阿拉可乐定与布林唑胺-噻吗洛尔滴眼液预防激光晶状体囊切开术后眼压升高的对照研究

目的：：比较1％布林唑胺和0.5％噻吗洛尔联合制剂(FCBT)与0.5％阿拉可乐定( APRA)滴眼液预防接受Nd：YAG激光晶状体囊切开术患者术后眼压升高的疗效。方法：前瞻随机对照临床研究。研究包括90例(90眼)接受Nd：YAG激光晶状体囊切开术治疗后囊膜混浊( PCO )患者。患者术前1 h随机给予APRA ( n=45)或FCBT ( n=45)治疗。一名设盲检查者使用Goldmann压平眼压计检查术前及术后1,2,3,24 h和7 d的眼压。眼压检查结果分为以下两类：术后眼压升高5~<10 mm Hg和眼压升高≥10 mm Hg。眼压升高<5 mm Hg认为没有临床上的显著改变。结果：APRA组和 FCBT 组术前当天的平均眼压分别为14.1±2.1 mm Hg和13.2±2.1 mm Hg,差异无统计学意义(P=0.066)。随访期间,FCBT组的平均眼压较低但差异无统计学意义。 APRA组中的6名患者(13.3％)和FCBT组中的4名患者(8.9％)术后至少有一次眼压升高5~<10 mm Hg,差异无统计学意义( P=0.243)。眼压升高≥10 mm Hg 在 APRA 组与 FCBT 组中分别出现3眼(6.7％)和1眼(2.2％),差异无统计学意义(P=0.542)。结论：APRA和FCBT均可有效预防眼压升高且APRA足以应对常规病例。对于需要加强降低眼压的患者-如预先存在青光眼的患者(其术后眼压升高的风险更大)可选择FCBT。     

Effect of pilocarpine in treatment of intraocular pressure elevation following neodymium: YAG laser posterior capsulotomy

A prospective study was conducted in 30 eyes of 30 patients to determine if pilocarpine would prevent increased intraocular pressure following Q-switched neodymium (Nd):YAG laser posterior capsulotomy. Fifteen eyes were given pilocarpine 4%, immediately following laser therapy and every hour until bedtime. Fifteen eyes served as untreated controls. Our results show that without prophylactic therapy, 10 of 15 eyes (67%) had a post-laser intraocular pressure (IOP) elevation of greater than 10 mmHg, while only one of 15 (6.6%) of the pilocarpine-treated eyes had a rise of that magnitude. The facility of outflow was reduced by 42% in the untreated eyes in contrast to an increase of 3% in those eyes treated with pilocarpine. Thus, pilocarpine 4% is effective in reducing the incidence and magnitude of elevated IOP following Nd:YAG posterior capsulotomy.     

Effect of 0.2% brimonidine in preventing intraocular pressure elevation after Nd:YAG laser posterior capsulotomy

BACKGROUND AND OBJECTIVE: To determine the prophylactic effect of 0.2% brimonidine in reducing the elevated intraocular pressure (IOP) in patients undergoing Nd:YAG laser posterior capsulotomy. PATIENTS AND METHODS: The 81 patients (81 eyes), who underwent Nd:YAG laser posterior capsulotomy, were allocated to two treatment groups. One drop of 0.2% brimonidine or vehicle was instilled 1 hour preoperatively and one drop immediately after capsulotomy. IOPs were measured preoperatively and 1, 2, 3, and 24 hours postoperatively. RESULTS: Intraocular pressure decreased from the baseline in the brimonidine group by the third postoperative hour (P<0.05), while the vehicle group exhibited an increase. Intraocular pressure elevations of 5 mm Hg or greater occurred in 7.3% (3/41) in the brimonidine group compared to 20.0% (8/40) in the vehicle group. IOP elevations of 10 mm Hg or greater occurred in 2.4% (1/41) in the brimonidine group compared to 7.5% (3/40) in the vehicle group. CONCLUSIONS: One drop of 0.2% brimonidine instilled 1 hour preoperatively and immediately after capsulotomy was found to be efficacious and safe in preventing IOP elevations that frequently follow Nd:YAG laser posterior capsulotomy.     

