications were evaluated at day 1, week 1, month 1, and month 3. Results: In 22 eyes (7.9 % of 277 eyes), the anterior hyaloid face couldn't be assessed biomicroscopically. Anterior hyaloid damage was observed in 49 eyes (19.2 % of 255 eyes). The pulse number, pulse energy, and total energy were observed to be higher in eyes with AHD ( P < .001, P = .024, P < .001, respectively). Cystoid macular edema was detected in five eyes (three with AHD) at 1-week examination. Localized retinal detachment occurred in one eye with AHD. Occurrence of retinal complication in the AHD(+) group was 12.7 times higher than in the AHD(−) group, adjusted for total energy used ( P < 0.001). Conclusion: The risk of AHD may increase with high pulse number, pulse energy, and total energy. Anterior hyaloid face integrity should be considered for YAG laser-related retinal complications. [ABSTRACT FROM AUTHOR]

Purpose: To compare neodymium-doped yttrium aluminum garnet laser posterior capsulotomy (LPC) rates between the Hoya FY60AD, Hoya PY60AD, and Alcon AcrySof SN60WF intraocular lenses (IOLs) after routine cataract surgery. Methods: In this retrospective comparative study, patients undergoing uncomplicated cataract surgery over a 3-year period were included, and those subsequently undergoing LPC were identified from laser clinic records. LPC rates at 2 years postoperatively were compared between the round-edged Hoya FY60AD, the newer sharp-edged Hoya PY60AD three-piece IOLs, and the one-piece AcrySof SN60WF IOL. Results: A total of 1,265 cataract operations were included, and 49 eyes (3.9%) underwent LPC within 2 years of surgery. Twenty-eight of 315 eyes (8.9%) implanted with the FY60AD underwent LPC by 2 years, compared to eleven of 254 (4.3%) with the newer sharp square-edged PY60AD and ten of 696 (1.4%) with the one-piece SN60WF (P< 0.05, Chi-squared analyses). Conclusions: The newer, sharper-edged Hoya PY60AD IOL has a lower LPC rate than the Hoya FY60AD IOL at 2 years post-cataract surgery. The one-piece AcrySof SN60WF has a lower LPC rate than both the three-piece Hoya IOLs in the same time period postoperatively. Variations in IOL-edge design and material effect may have contributed to the different rates observed. [ABSTRACT FROM AUTHOR]

Purpose: To observe changes in posterior capsule opacification (PCO) after Nd:YAG treatment with and without opening the posterior lens capsule. Method: This prospective randomized study included patients with regeneratory PCO. In substudy 1, a small low-energy Nd:YAG capsulotomy was performed (MiniYAG). In substudy 2, a low-energy Nd:YAG laser treatment without opening the lens capsule was performed (GentleYAG). Concerning analysis, in both substudies, the posterior capsule was divided into 4 quadrants and the quadrant where the Nd:YAG laser treatment was performed was randomly allocated. Change in PCO was analyzed using retroillumination images objectively (AQUA score: 0-10). Results: In total, 27 eyes of 25 patients were used for this study. In substudy 1, the mean amount of PCO (AQUA score) for the entire posterior capsule decreased significantly (p < 0.05, ANOVA) from 5.2 (SD: 1.6) before to 4.0 (SD: 1.9) immediately after the MiniYAG. In substudy 2, the mean amount of PCO (AQUA score) for the entire posterior capsule analyzed before and immediately after the GentleYAG was 5.1 (SD: 2.4) and 5.2 (SD: 2.3), respectively. Conclusion: Performing a MiniYAG led to a significant PCO reduction. Gentle polishing of the posterior capsule resulted in a relevant reduction of PCO in one third of the patients. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

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

Purpose: The aim of this study was to investigate the effects of neodymium yttrium aluminum garnet (Nd:YAG) laser capsulotomy on axial length (AL), refraction, keratometry (K), white to white distance (WTW), central corneal thickness (CCT), anterior chamber depth (ACD) and pupil diameter. Materials and Methods: We included pseudophakic patients with posterior capsule opacification complaining of decreased visual acuity, glare, or decreased contrast sensitivity who consecutively came to our clinic. All cases underwent Nd:YAG laser (Ellex Super Q, Adelaide, Australia) capsulotomy. The measurements were performed before and one week after the Nd:YAG laser capsulotomy using a Scheimpflug imaging system (Nidek Optical biometer AL-Scan, Gamagori, Japan). Results: Thirty one eyes of 22 pseudophakic patients with clinically significant posterior capsule opacification were enrolled in the study. The mean pupil diameter was 5.47±1.18 mm before and 4.55±1.35 mm after Nd:YAG laser capsulotomy. There was a statistically significant change in pupil diameter (p=0,001). The average keratometric parameter K1 values before and after capsulotomy were 42.67±2.80 D and 42.54±2.81 D respectively. This difference was statistically significant (p=0.040). The changes in AL, spherical and cylindrical powers, K2, mean K, WTW, CCT and ACD were not found statistically significant (p=0.247, p=0.484, p=0.686, p=0.769, p=0.085, p=0.138, p=0.171 and p=0.891 respectively). Conclusion: We found no statistically significant change in AL, ACD, CCT, mean K, K2, WTW, spherical and cylindrical powers after Nd:YAG laser capsulotomy. However, we found a statistically significant change in K1 and pupil diameter in this study. [ABSTRACT FROM AUTHOR]

