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Visual outcome and complications after Nd YAG
laser Capsulotomyin patients with PCO
NZOZ ZBM Zdrowie Ophthalmology Department Bartosz
Wieczorek Head of the Department Maria Sadowska
Wieczorek
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Introduction
PCO (posterior capsular opacification) is the
most frequent consequence of primary cataract
extraction, phacoemulsification with IOL
implantation which lead to vision decrease. It
occurs in up to 30 of patients in the term of
two to five years after surgery. Age of patient,
type of cataract, type of implanted lens,
experience of surgeon, surgery tools,
accompanying diseases are PCO risk factors. The
only effective and safe treatment method is
Neodymium YAG laser capsulotomy which cause
photodisruption of changed posterior capsule and
clear the visual axis.
Purpose
The aim of the study was evaluation of visual
outcome and complications after Nd YAG Light
Pulsa 9000 laser capsulotomy in patients with
posterior capsular opacification (PCO) after
cataract phacoemulsification in 69 patients (70
eyes) in 2008.
Methods
The study was conducted on 69 patients (70 eyes)
admitted to ophthalmology department due to PCO
after primary phacoemulsification. Out of 69
patients 40 was males (57,14), 39 females
(42,86), the mean age was 67 years old, the mean
term from phacoemulsification was 36,06 months.
Laser YAG capsulotomy was conducted on 70 eyes,
31 right eyes (44,28), 39 left eyes (55,71 ).
Fifty two cases (74,25 ) had capsular fibrosis,
18 cases (25,75 ) had Elschning pearls. Visual
acuity before laser was from 1/50 to 5/50 in 18
eyes (25,71 ), from 5/25 to 5/16 in 32 eyes
(45,71 ) and 5/10 and more in 20 eyes (28,57
). Among treated eyes atrophia n. II in 3 eyes
(4,28 ), high myopia in 2 eyes (2,85 ), AMD in
6 eyes (8,57 ) NPDR and ERM in 3 eyes (4,28)
were present. Different types of laser technique
were applied. Topical NSAIDs drops were applied
after the procedure as an inflammation prevention
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Fig.1 Diferent laser technique
Fig.2 Elschnig Pearls
Results
Improvement of visual acuity was present in 67
eyes (95,71 ), in 56 cases (80) acuity was from
5/7 to 5/5, in 11 cases (15,71 ) from 5/25 to
5/10. Lack of improvement was observed in 3 eyes
(4,28) due to retinal disease highly advanced
AMD, NPDR. Post laser lens damage was present
in 12 eyes (17,14 ) decrease of IOP in 2 eyes
(2,85) and 1 (1,42) case of iritis were
observed as post laser complications. There were
no other complications ascertained like retinal
detachment, lens dislocation and subluxation,
corneal edema or inflammatory process.
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Fig.3 Lens Pitting
Discussion
YAG laser capsulotomy seems to be the simplest
procedure of PCO treatment. It leads to acute
vision improvement in most cases. Frequency of
complications is relatively low. It is easy to
perform and learning curve is short. The
important thing of prelaser period is individual
patients explanation of chance for better visual
acuity. Diseases of posterior segment decrease
vision improvement.
Conclusions
Majority of patients had improvement of visual
acuity. Described complications did not have
significant influence on visual acuity what
verified YAG laser capsulotomy as a safe
treatment method of PCO.