Mahtab Alam Khanzada, Shafi Muhammad Jatoi, Ashok Kumar Narsani, Syed Asher Dabir, Siddiqa Gul.
Experience of ND: YAG laser posterior Capsulotomy in 500 cases.
J Liaquat Uni Med Health Sci Jan ;6(3):109-15.

BACKGROUND/ OBJECTIVES: Posterior capsular opacification (PCO) is the commonest cause of glare and reduced visual acuity after cataract surgery. The Nd: YAG Laser is the alternate to surgical treatment for capsulotomy. To determine the time period of development of PCO, the complications of Nd: YAG laser during capsulotomy and post laser best corrected visual acuity, this study was carried out. SETTING: Department of Ophthalmology Eye Hospital Hyderabad Sindh attached with Liaquat University of Medical and Health Sciences Jamshoro, Sindh – Pakistan; from January 2002 to March 2004. METHODS: Five hundred pseudophakic eyes of 500 patients older than 15 years having PCO with decreased best corrected Visual Acuity (VA) of two or more Snellen`s chart line and met the inclusion and exclusion criteria were selected from out patients department for Nd: YAG laser capsulotomy. Before laser treatment, the VA was assessed and all patients were examined on slit lamp for IOP and to rule out the causes for reduced vision other than PCO. Then 2-3 mm size capsulotomy was done with Q-switched Nd: YAG Laser, with Abraham`s posterior capsulotomy lens, after topical anesthesia, by using minimum amount of energy and fewest numbers of pulses. Patients were followed for assessment of best corrected VA and for possible complications just after laser and at the end of 1st week, 2nd week and the 4th week. The post-laser treatment was advised in accordance with complications to each patient. RESULTS: Of the five hundred eyes, 230 (46.0%) belonged to male sex and 270 (54.0%) females. The majority of patients i.e. 230 eyes (46%) had PCO between 3 to 12 months postoperatively. The mean period between cataract surgery and Nd: YAG laser capsulotomy was 2.06 years. The types of PCO were fibrosis in 339 (67.8%) eyes, Elschnig pearls in 102 (20.4%) eyes and wrinkling in 59 (11.8%) eyes. Pre-laser visual acuity was CF-6/60 in 262 (52.4%) eyes, 6/36-6/24 in 140 (28.0%) eyes and 6/18-6/12 in 98 (19.6%) eyes. Post-laser VA was improved to 6/9-6/6 in 372 (74.4%) eyes. Out of 500 patients, 40 (8.0%) eyes developed the complications due to YAG laser which included IOL pitting in 27 (5.40%) eyes, raised IOP in 04 (0.80%), uveitis in 03 (0.60%), iris bleeding (hyphema) in 03 (0.60%), vitreous in anterior chamber in 02 (0.40%), and cystoids macular edema (CME) in 01(0.20%) eye. None of the eye developed sight threatening complications like retinal detachment or macular hole. The 128 (25.6%) eyes did not achieve the significant improvement because of pre-existing pathology in the posterior segment that was not diagnosed at the time of screening due to thick PCO. CONCLUSION: Nd: YAG laser capsulotomy is effective and convenient method for doing capsulotomy in all types of PCO. It is free from the risk of endophthalmitis found in surgical capsulotomy.

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