Posterior capsule opacification (PCO) is the most common postoperative complication of uncomplicated cataract surgery. At present, Nd:YAG laser capsulotomy is the standard method for the treatment of PCO. In this method, fibrotic tissue that covers the visual axis is destructed without any need for intraocular intervention. This treatment has a quite high success rate, but is associated with some complications. In this presentation, we aimed to discuss clinical findings of a case with vitreous prolapse and intraocular lens dislocation after Nd:YAG capsulotomy, application methods of Nd:YAG laser capsulotomy, its potential complications, and their causes. [ABSTRACT FROM AUTHOR]

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 anterior-chamber 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 12 th -month follow up. This case shows that neovascular glaucoma may present as a complication of capsulotomy in uveitic/diabetic eyes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the changes of refractive values in pseudophakic eyes with posterior capsular opacification after Nd:YAG laser capsulotomy. Materials and Methods: In this prospective study, fifty-six eyes of fifty-one patients (28 male, 23 female) having Nd:YAG laser capsulotomy for posterior capsular opacification were recruited. The mean age was 63.6±14.6(SD). The refractive status, uncorrected visual acuity and best corrected visual acuity of the patients were measured before laser and first week after. Results: The mean pre-treatment spherical and cylindrical values with autorefractometer were -0.43±3.42 D and -2.01±1.27 D respectively and post-treatment values were -0.45±3.18 D and -1.14±0.81 D respectively. While the reduction of mean cylindrical value was significant, (p<0.001) there was no statistically significant change in the mean spherical value (p=0.87). The mean uncorrected and best corrected visual acuities were improved significantly after posterior capsulotomy. Conclusion: Nd:YAG laser capsulotomy is an effective and safe alternative for the treatment of posterior capsular opacification. Although Nd:YAG laser posterior capsulotomy did not significantly change the spherical values, it decreased the astigmatic values at 1st week examination following treatment. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: To examine the results of neodymium:yttrium-aluminium-garnet (Nd:YAG) laser posterior capsulotomy in eyes with late or previously unrecognized capsular block syndrome (CBS) presenting with deterioration of vision owing to posterior capsular opacification (PCO). Methods: Patients, who underwent uneventful phacoemulsification with intraocular implantation and were referred for Nd:YAG laser capsulotomy owing to PCO, were prospectively examined for the presence of CBS. When indicated, Nd:YAG laser posterior capsulotomy was carried out. Prospective follow-up examinations were performed for the next 6 months. The outcome measures were post-laser change in best corrected visual acuity, refraction, change in intraocular pressure, inflammation and complication rate. Results: Of 655 patients referred for capsulotomy, eight had an associated CBS in that eye. These eight eyes comprised the study cases. The presence of CBS had not been recognized before the development of PCO. Best corrected visual acuity improved in all cases. In seven out of eight (87.5%) eyes refraction was unchanged throughout the follow up. Ocular hypertension, inflammation or other complications did not develop. Conclusion: Nd:YAG laser capsulotomy in eyes with PCO and late or previously unrecognized CBS is a safe procedure, resulting in improved visual acuity without refractive change. [ABSTRACT FROM AUTHOR]

