EXPERIENCE OF ND: YAG LASER POSTERIOR
CAPSULOTOMY IN 500 CASESMahtab Alam Khanzada, Shafi Muhammad Jatoi, Ashok Kumar Narsani,
Syed Asher Dabir and Siddiqa Gul.
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 Ė Pakistan; from January 2002 to
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 Snellenís 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 Abrahamís 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.
American Journal of Diagnostic Imaging
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