Brimonidine 0.15% versus apraclonidine 0.5% for prevention of intraocular pressure elevation after anterior segment laser surgery

PURPOSE: To compare the efficacy and safety of brimonidine 0.15% with those of apraclonidine 0.5% in preventing intraocular pressure (IOP) elevations after anterior segment laser surgery. SETTING: Massachusetts Eye and Ear Infirmary, Glaucoma Service, Boston, Massachusetts, USA. METHODS: This double-masked randomized trial 80 eyes of 80 patients who had laser peripheral iridotomy, argon laser trabeculoplasty, or neodymium:YAG laser capsulotomy. Eyes received 1 drop of brimonidine 0.15% or apraclonidine 0.5% before laser surgery. Intraocular pressure, heart rate, and blood pressure were measured before laser surgery and at 1 hour, 3 hours, 24 hours, and 1 week after laser surgery. RESULTS: Before laser treatment, 41 patients received brimonidine 0.15% and 39 received apraclonidine 0.5%. Thirteen (31.7%) patients in the brimonidine group and 11 (28.2%) in the apraclonidine group had postoperative IOP elevations of 5 mm Hg or more (P = .5). Four patients (9.8%) in the brimonidine group and 3 (7.7%) in the apraclonidine group had IOP increases of 10 mm Hg or more (P = .5). There were no statistically significant changes in mean heart rate or blood pressure in either group except a slight reduction in diastolic blood pressure at 1 hour in the brimonidine group (-4.7 +/- 9.2 mm Hg) compared with that in the apraclonidine group (-0.1 +/- 9.1 mm Hg) (P = .01). No clinically significant side effects were noted in either group. CONCLUSION: A single preoperative drop of brimonidine 0.15% had similar efficacy and safety as apraclonidine 0.5% in preventing IOP elevations immediately after anterior segment laser surgery.     

Prophylactic use of timolol maleate to prevent intraocular pressure elevation after Nd-YAG laser posterior capsulotomy

Purpose To evaluate the effective prophylaxis of topical 0.5% timolol maleate for the intraocular pressure rise following Nd-YAG laser posterior capsulotomy. Methods A total of 190 eyes of 184 patients who underwent Nd-YAG laser posterior capsulotomy were randomly assigned to pre-treatment with either topical application of 0.5% timolol maleate (treatment group) or nothing (control group). Results The mean intraocular pressure (IOP) of the treatment group was 14.8 ± 3.0 mmHg before capsulotomy and 15.7 ± 3.4 mmHg after capsulotomy (P > 0.05), whereas IOP was 15.1 ± 3.3 mmHg and 17. 2 ± 4.3 mmHg (P < 0.05) for the control group. There was no statistically significant difference between the two groups with regard to mean IOP before capsulotomy (P > 0.05), but a statistically significant difference was seen between the two groups after capsulotomy (P < 0.05). Six of 91 eyes (6.6%, two with aphakia) in the treatment group had an IOP elevation greater than 6 mmHg compared with 14 of 99 eyes (14.1%, eight with aphakia) in the control group (P < 0.01). Conclusion Pre-treatment with a topical application of 0.5% timolol maleate is effective in preventing IOP elevation after Nd-YAG laser posterior capsulotomy.     

Dorzolamide X apraclonidine in the prevention of the intraocular pressure spike after Nd : YAG laser posterior capsulotomy

