Acute angle-closure glaucoma caused by vitreous prolapse after neodymium:YAG posterior capsulotomy

We report the second known case of acute angle-closure glaucoma from vitreous prolapse after neodymium:YAG (Nd:YAG) laser posterior capsulotomy in a patient with a posterior chamber intraocular lens (IOL). This is the first reported case to result in corneal decompensation that required penetrating keratoplasty. The rare complication of vitreous prolapse was unusual in this patient because of the presence of a posterior chamber IOL, a small 4.0 mm capsulotomy opening, and low (26 mJ) Nd:YAG laser energy.     

Vitreous opacification after neodymium:YAG posterior capsulotomy.

PURPOSE: To describe the clinical picture in eyes that developed vitreous opacification behind the intraocular lens (IOL) after neodymium:YAG (Nd:YAG) laser posterior capsulotomy and determine whether this type of opacification tends to occur in patients with diabetes. SETTING: Shinjo Eye Clinic, Miyazaki, Japan. METHODS: The clinical course in 728 eyes that had Nd:YAG posterior capsulotomy was reviewed. RESULTS: After Nd:YAG posterior capsulotomy, opacification developed in the vitreous in contact with the IOL in 9 eyes (1.2%). All occurred in diabetic patients, and the vitreous opacification developed within 1 month after the capsulotomy. A vitrectomy was performed in 8 eyes and in 1, the opacification spontaneously absorbed. Vitreous opacification occurred in 8.9% of 101 eyes of diabetic patients, and the prevalence in diabetic eyes was significantly higher than in nondiabetic eyes (P < .0001). Nine of the diabetic eyes were opaque and 92 nonopaque. In the opaque eyes, the prevalence of panretinal photocoagulation was higher than in the nonopaque eyes (P = .013), and hemoglobin Alc (P = .030) was higher; the interval between cataract surgery and Nd:YAG capsulotomy was shorter (P = .047) and the final visual acuity, lower (P = .045). CONCLUSION: The prevalence of vitreous opacification after Nd:YAG laser posterior capsulotomy was significantly higher in diabetic than in nondiabetic eyes. Viterectomy was effective for this type of opacification.     

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.     

Retinal breaks before and after neodymium:YAG posterior capsulotomy

PURPOSE: To determine the frequency of asymptomatic retinal breaks before and after neodymium:YAG (Nd:YAG) laser posterior capsulotomy. SETTING: Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. METHODS: Of 350 consecutive patients referred for their first laser Nd:YAG posterior capsulotomy, 235 eligible eyes were enrolled and 220 eyes completed the study. A vitreoretinal surgeon looked for retinal breaks using binocular indirect ophthalmoscopy with scleral indentation. The eyes were examined 1 week before and 1 hour and 1 month after the posterior capsulotomy. The number, type, and location of retinal breaks were recorded. RESULTS: The median age of eligible patients who did not participate in the study was higher than that of enrolled patients (79.6 versus 74.4 years; P =.0005). The mean axial length, median time from cataract surgery, and the course of cataract surgery were comparable in both groups. Before the posterior capsulotomy, an untreated retinal break was diagnosed in 4 of the 235 eyes (1.7%; 95% confidence interval [CI] 0 to 4) scheduled for surgery and an undiagnosed retinal detachment was present in 2 additional eyes (0.9%; 95% CI 0 to 3). An asymptomatic retinal break was also present in 4 fellow eyes (1.7%, 95% CI 0 to 4). No new breaks developed during Nd:YAG posterior capsulotomy using a median total energy of 51 mJ (range 10 to 901 mJ) and a median number of 22 applications (range 4 to 341 applications) and resulting in an opening with a median largest diameter of 3.4 mm (range 2.0 to 4.6 mm). In 1 treated eye (0.4%; 95% CI 0 to 2), a new retinal break had developed by 1 month postoperatively. CONCLUSIONS: The observed 2.1% frequency of asymptomatic retinal breaks that had escaped the attention of the referring ophthalmologist or had developed by 1 month after Nd:YAG posterior capsulotomy can be contrasted with the 0.5% to 2.0% frequency of retinal detachment reported in the literature. However, it is not known which proportion of such asymptomatic breaks, if any, will progress to detachment after Nd:YAG laser posterior capsulotomy.     

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.     

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.     

Late onset of acute angle-closure glaucoma following neodymium:YAG laser posterior capsulotomy.

Acute angle-closure glaucoma due to vitreous prolapse immediately following neodymium:YAG (Nd:YAG) laser posterior capsulotomy in eyes with posterior chamber intraocular lens implants is rare. Previously described cases were associated with advanced age, excessive amounts of laser energy, and a large-diameter capsular opening. The authors describe a case of acute angle-closure glaucoma occurring 21 days after Nd:YAG laser posterior capsulotomy in a young patient with a small-diameter capsule opening and a small amount of laser energy to stress the importance of close extended follow-up even in eyes with a theoretical low risk for this complication     

Pupil block glaucoma after neodymium:YAG capsulotomy in a patient with a partially subluxated posterior chamber intraocular lens

A 73-year-old-woman presented following neodymium:YAG capsulotomy for posterior capsular opacification with acute glaucoma. Previous cataract surgery had left her with a subluxated lens. Cornea edema obscured detail of the anterior chamber, but the edge of the lens could be seen clearly within the pupillary space. This produced a diagnostic dilemma because no obvious cause for pupil block could be seen. She failed to respond to medical therapy and had a laser iridotomy, following which her symptoms resolved. We believe this case demonstrates the importance of a laser iridotomy to exclude pupil block glaucoma when adequate visualization of the pupillary space is obscured.     

