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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 20  |  Issue : 4  |  Page : 157-160

Influence of yttrium aluminum garnet laser posterior capsulotomy opening size on intraocular pressure and central macular thickness


Ophthalmology Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Menoufia, Egypt

Date of Submission01-Feb-2019
Date of Acceptance07-Aug-2019
Date of Web Publication17-Dec-2019

Correspondence Address:
MD Ahmed A Alhagaa
Menoufia University, Shebin Elkom, Menoufia 11835
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/DJO.DJO_6_19

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  Abstract 


Purpose This study aimed to show the effect of yttrium aluminum garnet (YAG) laser posterior capsulotomy opening size on intraocular pressure (IOP) and central macular thickness (CMT).
Patients and methods Two hundred eyes having posterior capsule opacification were included in this study. These eyes were classified into two groups: the first group (100 eyes) had undergone small YAG laser posterior capsulotomy, whereas the second group (100 eyes) had undergone large YAG laser posterior capsulotomy. Eyes in both groups were carefully examined preoperatively and at 1 day, 3 days, 1 week, 1 month, 3 months, and 6 months postoperatively. In each visit, IOP and CMT were recorded in all eyes, and the results were compared between both groups.
Results Patients in the second group with large YAG laser posterior capsulotomy opening size showed significantly higher IOP and higher CMT.
Conclusion Neodymium : YAG laser posterior capsulotomy is a safe technique even with the presence of some possible complications like increased IOP, which is controlled rapidly after the first postoperative day, and macular edema, which improved rapidly with no long-lasting effect on vision.

Keywords: intraocular pressure, macular thickness, yttrium aluminum garnet laser


How to cite this article:
Alhagaa AA, Badawi NM. Influence of yttrium aluminum garnet laser posterior capsulotomy opening size on intraocular pressure and central macular thickness. Delta J Ophthalmol 2019;20:157-60

How to cite this URL:
Alhagaa AA, Badawi NM. Influence of yttrium aluminum garnet laser posterior capsulotomy opening size on intraocular pressure and central macular thickness. Delta J Ophthalmol [serial online] 2019 [cited 2020 Feb 27];20:157-60. Available from: http://www.djo.eg.net/text.asp?2019/20/4/157/273324




  Introduction Top


One of the most common complications after cataract surgery is posterior capsule opacification (PCO) [1]. Neodymium : yttrium aluminum garnet (Nd : YAG) laser was widely used for more than 20 years in the treatment of posterior capsular opacification [2]. Several complications were reported in the procedure of YAG laser posterior capsulotomy, like elevated intraocular pressure (IOP), retinal breaks which may proceed to retinal detachment, macular edema, damage to the intraocular lens (IOL), and iritis [3],[4].

This study aimed to show the effect of YAG laser posterior capsulotomy size on IOP and central macular thickness (CMT).


  Patients and methods Top


Full detailed written consent was signed by every patient included in the study. Each patient had been informed about the benefits of the procedure, the hazards that may occur, and all steps of the study. All study procedures were carried out in accordance with the declaration of Helsinki and were approved by the Institutional Ethical Committee.

Two hundred eyes having PCO were included in this study. The eyes belonged to 200 patients who had successful uncomplicated phacoemulsification with posterior chamber foldable in the bag IOL implantation. All 200 eyes were totally free from any anterior segment or posterior segment abnormalities apart from PCO. Patients with diabetes mellitus or connective tissue disorders were excluded from the study. Patients having high myopia more than −6.0 diopters (D) or hyperopia more than +4.0 D were also excluded from the study.

All 200 eyes included in the study underwent Nd : YAG laser posterior capsulotomy between January 2016 and March 2018, and they were carefully and meticulously examined preoperatively and at 1 day, 3 days, 1 week, 1 month, 3 months, and 6 months postoperatively. In each visit, all eyes were subjected to complete slit lamp examination of the anterior segment, fundus examination with indirect ophthalmoscope and with +90 D lens (OICO, London, UK) on the slit lamp after full pupillary dilatation with tropicamide 1% eye drops, IOP measurement with Goldmann applanation tonometer (Haag-Streit, Gartenstadtstassee, Koeniz, Switzerland), and optical coherence tomography (macular study) by Zeiss Cirrus HD-OCT (Carl Zeiss Meditec AG, Oberkochen, Germany).

Concerning the procedure of Nd : YAG laser posterior capsulotomy, full pupillary dilatation was achieved using tropicamide 1% (Mydrapid; EIPICO, Cairo, Egypt) eye drops which were instilled into the eye before the procedure every 10 min for 2 h. Timolol 0.5% (Timolol; EIPICO) was instilled into the eye before the procedure (taken twice daily from the day of YAG laser capsulotomy). Topical anesthesia was applied and benoxinate hydrochloride 0.4% (Benox; EIPICO) eye drops were instilled into the eye before the procedure. Abraham capsulotomy lens was used in all eyes. Posterior capsulotomy was done in all eyes with Zeiss Visuals YAG III (Carl Zeiss Meditec AG). The eyes were classified into two groups. In group 1, the energy used was 1.2 mJ with a mean number of 10.3±3.6 shots in each eye, whereas in group 2, the energy used was 1.2 mJ, with a mean number of 13.2±2.8 shots in each eye. After doing posterior capsulotomy as planned, prednisolone acetate 1% eye drops four times per day, timolol 0.5% two times per day, and moxifloxacin eye drops four times per day were prescribed for all patients for 5 days.