OBJECTIVE: To evaluate the efficacy of dorzolamide compared to apraclonidine, in the prevention of the intra-ocular pressure (IOP) spike after Nd :YAG laser posterior capsulotomy. SITE: Department of Ophthalmology, State University of Campinas (UNICAMP) General Hospital, Campinas, S?o Paulo, Brazil. METHODS: In a double masked prospective clinical trial, 217 eyes from 217 patients were randomly assigned to receive either dorzolamide 2 h before and placebo 1 h before Nd : YAG laser capsulotomy or placebo 2 h before and apraclonidine 1 h before the procedure. Inclusion criteria were secondary cataracts with reduction in best corrected visual acuity (BCVA < 20/40), absence of manifest or suspected glaucoma and no known hypersensitivity to the study drugs. IOP was measured 2 h and 1 h before applying the laser, and 1 h, 2 h, 3 h and 7 days after. RESULTS: There were no statistically significant differences between the two groups regarding the IOP 2 h and 1 h before the procedure, and 1 h, 2 h, 3 h and 7 days after the laser treatment (p values, respectively: 0.077, 0.21, 0.085, 0.36, and 0.60). CONCLUSION: The results of this study suggest that dorzolamide is as safe and effective as apraclonidine in the prevention of the IOP elevation after Nd : YAG laser posterior capsulotomy. Synopsis. The efficacy of dorzolamide was compared to apraclonidine in the prevention of the intraocular pressure spike after Nd : YAG laser posterior capsulotomy in 217 patients and the results were similar with both drugs.     

Retinal detachment after neodymium:YAG laser posterior capsulotomy

We reviewed the records of 397 patients who had undergone Nd:YAG laser posterior capsulotomy between July 1983 and August 1988. Of the 366 eyes that had been followed up for three months or more, 13 (3.6%) developed a retinal detachment after capsulotomy; of these 13 detachments, 11 (84.6%) occurred within the first year. The combination of male gender with axial myopia (greater than or equal to 25.00 mm), a history of lattice degeneration, or a history of retinal detachment in the fellow eye was a significant risk factor for the development of retinal detachment after YAG capsulotomy.     

Neodymium: YAG laser posterior capsulotomy: visual acuity outcome and intraocular pressure elevation

A Q-switched neodymium: YAG laser was used to perform 67 posterior capsulotomies in 67 patients. A clear visual axis was produced in all the eyes. The visual acuity improved by one or more Snellen lines in 90% of the eyes, and the final visual acuity was 20/40 (6/12) or better in 78% of the eyes. Cystoid macular edema developed in two patients after capsulotomy. Increases in intraocular pressure were most prevalent in the early postoperative period. No significant correlation was found between the acute pressure rise and the laser energy used, a previous history of glaucoma or the presence of an intraocular lens. After 6 months of follow-up none of the eyes showed a permanent pressure elevation.     

Posterior vitreous detachment after neodymium:YAG laser posterior capsulotomy

PURPOSE: To determine whether retinal detachment (RD) after neodymium:YAG (Nd:YAG) laser posterior capsulotomy is due to a greater incidence of posterior vitreous detachment (PVD) than in controls and whether vitreous status at the time of capsulotomy is useful in predicting the risk for RD. SETTING: Teaching hospital ophthalmology service. METHODS: Patients having Nd:YAG laser posterior capsulotomy after uneventful cataract surgery (treatment group) were prospectively studied. Fellow eyes that had extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation but no Nd:YAG capsulotomy (no-laser group) formed 1 control group, and eyes that had no cataract surgery (phakic group) formed a second control group. The treatment group comprised 322 eyes; the no-laser group, 97; and the phakic group, 142. Dilated fundus and vitreous examinations were performed at baseline (before Nd:YAG capsulotomy) and 12 months postoperatively. RESULTS: At baseline, the prevalence of PVD was similar in the treatment and no-laser groups (61.8% and 63.9%, respectively; P=.2014) but was significantly lower in the phakic group (50.7%; P=.0151). There was no significant difference among the groups in the development of PVD in eyes with attached vitreous at baseline (17.9%, treatment group; 11.4%, no-laser group; 17.1%, phakic group) (P=.6588). CONCLUSIONS: The prevalence of PVD was significantly higher in eyes after ECCE and IOL implantation than in phakic eyes independent of Nd:YAG laser posterior capsulotomy. Capsulotomy was not associated with a significantly higher incidence of new PVD; therefore, the presence or absence of PVD at the time of capsulotomy is not helpful in assessing the risk for RD in the first year after laser treatment.     

