A Study of Adverse Clinical Consequences of Neodymium Doped Yttrium Aluminum Garnet (Nd : YAG) Laser Treatment for Posterior Capsular Opacification : A Rural Hospital Based Approach
Journal Title: Ophthalmology and Allied Sciences - Year 2019, Vol 5, Issue 2
Abstract
Introduction: Posterior capsular opacification (PCO) is the most common delayed complication after ECCE surgery with or without PC-IOL. Neodymium Doped Yttrium Aluminum Garnet (Nd : YAG) laser for posterior capsulotomy is widely used and it has been gradually replacing surgical capsulotomy because it is safe, non-invasive and effective procedure with minimal complications of vitreous loss and endophthalmitis as compared to surgical capsulotomy. Complications of Nd : YAG laser posterior capsulotomy are raised intraocular pressure (IOP), corneal damage, iritis, intraocular lens (IOL) pitting or dislocation, cystoid macular edema (CME), disruption of the anterior vitreous face, retinal detachment (RD), endophthalmitis and vitreous hemorrhage. The purpose of the present study is to to evaluate the complication rate following Nd : YAG laser capsulotomy. Aims and Objectives: To assess the complication following Nd : YAG laser capsulotomy. Material and Methods: The study has been performed in our institute between September 2013 to September 2015. 100 eyes of 100 patients with PCO were considered for Nd : YAG laser capsulotomy after minimum period of 6 months following uncomplicated extracapsular cataract extraction. Following the capsulotomy, all patients were routinely given topical antibioticssteroid combination and topical anti-glaucoma drops. Patients were reviewed after 1 hr for assessment for tonometry, slit lamp biomicroscopy. Anterior chamber reaction were looked. IOP assessment was done after 1hr, 1week, 1month and 6month. Rise in IOP was noted. If IOP was raised for hours and retured to normal at the end of 7 days, it labelled as transient IOP rise. Persistent IOP rise was labeled if sustained high IOP on follow up visits. Patients were also looked for visual acuity, any incidence of iritis, retinal detachment, cystoid macular edema. Results: In our study, most frequent complication was rise in IOP. The immediate IOP rise (IOP one hour after Nd : YAG laser capsulotomy) was recorded in 31% of patients. Mean summated laser energy in a group of patients with immediate IOP rise (62.39) was significantly high as compared to group of patients with normal IOP. In our study, pitting of IOL was seen in 6% of patients. Mean summated laser energy level in patients with pitting of IOL was 80.67 mJ as compared to 52.36 mJ in patients without IOL pitting. The mean summated laser energy was significantly higher (p=0.002) in a group of patients with IOL itting. In our study, iritis was noted in 7% of patients. The mean summated laser energy was significantly higher (p<0.001) in a group of patients with iritis. The mean summated laser energy level in patients with iritis was 85.14J as compared to 51.72 mJ in patients without iritis. In our study, CME was seen in 3% of patients. Mean summated laser energy in patients with CME was 74.67 mJ versus 53.42 mJ in patients without CME (97%). Mean summated laser energy was not significantly higher in patients with CME (p=0.098). In our study, anterior hyaloid face rupture was noted in 9% of patients, but none of the patient had vitreous in anterior chamber. Mean summated laser energy level in patients with anterior hyaloid face rupture was 75.11 mJ which was significantly higher (p=0.002) as compared to 51.98 mJ in patients without rupture of anterior hyaloid face (n=91). Conclusion: Complications with Nd : YAG laser capsulotomy are minimal and transient. Complications such as raised intraocular pressure, pitting of IOL, iritis, anterior hyaloid face rupture more common if mean summated energy level was high. The total laser energy delivered were not risk factor for the development of cystoid macular edema. Healthy pseudophakia eyes generally do not have retinal detachment after Nd : YAG laser capsulotomy. To minimize the complications, lowest possible laser energy level should be used for Nd : YAG laser capsulotomy.
Authors and Affiliations
Preeti A Rawandale Patil
Keywords
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- EP ID EP649167
- DOI 10.21088/oas.2454.7816.5219.9
- Views 139
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