Suprachoroidal haemorrhage following Nd:YAG laser posterior capsulotomy

Nd:YAG laser posterior capsulotomy is the commonest procedure for posterior capsule thickening following cataract surgery. Complications following this laser surgery are relatively few, and this is ordinarily a safe and effective procedure. Herein a case is described of suprachoroidal haemorrhage following Nd:YAG laser posterior capsulotomy. To the best of the authors' knowledge, this is the first report of this complication.Patients undergoing this procedure should be warned of this rare but potentially devastating complication.     

Nd:YAG laser treatment for Valsalva premacular hemorrhage

OBJECTIVE:To report a case of Valsalva premacular hemorrhage treated by Nd:YAG laser.;METHODS:A patient who presented with Valsalva premacular hemorrhage was treated with photodisruptive Nd:YAG laser to drain the entrapped premacular blood into the vitreous.;RESULTS:After photodisruption, vision in the affected eye improved rapidly due to exposure of the macula.;CONCLUSIONS:Nd:YAG laser treatment may be a good alternative for recent preretinal hemorrhages. Clinical benefits include rapid visual rehabilitation and the avoidance of vitrectomy.     

Long-term results of Nd:YAG laser treatment for premacular subhyaloid haemorrhage owing to Valsalva retinopathy

AIMS: Valsalva retinopathy produces sudden visual loss, which may be prolonged if untreated. Nd:YAG laser enables rapid diffusion of premacular subhyaloid haemorrhage. This study was performed to assess the long-term results and safety of Nd:YAG laser treatment in cases with Valsalva retinopathy. METHODS: Sixteen patients had Nd:YAG laser treatment to drain premacular haemorrhage. The follow-up period was 24 months. RESULTS: All eyes had marked clearing of haemorrhage and immediate improvement of vision following laser treatment. In 14 eyes visual acuity improved to 20/20 level at the end of the first week and the remaining two patients achieved 20/20 level within 1 month. No patient had evidence of retinal or choroidal damage. CONCLUSION: Nd:YAG laser treatment for Valsalva retinopathy is an effective, non-invasive, and safe procedure for patients with a premacular subhyaloid haemorrhage larger than 3 disc diameter and no longer than 3 weeks of duration.     

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.     

Nd:YAG laser photodisruption of the lens nucleus before phacoemulsification

We studied the use of Q-switched Nd:YAG laser pulses to soften sclerotic lens nuclei before phacoemulsification. We obtained 105 lens nuclei from extracapsular cataract extractions, graded them for degree of sclerosis, and randomized them into laser treatment (53 lenses) or control groups (52 lenses). The treated lenses received laser pulses until confluent pits and clefts were visible. All lenses were phacoemulsified and the times recorded. Nd:YAG laser pretreatment decreased phacoemulsification time in all grades. In moderately sclerotic nuclei, average phacoemulsification time was reduced from 40.1 to 23.9 seconds (40.4%). The nuclei of ten lenses obtained from intracapsular cataract extractions were treated intracapsularly, and the posterior capsule was inadvertently ruptured in five.     

YAG curios #2: Nd:YAG laser treatment following suction posterior capsulorhexis

Suction posterior capsulorhexis (SPC) is a relatively new technique for creating a posterior capsulorhexis. We present a case series of seven patients who required Nd:YAG laser treatment 27 months after SPC. No patient had pre-existing risk factors for increased postoperative inflammation and all received a one-piece polymethylmethacrylate intraocular lens placed in-the-bag. Although it reduces the need for Nd:YAG laser treatment, SPC, like the more usual forceps posterior capsulorhexis, does not completely eliminate it.     

Nd:YAG laser photodisruption of hemorrhagic detachment of the internal limiting membrane

We used a Q-switched Nd:YAG laser to create an opening in the internal limiting membrane in three eyes with hemorrhagic detachment of the internal limiting membrane. In all instances, after membranotomy blood was rapidly cleared from the preretinal space resulting in prompt improvement in visual acuity. No retinal injury was observed. Nd:YAG laser photodisruption may be useful in the treatment of some cases of subinternal limiting hemorrhages.     

"String of pearls" following Nd:YAG laser posterior capsulotomy

Posterior capsular re-opacification can occur following Nd-YAG capsulotomy. This necessitates multiple capsulotomies with its potential complications. We report one such case and discuss possible predisposing factors and preventive measures for this condition.     

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.     

Acute elevations of intraocular pressure following Nd:YAG laser posterior capsulotomy

We performed applanation tonometry preoperatively, hourly for the first four postoperative hours and on the first postoperative day in 66 eyes after Nd:YAG laser posterior capsulotomy in order to determine the nature of the acute intraocular pressure (IOP) elevation and the risk factors involved. Forty-one percent of eyes developed an intraocular pressure greater than 30 mmHg and 14% greater than 40 mmHg. The IOP spike occurred on the second postoperative hour in 35% of eyes. Patients with controlled glaucoma prior to capsulotomy had a significantly lower mean IOP rise than patients without glaucoma. Eyes with posterior chamber IOLs were less likely to develop an IOP greater than 30 mmHg than were aphakic eyes without IOLs. There was no correlation between the laser energy or the size of the capsulotomy and the IOP rise.     

Photodisruptive Nd:YAG laser in the management of premacular subhyaloid hemorrhage.