Intraocular pressure elevation following Nd:YAG laser posterior capsulotomy

Intraocular pressures (IOP) and tonographic outflow facilities were measured following neodymium (Nd): YAG laser posterior capsulotomy in 13 pseudophakic and 8 aphakic eyes. Mean intraocular pressure (IOP) peaked by three hours with a mean increase of 13 mmHg, remained elevated by 5 mmHg at 24 hours but returned to baseline by one week. Fourteen eyes (67%) had greater than or equal to 10 mmHg elevation and eight (38%) had greater than or equal to 40 mmHg maximum IOP. All the patients who eventually demonstrated a greater than or equal to 10 mmHg elevation within six hours of the capsulotomy initially had an IOP elevation greater than or equal to 5 mmHg at one hour. The mean outflow facility was reduced from 0.18 microl/min/mmHg before capsulotomy to 0.08 microl/min/mmHg (55%, P less than 0.0001) at four hours and was still decreased at 0.13 microl/min/mmHg (27%, P less than 0.05) at one week. Seventy-five percent of aphakic and 15% of pseudophakic patients had maximum IOP greater than or equal to 40 mmHg (P less than 0.01). Measurements should be performed one hour postlaser in all patients for IOP and three to four hours in aphakic patients, glaucomatous patients, patients receiving greater than or equal to 200 mjoules total laser energy, and patients with greater than or equal to 5 mmHg elevation at one hour in order to detect and treat significant IOP elevations.     

Brimonidine 0.2% versus apraclonidine 0.5% for prevention of intraocular pressure elevations after anterior segment laser surgery

OBJECTIVE: To compare the efficacy of brimonidine 0.2% with apraclonidine 0.5% in preventing intraocular pressure (IOP) elevations after anterior segment laser surgery. DESIGN: Double-masked, randomized clinical trial. PARTICIPANTS: Sixty-six patients underwent either laser peripheral iridotomy, argon laser trabeculoplasty, or neodymium:yttrium-aluminum-garnet laser capsulotomy. INTERVENTION: Eyes received either one drop of brimonidine 0.2% or apraclonidine 0.5% before laser surgery. MAIN OUTCOME MEASURES: Intraocular pressure, heart rate, and blood pressure were measured before laser surgery and at 1 hour, 3 hours, 24 hours, and 1 week after laser surgery. RESULTS: Before the laser treatment, 33 patients (50.0%) received brimonidine 0.2% and 33 patients (50.0%) received apraclonidine 0.5%. Eight of 33 patients (24.2%) in the brimonidine-treated group and 9 of 33 patients (27.3%) in the apraclonidine group had postoperative IOP increases of 5 mmHg or more. This was not statistically different (P = 0.80). By the time of last follow-up examination, 3 of 33 patients (9.1%) in the brimonidine-treated group and 3 of 33 patients (9.1%) in the apraclonidine group had IOP increases of 10 mmHg or more. This was also not statistically different (P > or = 0.95). The mean IOP reduction from baseline in the brimonidine group (-2.8 +/- 2.8 mmHg) was not statistically different (P = 0.55) compared with the mean IOP reduction in the apraclonidine group (-3.6 +/- 3.3 mmHg). There were no statistically significant changes in mean heart rate or blood pressure in either group except for a slight reduction in diastolic blood pressure at 1 hour (P = 0.005) in the brimonidine group (-5.2 +/- 7.4 mmHg) compared with the apraclonidine group (-0.2 +/- 6.4 mmHg). There were no clinically significant side effects noted in either group. CONCLUSIONS: A single preoperative drop of brimonidine 0.2% is as effective as apraclonidine 0.5% in preventing IOP elevation immediately after anterior segment laser surgery.     

Prophylactic use of acetazolamide to prevent intraocular pressure elevation following Nd-YAG laser posterior capsulotomy.

