Comparing the outcomes of YAG laser anterior capsulotomies performed by an advanced nurse practitioner to ophthalmologists in the management of anterior capsular contraction syndrome

Abstract

Background:Anterior capsular contraction syndrome (ACCS) describes the progressive fibrotic phimosis of the anterior capsular bag that usually occurs a few months after cataract surgery. YAG laser anterior capsulotomy (YAGAC) is the most common treatment option due to the low-risk profile of this intervention.Purpose:In this series, we evaluated the outcomes of an advanced nurse practitioner (ANP) in conducting this laser intervention, comparing the results with those of ophthalmologists.Methodology:Our study represents a single-centre, retrospective, continuous case series of 108 eyes that underwent YAGAC due to ACCS between January 2017 and July 2020 at the Birmingham and Midland Eye Centre, the second largest tertiary referral centre in the United Kingdom.Results:The groups treated by ANPs and ophthalmologists were similar in respect to age, gender, and laterality of the laser procedure. Eyes treated by ophthalmologists had significantly more ocular comorbidities (p < .001), the most common of which was glaucoma. Although the complication rate was higher in the ophthalmologist group, it did not reach statistical significance. However, there was a trend toward significance in the retreatment rate, with 8.6% (7/81) of eyes lasered by ophthalmologists requiring further YAGAC, and no repeat procedure was needed in the ANP group.Conclusions:YAGAC leads to good visual outcomes and a low complication rate in both ophthalmologist and ANP groups.Implications:Advanced nurse practitioners can deliver results that are comparable with those of experienced ophthalmologists.

Exploring anterion capsular contraction syndrome in cataract surgery: insights into pathogenesis, clinical course, influencing factors, and intervention approaches

“…It utilizes the shockwave produced by the resulting explosion to disrupt and disintegrate the tissue. This makes it an ideal non-surgical choice for treating ACCS ( 104 ). Hayashi et al ( 105 ) analyzed the anterior capsulotomy area before and after Nd:YAG laser capsulotomy in 32 eyes, and found that contrast sensitivity at most visual angles significantly improved following the procedure.…”