PURPOSE: Premacular subhyaloid hemorrhage is usually a benign condition that generally improves spontaneously and rarely causes visual loss. However, because the hemorrhage may cause permanent macular changes before it resolves, Nd:YAG laser posterior hyaloidotomy may be indicated in selected cases. This study investigated the effects of drainage of premacular subhyaloid hemorrhage into the vitreous with Nd:YAG laser treatment. METHODS: This study was conducted between February 1996 and March 1999. Six patients had a circumscribed premacular hemorrhage in one eye and were treated with the Nd:YAG laser to drain the blood into the vitreous cavity. The hemorrhage originated from Valsalva retinopathy (2 cases), proliferative diabetic retinopathy (2 cases), central retinal vein occlusion (1 case), and blunt ocular trauma (1 case). The size of the hemorrhage is expressed in disc diameters. RESULTS: The mean pretreatment hemorrhage measured 5.7 disc diameters (range 3.5-8.0). Visual acuity in all cases before laser treatment was hand movement. After laser treatment, the hemorrhage instantly drained into the vitreous cavity, resulting in rapid improvement of vision. Drainage was complete within one week and visual acuity improved dramatically. The mean follow-up was 26.3 months (range 7-42 months). No retinal damage or rebleeding occurred due to the laser treatment, and vitrectomy was not required in any eye. CONCLUSIONS: Nd:YAG laser posterior hyaloidotomy may be useful for draining a premacular hemorrhage into the vitreous cavity in selected cases. To establish this as a routine procedure, a randomized prospective study is needed to compare observation, primary vitrectomy, and Nd:YAG laser treatment.     

Nd:YAG laser therapy for non-resolving premacular subhyaloid hemorrhage in Saudi patients

Purpose

To report anatomical and visual outcomes of Nd:YAG laser posterior hyaloidotomy (NYPH) in Saudi patients affected by Premacular subhyaloid haemorrhage (PMSHH).

Anterior hyaloid face opacification after pediatric Nd:YAG laser capsulotomy.

PURPOSE: The purpose of this study was to examine the clarity of the visual axis after Nd:YAG laser capsulotomy following cataract extraction and primary intraocular lens implantation in a pediatric population. METHODS: A retrospective review was performed of all cases of cataract extraction and primary intraocular lens implantation over a period of 5 years. A group of children who had been treated by primary surgical posterior capsulotomy and anterior vitrectomy (Group 1) was used as the "gold standard," with whom the children treated with Nd:YAG laser capsulotomy (Group 2) were compared. The groups were studied for the incidence of opacification of the visual axis after the primary procedure. RESULTS: Data on 78 eyes were reviewed, and 56 eyes met inclusion criteria. Of these, 33 eyes were treated with primary posterior capsulotomy and anterior vitrectomy (Group 1) and 23 eyes were treated with Nd:YAG laser capsulotomy (Group 2). One eye (3%) of Group 1 experienced postoperative visual axis reopacification. Thirteen (57%) of 23 eyes in Group 2 experienced reopacification, requiring retreatment. Four eyes (17%) treated with Nd:YAG laser required a third treatment. CONCLUSIONS: In our series, 57% of patients treated with Nd:YAG laser capsulotomy experienced reopacification across the anterior hyaloid face. With the removal of the anterior vitreous at the time of cataract extraction, the scaffolding for cell migration is removed and reopacification of the visual axis is rarely seen. For patients in whom slit-lamp capsulotomy is not possible, especially if there is no Nd:YAG laser available for use in the operating room or when loss to follow-up may be an issue, primary posterior capsulotomy and anterior vitrectomy should be strongly considered.     

Nd: YAG laser photodisruption: an experimental investigation on shielding and multiple plasma formation

In an ocular model plasmas were induced by Q-switched, commercially available Nd:YAG lasers that operated in low order or fundamental mode. Plasma shielding was measured and analysed in relation to energy input, number of plasmas and plasma evolution. Near breakdown threshold, attenuation or shielding of the laser beam resulting from absorption and scattering by the plasma is low and is characterized by high variability from shot to shot. More importantly, shielding does not increase when multiple plasmas are formed, possibly due to a competitive mechanism between these plasmas. Further evidence of this mechanism was obtained from measurement performed using a streak camera. The effectiveness of shielding is scarcely changed by an increase in the cone angle of the incident radiation. In the light of these experiments and other published data, safety guidelines for the clinical use of the Nd:YAG laser have been formulated.     

Delayed posterior dislocation of silicone plate-haptic lenses following anterior and posterior Nd:YAG laser capsulotomy

To observe the stability of silicone plate-haptic intraocular lenses implanted following cataract surgery and analyze the reasons related to decentration and dislocation into the posterior segment. · METHODS: We report 3 cases of posterior dislocation of silicone plate-haptic lenses (Bausch and Lomb C11UB and Chiron C11UB) in patients who underwent uneventful phacoemulsification. · RESULTS: One occurred 4 years following sectoral anterior capsulotomy for advanced anterior capsular contraction, the other in the early post-operative period following posterior capsulotomy and the third is a delayed (3 months), dislocation following uneventful posterior capsulotomy. None of the cases were associated with a history of trauma or other precipitating event. · CONCLUSION: Silicone plate haptic IOLs seem to be prone to dislocation due to poor capsular adherence as they are only held in place by the fibrotic fusion of the haptics. If either the posterior or anterior capsules are disrupted, the forces created by capsular contraction may cause extension of radial tears, with subsequent posterior dislocation of the implant. Though the use of silicone plate-haptic lenses has been surpassed by other models, there are patients who had implantation of such lenses that may undergo YAG laser capsulotomy. It is important to inform them about the potential risk of posterior dislocation as an early or late complication following this procedure.