Fifty four eyes of 54 patients undergoing Nd-YAG laser posterior capsulotomy were randomly assigned to pretreatment with either 125 mg of oral acetazolamide (group A) or placebo (group B). During the first 3 hours following capsulotomy, an intraocular pressure (IOP) rise of at least 10 mm Hg was recorded in eight of the 26 eyes of group B (30.8%) and in none of the 28 eyes of group A (p < 0.01). A rise of at least 5 mm Hg was recorded in 16/26 (61.5%) and 4/28 (14.3%) eyes respectively (p < 0.001). Three eyes of group B developed an IOP greater than 35 mm Hg. We found that pretreatment with a low dose of acetazolamide is highly effective in preventing IOP elevation following Nd-YAG laser posterior capsulotomy.     

Cumulative probability of neodymium: YAG laser posterior capsulotomy after phacoemulsification

PURPOSE: To retrospectively analyze the cumulative probability of neodymium:YAG (Nd:YAG) laser posterior capsulotomy after phacoemulsification and to evaluate the risk factors. SETTING: Ando Eye Clinic, Kanagawa, Japan. METHODS: In 3997 eyes that had phacoemulsification with an intact continuous curvilinear capsulorhexis, the cumulative probability of posterior capsulotomy was computed by Kaplan-Meier survival analysis and risk factors were analyzed using the Cox proportional hazards regression model. The variables tested were sex; age; type of cataract; preoperative best corrected visual acuity (BCVA); presence of diabetes mellitus, diabetic retinopathy, or retinitis pigmentosa; type of intraocular lens (IOL); and the year the operation was performed. The IOLs were categorized as 3-piece poly(methyl methacrylate) (PMMA), 1-piece PMMA, 3-piece silicone, and acrylic foldable. RESULTS: The cumulative probability of capsulotomy after cataract surgery was 1.95%, 18.50%, and 32.70% at 1, 3, and 5 years, respectively. Positive risk factors included a better preoperative BCVA (P =.0005; risk ratio [RR], 1.7; 95% confidence interval [CI], 1.3-2.5) and the presence of retinitis pigmentosa (P<.0001; RR, 6.6; 95% CI, 3.7-11.6). Women had a significantly greater probability of Nd:YAG laser posterior capsulotomy (P =.016; RR, 1.4; 95% CI, 1.1-1.8). The type of IOL was significantly related to the probability of Nd:YAG laser capsulotomy, with the foldable acrylic IOL having a significantly lower probability of capsulotomy. The 1-piece PMMA IOL had a significantly higher risk than 3-piece PMMA and 3-piece silicone IOLs. CONCLUSIONS: The probability of Nd:YAG laser capsulotomy was higher in women, in eyes with a better preoperative BCVA, and in patients with retinitis pigmentosa. The foldable acrylic IOL had a significantly lower probability of capsulotomy.     

Influence of intraocular lens material on regeneratory posterior capsule opacification after neodymium:YAG laser capsulotomy

PURPOSE: To evaluate the influence of a neodymium:YAG (Nd:YAG) laser capsulotomy on the morphology and development of regeneratory opacification of the remaining surrounding posterior capsule. SETTING: Department of Ophthalmology, Medical School, University of Vienna, Vienna, Austria. METHODS: Standardized digital retroillumination photographs were taken immediately before and after Nd:YAG laser capsulotomy and at 1 week, 6 months, and 1 to 3 years in 38 eyes of consecutive patients. Changes in regeneratory posterior capsule opacification (PCO) and opacification around the capsulotomy opening were evaluated. The influence of the type of intraocular lens (IOL) material and design (acrylic, n = 8; hydrogel, n = 8; silicone open loop, n = 11; silicone plate haptic, n = 6; poly(methyl methacrylate) [PMMA], n = 5) was assessed. The state of the anterior vitreous surface was examined at the slitlamp in all eyes. RESULTS: In 8 of 17 eyes with a silicone IOL, reduced regeneratory PCO was observed. Massive pearl formation on the margin of the Nd:YAG capsulotomy was typical with silicone IOLs (8 eyes) but also occurred with PMMA IOLs. Eyes with acrylic IOLs had no change in regeneratory PCO after the capsulotomy. Three of 8 eyes with hydrogel IOLs had complete closure of the posterior capsulotomy opening. CONCLUSIONS: Neodymium:YAG laser capsulotomy induced changes in the development and morphology of regeneratory PCO. Silicone and PMMA IOLs led to significant pearl formation on the capsulotomy margin, often combined with a reduction of peripheral regeneratory PCO (silicone). Hydrogel IOLs led to a higher incidence of reclosure of the Nd:YAG capsulotomy opening.     