Capsule membrane growth complicating glaucoma and corneal decompensation after neodymium:YAG capsulotomy

We report a case of progressive capsule membrane growth 4 months after neodymium:YAG capsulotomy for posterior capsule opacification. The clinical picture closely resembled epithelial ingrowth, but histology proved otherwise. Multiple operations were required to control glaucoma and capsule proliferation. However, the patient's visual potential was limited by corneal decompensation and glaucomatous damage. FINANCIAL DISCLOSURE: No author has a 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.     

Secondary closure of neodymium:YAG laser posterior capsulotomy.

A 67-year-old man reported reduced vision after cataract surgery and neodymium:YAG (Nd:YAG) laser posterior capsulotomy. The diagnosis was complicated due to severe glistenings within the optic of an acrylic foldable intraocular lens (IOL), proliferation of lens epithelial remnants over the capsulotomy opening, and presumed vitreous opacity. Although IOL exchange surgery was considered, a second Nd:YAG laser intervention successfully removed the proliferated lens materials and restored the visual acuity. The glistenings were not the cause of the reduced vision.     

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     

Early complications following Q-switched neodymium: YAG laser posterior capsulotomy

A prospective evaluation was conducted of Q-switched neodymium: YAG laser capsulotomy in 53 eyes followed for one postoperative month. The first 31 eyes were seen at two-hour intervals for the first eight hours, and the remaining eyes were checked only at the second postoperative hour during that day. Eighty-nine percent of eyes required a pulse setting of less than 1.7 mJ to successfully penetrate the posterior capsule. Visual acuity was improved in 91% of eyes. A transient immediate postoperative intraocular pressure (IOP) elevation was seen in over 75% of treated eyes, and one-third had an IOP elevation greater than 10 mmHg over the preoperative IOP. This elevation was most common in glaucomatous eyes and occurred in almost one-half of the treated eyes by the second postoperative hour. This IOP change did not correlate with the degree of inflammation, bleeding, anterior chamber debris, or total energy delivered. Minimal iris bleeding occurred in 9% of treated eyes and was associated with iridocapsular adhesions. Eighty-one percent of eyes with posterior chamber implants developed some degree of lens damage.     

A prospective study of cystoid macular edema after neodymium: YAG laser posterior capsulotomy

To establish the clinical and angiographic incidence of cystoid macular edema (CME) after neodymium:YAG (Nd:YAG) laser capsulotomy, the authors have prospectively studied 136 patients who underwent Nd:YAG laser discission for secondary opacification of the posterior capsule after extracapsular cataract extraction. In all patients, fluorescein angiography was obtained before the laser discission. Of the 136 patients, 78 (57%) were followed for at least 6 months, and fluorescein angiography was repeated 4 to 8 weeks after the procedure. CME did not develop in any of the patients in this series.     

Results of neodymium:YAG laser posterior capsulotomy following penetrating keratoplasty

Fifty-six eyes which had a triple procedure (penetrating keratoplasty, extracapsular cataract extraction, and posterior chamber intraocular lens implantation) were evaluated for the incidence, results, and complications of neodymium:YAG laser posterior capsulotomy. Ten of the 56 eyes (17.8%) required YAG laser posterior capsulotomy. Overall, nine of the ten eyes (90.0%) improved their visual acuity one Snellen line or more. Lens pitting (one case) and bleeding (one case) were complications of the laser treatment. The addition of the corneal transplant does not appear to alter the results of the YAG laser posterior capsulotomy, nor does it jeopardize the success of the corneal transplant.     

掺钕钇铝石榴石激光治疗人工晶状体眼晶状体后囊膜混浊的视功能评价方法

目的探讨对比敏感度和眩光敏感度检查在晶状体后囊膜混浊(posterior capsule opacification, PCO)患者视功能评价中的意义,为掺钕钇铝石榴石(neodymium-yttrium aluminum garnet,NdYAG)激光治疗晶状体PCO提供视功能评价方法.方法对67例(73只眼)超声乳化白内障吸除人工晶状体植入术后晶状体PCO患者行NdYAG激光晶状体后囊膜切开术,分别于手术前、后进行视力、对比敏感度和眩光敏感度检查,并加以分析.NdYAG激光晶状体后囊膜切开术采用环形切开向后翻转法,晶状体后囊膜瓣直径为5 mm,平均单次脉冲能量为(2.93±0.63) mJ,平均脉冲次数为(19.09±8.63)次,平均总能量为(57.47±36.05) mJ.术后平均随访时间(14±6)个月.结果术后视力、对比敏感度和眩光敏感度均较术前明显提高,差异有非常显著意义(P＜0.01).术前矫正视力≥0.8的16只眼手术前、后最佳矫正视力比较,差异无显著意义(P＞0.05);不同视角的对比敏感度和眩光敏感度比较,差异均有显著意义(P＜0.05).术前不同视力患者各频段的对比敏感度比较,差异均无显著意义(P＞0.05).术前不同视力患者低频段和中频段眩光敏感度间差异有显著意义(P＜0.05),高频段眩光敏感度间差异无显著意义(P＞0.05).术前晶状体后囊膜2级混浊者不同频段的平均对比敏感度和眩光敏感度与1级混浊者比较,差异均有显著意义(P＜0.05).NdYAG激光晶状体后囊膜切开术中人工晶状体出现激光损伤斑者5只眼(6.8%),术后无高眼压、黄斑囊样水肿、视网膜脱离和人工晶状体移位等并发症发生.结论对比敏感度和眩光敏感度检查可灵敏、全面反映晶状体PCO患者的视功能状态,可成为确定NdYAG激光晶状体后囊膜切开术手术时机和评价手术疗效的方法.