Bleb failure and intraocular pressure rise following Nd: Yag laser capsulotomy

Abstract

BackgroundTo report the negative effect of Nd: Yag (Neodymium-doped: Yttrium Aluminium Garnet) laser capsulotomy on the intraocular pressure (IOP) and the trabeculectomy bleb integrity, in a small series of eyes, both trabeculectomised and pseudophakic, following the laser application for the management of posterior capsular opacification (PCO).MethodsThis is a retrospective, non-comparative interventional case series study, in which 20 trabeculectomised and pseudophakic eyes from 15 patients, with otherwise well functioning blebs, were presented with uncontrolled IOP, in a variable distance of time following the application of YAG laser capsulotomy. Student paired t-test confirmed a statistically significant difference (P < 0.05) between IOP before Nd: YAG laser capsulotomy (16 mmHg ± 3 mmHg) and the respective one, 2 to 6 months after Nd: Yag capsulotomy (34.5 ± 11 mmHg).ResultsAll of the cases failed to respond to conservative treatment and were successfully managed with the implantation of Ahmed drainage devices. All patients showed flat filtering bleb and uncontrolled IOP (34.5 ± 11 mmHg), under maximum topical treatment, in a period of 2 to 6 months following Nd: YAG laser caspulotomy. The implantation of Ahmed valve proved to be effective treatment for these patients (IOP < 21 mmHg).ConclusionsAlthough Nd: Yag laser capsulotomy is considered a safe surgical procedure and usually is done without second thought, in this series of eyes, it is postulated that it may be responsible for the deregulation of the filtering bleb and subsequent loss of IOP control. We consider that laser capsulotomy should be performed with caution, especially in eyes with previous trabeculectomy. Also close monitoring of the intraocular pressure and assessment of eventual bleb morphology variations in the follow-up period is mandatory. Further studies are needed in order to confirm our findings.

Clinical implications of energy used in Neodymium: Yttrium Aluminum Garnet posterior capsulotomy on intraocular pressure

“…The rise of IOP becomes even more significant in glaucomatous eyes after ND: YAG capsulotomy, where need for additional antiglaucoma medications or complications like bleb failure have been reported. [ 13 ]…”

Analysis of the Ophthalmic YAG-Laser Pulses Inside the Animal Eyes Using an Sscilloscope

“…Posterior capsular opaci cation (PCO) is the most common (to 50-70%) complication of cataract surgery and may develop soon after surgery or 5,5 years after it [1][2][3][4][5][6]. The younger the patient, the higher the incidence of posterior capsule opacities, in children it is up to 60-100% [7][8][9] and can cause a decrease in best corrected visual acuity (BCVA), contrast sensitivity and cause the appearance of optical aberrations [10].…”

The Immediate Early Response of Lens Epithelial Cells to Lens Injury

“…While modern cataract surgery has revolutionized the practice of ophthalmology, like all surgeries, it results in elevated inflammation at the wound site [ 4 , 5 , 6 ] leading to post-surgical pain and discomfort. As ocular inflammation can also trigger retinal edema, retinal detachment, and exacerbate uveitis [ 6 , 7 , 8 , 9 , 10 ] as well as fibrotic conditions [ 11 , 12 ], it is typically aggressively treated with a combination of steroids and NSAIDs either via eye drops [ 13 , 14 ] or “drop-less” methods [ 15 ] which instill anti-inflammatories into the eye at the time of surgery.…”