Brimonidine 0.2% versus brimonidine Purite 0.15%: prophylactic effect on iop elevation after Nd:YAG laser posterior capsulotomy.

AIMS: The aim of this study was to compare the prophylactic effect of brimonidine 0.2% versus brimonidine Purite 0.15% on intraocular pressure (IOP) increase after Nd:YAG laser posterior capsulotomy. METHODS: In this prospective, double-masked, randomized, controlled study, 106 patients (106 eyes) who underwent Nd:YAG laser posterior capsulotomy were allocated to a brimonidine 0.2% group (35 eyes), a brimonidine Purite 0.15% group (36 eyes), or a vehicle group (35 eyes). One (1) drop of brimonidine 0.2%, brimonidine Purite 0.15%, or vehicle was instilled 1 h preoperatively and 1 drop immediately after Nd:YAG laser posterior capsulotomy. IOPs were measured preoperatively and at 1, 2, 3, and 24 h postoperatively. RESULTS: Decreases in IOP from baseline ranged from 2.3 to 2.7 mmHg in the brimonidine 0.2% group and 2.2-2.5 mmHg in the brimonidine Purite 0.15% group (P < 0.05), whereas the vehicle group exhibited a rise in IOP. IOP elevations of less than 5 mmHg occurred in 22.9% of patients in the brimonidine 0.2% group, 27.8% in the brimonidine Purite 0.15% group, and 48.6% in the vehicle group. Spikes of IOP greater than 10 mmHg occurred in 2.9% of patients in the brimonidine 0.2% group, 2.8% in the brimonidine Purite 0.15% group, and 8.6% in the vehicle group. The incidence of IOP elevation was not statistically significant between the brimonidine 0.2% and the brimonidine Purite 0.15% groups (P < 0.05). CONCLUSIONS: Brimonidine 0.2% and brimonidine Purite 0.15% have similar efficacy in the prevention of IOP elevation after Nd:YAG laser posterior capsulotomy.     

Monocular diplopia after neodymium: YAG laser capsulotomy

Purpose To present an unusual complication of posterior capsulotomy such as monocular diplopia and to discuss the importance of capsulotomy size. Methods Case report: A 57-year old man came to our clinic complaining of horizontal monocular diplopia in his right eye for the past 3 days. The patient had undergone a Nd:YAG capsulotomy in this eye 3 weeks before. Slit-lamp biomicroscopy under pupil dilation revealed a small capsulotomy and a considerable Elschnig pearl as the presumable cause of the diplopia. The rest of the examination was completely normal. Results After repeat Nd:YAG capsulotomy treatment, the diplopia disappeared. Conclusion Capsulotomy size is a significant factor to consider when treating a posterior capsular opacification. A capsulotomy that is larger than the pupil diameter under scotopic conditions may avoid disturbances of vision such as monocular diplopia. Presented at the 80th Spanish Society of Ophthalmology Congress, Cordoba, Spain, September–October 2004 None of the authors has any financial or proprietary interest in any material or method mentioned     

Recurrent endophthalmitis after neodymium: YAG laser capsulotomy

A 69-year-old woman underwent phacoemulsification and aspiration with intraocular lens implantation and sutureless wound closure in the right eye. Two days after cataract surgery, Staphylococcus aureus endophthalmitis occurred and was treated successfully. After neodymium: YAG laser capsulotomy 9 1/2 months later, endophthalmitis recurred, and retinal detachment ensued. Vitreous and aqueous cultures were negative for bacteria. Vitrectomy and removal of the intraocular lens were performed. The inflammation diminished, and visual acuity returned to 0.2.