Objective To determine Nd:YAG laser energy requirements for posterior capsulotomy and intraocular lens (IOL) damage threshold for foldable acrylic IOLs as compared to traditional polymethylmethacrylate (PMMA). Materials and procedures Four groups of five–six fresh canine cadaver eyes were used in this study. The groups included (1) unaltered eyes (2) aphakic eyes (3) eyes implanted with PMMA IOLs, and (4) eyes implanted with acrylic IOLs. Laser energy was delivered to the posterior capsule in grid fashion for 10 sites each of five levels of laser energy ranging from 0.5 mJ to 9 mJ. Number of successful capsulotomy sites was recorded based on slit-lamp observation. Sites of IOL damage were evaluated using scanning electron microscopy (SEM). Statistical analysis of number of capsulotomies and IOL defects per laser energy level was conducted among and between groups usinganova with Tukey's HSD test. Results When comparing groups (a) including all energy levels ( n = 25) and (b) by specific energy levels ( n = 5), there was no significant difference ( P < 0.05) in number of successful capsulotomy sites between IOL types. The 50% incidence threshold for successful capsulotomy was 2.74 mJ for acrylic IOLs and 2.64 mJ for PMMA IOLs. Energy-dependent damage to both types of IOL was detected for medium, high-medium, and high laser energy. Calculated 50% damage threshold was 4.9 mJ for acrylic IOL and 5.7 mJ for PMMA IOL. Damage to the IOL varied subjectively between IOL type, but there was no significant difference in number of defects caused, with the exception of high-medium energy. Conclusions Both posterior lens capsules and IOLs were disrupted in an energy-dependent manner with minimal difference in number of capsulotomy sites or damage to the IOL between acrylic and PMMA IOLs. A therapeutic margin between capsulotomy threshold (2.6–2.7 mJ) and IOL damage threshold (4.9–5.7 mJ) was determined to reliably achieve capsulotomies with minimal IOL damage for both acrylic and PMMA IOLs in normal canine cadaver eyes. [ABSTRACT FROM AUTHOR]

Purpose : To compare the cost-effectiveness of different intra-ocular lens (IOL) materials (Hydrophobic acrylic, Polymethylmethacrylate (PMMA), Hydrophilic acrylic and Silicone) implanted after cataract surgery with reference to Nd:YAG laser capsulotomy and Nd:YAG-related complications in four European countries (France, Italy, Germany and Spain). Setting : A retrospective review of 1,525 patients (eyes), aged 50 to 80 years, operated with phacoemulsification for cataract in 1996 or 1997 in 16 surgical centres (4 per country). Methods : The study was conducted using a cost-effectiveness approach. Medical charts were reviewed to collect retrospective information during the 3-year period following cataract surgery in order to identify patients who underwent Nd:YAG laser capsulotomy post-operatively. Clinical data were combined with unit costs assessed by experts for Nd:YAG laser capsulotomy and their complications. A cost-effectiveness ratio (cost per patient without Nd:YAG laser capsulotomy intervention) was estimated in relation to each IOL material used in each of the four European countries. Results : Hydrophobic acrylic, specifically Acrysof ®, was the most cost-effective IOL material in all the countries except Germany where it was second. PMMA had the best ratio in Germany, was second in Spain and only third in Italy and France. Silicone was second in France and ranked third in the other countries, while hydrophilic acrylic had the worst ratio overall in all countries. Conclusions : Cost-effectiveness ratios of hydrophobic acrylic (Acrysof ®) were better than those of other types of IOL materials used in most of the countries. Sensitivity analyses were performed to vary the base case analysis to demonstrate the economic importance of the assumptions. In all cases, hydrophobic acrylic IOL material was shown to be a highly cost-effective option. [ABSTRACT FROM AUTHOR]

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We aimed to survey whether the timing of neodymium:yttrium–aluminum–garnet (Nd:YAG) laser capsulotomy would alter the corneal endothelial morphology and density. A retrospective cohort study was conducted, and 48 patients with unilateral posterior capsular opacity (PCO) and Nd:YAG laser capsulotomy performance were enrolled. The participants were divided into the early Nd:YAG group (timing ≤ 12 months, n = 20) and late Nd:YAG group (timing > 12 months, n= 28) depending on elapsed months between phacoemulsification and Nd:YAG laser capsulotomy. Endothelial cell density (ECD), coefficient of variant (CV), hexagonality (HEX), and central corneal thickness (CCT) between the two groups were collected. A generalized estimate equation was conducted to evaluate the corneal endothelial parameters between the two groups with an adjusted odds ratio (aOR) and 95% confidence interval (CI). The CDVA was improved after treatment in both groups (both p < 0.001). Chronically, ECD in the early group was significantly decreased one week after treatment (2221.50 ± 327.73/mm2 vs. 2441.55 ± 321.80/mm2, p < 0.001), which recovered to 2369.95 ± 76.37/mm2 four weeks after the treatment but was still lower than the preoperative status (p < 0.001). In addition, the HEX percentage showed a significant reduction at four weeks after treatment (p = 0.028). The ECD in the early group was significantly lower than that in the late group (aOR: 0.167, 95% CI: 0.079–0.356, p = 0.003) in both week 1 (p < 0.001) and week 4 (p = 0.004) after laser treatment. In conclusion, the early application of Nd:YAG laser capsulotomy within one year after cataract surgery may be the reason for postoperative ECD decrement without known etiology. [ABSTRACT FROM AUTHOR]