Retrospective Study of Nd:YAG Capsulotomy Following Phacoemulsification.

Corresponding Author:
Dr. Puneet Hegde,
Flat No. 403, Haribhakthi Apts.,
Pintos Lane, Mangalore-575004,
Karnataka, India.
E-mail: drpuneethegde@gmail.com

ABSTRACT

BACKGROUND

Posterior Capsular Opacification (PCO) or After Cataract is one of the most common delayed postoperative complications of uncomplicated phacoemulsification cataract surgery, which occurs due to the migration of lens epithelial cells (LECs) on the posterior capsule. PCO is primarily treated by Nd:YAG capsulotomy which involves creating an opening in the posterior capsule, thereby improving vision. Our aim was to evaluate the incidence of Posterior Capsular Opacification (PCO) in different types of foldable IOLs and also to estimate the duration between phacoemulsification surgery and PCO formation requiring Nd:YAG capsulotomy.

METHODS

This retrospective study included all patients who had undergone Nd:YAG capsulotomy after uncomplicated phacoemulsification surgery with foldable IOL implantation in the past 5 years. Thirteen types of acrylic foldable IOLs were analysed for the incidence and time taken for PCO formation after phacoemulsification surgery.

RESULTS

A total of 28149 eyes of 27779 patients, with mean age of 69±7.27 years, underwent uncomplicated phacoemulsification with foldable IOL implantation during the study period. 1.3% (354) eyes of 182 males and 162 females underwent Nd:YAG capsulotomy for clinically significant PCO. The overall incidence of hydrophobic and hydrophilic IOLs showing PCO formation was 0.73% and 2.4% respectively, the difference being statistically significant (p=0.042). Individually, the IOL with the highest incidence of PCO formation was SENSAR, 3.75% (AR40e) followed by ULTIMA, 3.47% (ULTIMA AC) while SENSAR-1 (AABOO) and Tecnis1 (ZCBOO) had the lowest incidence of PCO. PCO was seen significantly higher in square edge optic designs compared with round edge (p=0.017), while there was no statistically significant difference between single- and three-piece designs (p=0.21). PCO was significantly higher in IOLs with optic diameter of 6 mm when compared to 5.5 mm (p=0.016). The average duration between phacoemulsification surgery and Nd:YAG capsulotomy was 32±3 months, the duration being significantly less for hydrophilic (27±4 months) than hydrophobic (35±3 months) (p=0.041).

CONCLUSIONS

The incidence of PCO formation was more and earlier with hydrophilic than with hydrophobic IOLs. It was more frequently seen with square edge optic design. However, lens design, single-piece or three-piece did not seem to influence the rate of PCO formation.

KEY WORDS

Posterior Capsular Opacification (PCO), Hydrophilic and Hydrophobic Intraocular Lenses (IOLs)