The ideal capsulotomy size should be equal to or slightly exceed the scotopic pupil diameter and should not exceed the borders of the IOL optic. So, the scotopic pupil diameter was measured accurately with the slit lamp before the procedure to divide the eyes included in the study into two groups: the first group included 100 eyes that were planned to have small-sized YAG laser posterior capsulotomy (<4 mm), and the second group included 100 eyes that were planned to have large-sized YAG laser posterior capsulotomy (4 mm or more). In some eyes, a slight change in capsulotomy size occurred in the first few postoperative days, so the terminal capsulotomy size was recorded 2 weeks after the procedure, and according to it, the eyes were classified to group 1 or group 2. The capsulotomy size was measured with the slit lamp beam length in both horizontal and vertical directions, and the average of these two values was recorded as the capsulotomy size. The results of the two groups were statistically analyzed.


  Results Top


The two hundred patients included in the study were divided into two groups: group 1 included 54 males and 46 females, whereas group 2 included 52 males and 48 females. There was no statistically significant difference in sex between the two groups (P=0.327). The mean age was 61.1±6.4 years (range, 52–71 years) in group 1 and 60.8±5.9 years (range, 53–70 years) in group 2, with a statistically insignificant difference (P=0.46, [Table 1]).
Table 1 Comparison of results between both groups

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The mean capsulotomy size was 3.39±0.29 mm (range, 2.8–3.9 mm) in group 1, whereas in group 2, the mean was 4.71±0.39 mm (range, 4.2–5.3 mm). There was a statistically significant difference in capsulotomy size between the two groups (P<0.005, [Table 1]).

In group 1, there was a statistically significant increase of IOP level in the first postoperative day (P<0.05), whereas in other postoperative visits, there was no statistically significant difference in IOP level in comparison with the preoperative level (P>0.05). In group 2, there was a statistically significant increase of IOP level in the first postoperative day (P<0.05), whereas in other postoperative visits, there was no statistically significant difference in IOP level in comparison with the preoperative value (P>0.05). Concerning IOP rise in the first postoperative day, which occurred in both groups, IOP was significantly higher in the second group in comparison with the first group (P<0.05, [Table 1]).

In group 1, there was a statistically significant increase in CMT at the 1-week postoperative visit in comparison with the preoperative value (P<0.05), whereas in earlier follow-up visits (at 1 day and at 3 days) and in later follow-up visits (at 1 month, 3 months, and 6 months), there was no statistically significant difference in comparison with the preoperative value (P>0.05). Similarly, in group 2, there was a statistically significant increase in CMT at the 1 week postoperative visit in comparison with preoperative value (P=0.008), whereas in earlier follow-up visits (at 1 day and at 3 days) and in later follow-up visits (at 1 month, 3 months, and 6 months), there was no statistically significant difference in comparison with the preoperative value (P>0.05). The increase in CMT at the 1-week postoperative visit, which occurred in both groups, was significantly higher in the second group in comparison with the first group (P<0.05, [Table 1]).


  Discussion Top


One of the most common complications of Nd : YAG laser posterior capsulotomy is increased IOP. Even with prophylactic treatment, elevated IOP level was reported in 15–30% of eyes in several studies [5],[6],[7]. Keates et al. [8] had elevated IOP in 0.6% of his patients, whereas Stark et al. [9], showed that elevated IOP was 1.0% after Nd : YAG posterior capsulotomy. Ge et al. [10] showed that elevated IOP had occurred in glaucomatous patients who developed a higher level of IOP within one hour of capsulotomy. However, Shani et al. [11] did not find any increase of IOP and postulated that healthy nonglaucomatous eyes do not show increased IOP level after Nd : YAG laser posterior capsulotomy. In addition, some authors [12],[13] did not find any IOP elevation in their studies despite significant changes in light scattering and optical quality. In both groups in the current study, there was a statistically significant increase of IOP level in the first postoperative day, whereas in other postoperative visits, there was no statistically significant difference in IOP level in comparison with the preoperative level. In addition, IOP was significantly higher in the second group in comparison with the first group. Thus, large capsulotomy size was associated with significantly higher IOP.

Raza [14] found cystoid macular edema in 3% of 550 patients subjected to Nd : YAG laser posterior capsulotomy for pseudophakic PCO. In another study, a number of 897 Nd : YAG laser posterior capsulotomies were followed for the development of cystoid macular edema which was reported in 11 patients. The number of laser shots and the level of laser energy delivered were not significant risk factors [15]. Lewis et al. [16] had followed 136 patients who underwent Nd : YAG laser posterior capsulotomy for opacification of the posterior lens capsule for 6 months after cataract extraction. Fundus fluorescein angiography was done 4 and 8 weeks after the laser. Cystoid macular edema did not develop in any of the patients in this study. In the present study, there was a statistically significant increase in CMT at the 1-week postoperative visit in comparison with the preoperative value, whereas in earlier follow-up visits (at 1 day and at 3 days) and in later follow-up visits (at 1 month, at 3 months, and at 6 months), there was no statistically significant difference in comparison with the preoperative level. In addition, the increase in CMT at the 1 week postoperative visit, which occurred in both groups, was found to be significantly higher in the second group in comparison with the first group. Thus, a large capsulotomy size was associated with significantly higher CMT.


  Conclusion Top


Nd : YAG laser posterior capsulotomy is a safe procedure even with the presence of some possible complications like increased IOP, which is controlled rapidly after the first postoperative day, and macular edema, which improved rapidly with no long-lasting effect on vision.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
MacEwen CJ, Dutton GN. Neodymium-YAG Laser in the management of posterior capsular opacification: complications and current trends. Trans Ophthalmol Soc UK 1986; 105:337–344.  Back to cited text no. 1
    
2.
Wormstone IM, Wang L, Liu CS. Posterior capsule opacification. Exp Eye Res 2008; 88:257–269.  Back to cited text no. 2
    
3.
Hu CY, Woung LC, Wang MC. Change in the area of laser posterior capsulotomy: 3 month follow-up. J Cataract Refract Surg 2001; 27:538–542.  Back to cited text no. 3
    
4.
Hu CY, Woung LC, Wang MC, Jian JH. Influence of laser posterior capsulotomy on anterior chamber depth, refraction, and intraocular pressure. J Cataract Refract Surg 2000; 26:1183–1189.  Back to cited text no. 4
    
5.
Garg P, Malhotra R, Singh L, Agarwal K, Garg A. Role of prophylactic use of timolol maleate (0.5%) in preventing rise of intraocular pressure (IOP) post neodymium: yttrium, aluminum, garnet (Nd:YAG) capsulotomy. Nigerian J Ophthalmol 2014; 22:20.  Back to cited text no. 5
    
6.
Pereira Minello AA, Prata JA Jr, Arruda Mello PA. Efficacy of topical ocular hipotensive agents after posterior capsulotomy. Arq Bras Oftalmol 2008; 71:706–710.  Back to cited text no. 6
    
7.
Lin JC, Katz LZ, Spaeth GL, Klancnik JM Jr. Intraocular pressure control after Nd:YAG laser posterior capsulotomy in eyes with glaucoma. Br J Ophthalmol 2008; 92:337–339.  Back to cited text no. 7
    
8.
Keates RH, Steinert RF, Puliafito CA, Maxwell SK. Long-term follow-up of Nd:YAG laser posterior capsulotomy. J Am Intraocul Implant Soc 1984; 10: 164–168.  Back to cited text no. 8
    
9.
Stark WJ, Worthen D, Holladay JT, Murray G. Neodymium: YAG lasers: an FDA report. Ophthalmology 1985; 92:209–212.  Back to cited text no. 9
    
10.
Ge J, Wand M, Chiang R, Paranhos A, Shields B. Long-term effect of Nd : YAG laser posterior capsulotomy on intraocular pressure. Arch Ophthalmol 2000; 118:1334–1337.  Back to cited text no. 10
    
11.
Shani L, David R, Tessler Z, Rosen S, Schneck M, Yassur Y. Intraocular pressure after neodymium: YAG laser treatments in the anterior segment. J Cataract Refract Surg 1994; 20:455–458.  Back to cited text no. 11
    
12.
Ari S, Cingu AK, Sahin A, Inar YC. The effects of Nd : YAG laser posterior capsulotomy on macular thickness, intraocular pressure, and visual acuity. Ophthalmic Surg Lasers Imaging 2012; 43:395–400.  Back to cited text no. 12
    
13.
Werner L, Stover JC, Schwiegerling J, Das KK. Light scattering, straylight, and optical quality following YAG laser posterior capsulotomy. J Cataract Refractive Surg 2016; 42:148–156.  Back to cited text no. 13
    
14.
Raza A. Complications after Nd : Yag posterior capsulotomy. J Rawalpindi Med Coll 2007; 11:27–29.  Back to cited text no. 14
    
15.
Steinert RF, Puliafito CA, Kumar SR, Dudak SD, Patel S. Cystoid macular edema, retinal detachment, and glaucoma after Nd : YAG laser posterior capsulotomy. Am J Ophthalmol 1991; 112:373–380.  Back to cited text no. 15
    
16.
Lewis H, Singer TR, Hanscom TA, Straatsma BR. A prospective study of cystoid macular edema after neodymium: YAG laser posterior capsulotomy. Ophthalmology 1987; 94:478–482.  Back to cited text no. 16
    



 
 
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