Role of Preoperative Nd:YAG Laser Anterior Capsulotomy in Mature Intumescent Cataracts

Abstract

Purpose: The aim of this study was to examine the role of preoperative Nd:YAG laser anterior capsulotomy in preventing intraoperative complications in mature intumescent cataracts. Design: A prospective, interventional, observational study. Methods: A total of 52 eyes of 52 patients were selected in this prospective study. Preoperative Nd:YAG laser anterior capsulotomy was performed in all eyes with 1 shot of 1.2 mJ and a gush of the liquified cortex was noted. Anterior chamber depth was measured using anterior segment optical coherence tomography and intraocular pressure using Goldmann applanation tonometer were measured pre- and post-laser. Intraoperative complications and surgeon's operative comfort were noted. Results: There was a mean increase in anterior chamber depth by 0.24 mm and a mean decrease in intraocular pressure by 1.61 mm Hg postlaser. No intraoperative complications were noted except for capsulorhexis extension in 1 eye (1.92%). The surgeon experienced a good control while performing the capsulorhexis and overall an uneventful surgery. Conclusions: Preoperative Nd:YAG laser anterior capsulotomy is a safe and effective technique in reducing intralenticular pressure and avoiding intraoperative complications in mature intumescent cataracts.

Prevention of Argentinian Flag Sign in Intumescent Cataracts Using Anterior Chamber Air Bubble and Cortical Fluid Release Techniques

“…Another aspect is the use of different techniques to open the anterior capsule and release pressure within the capsule to avoid excessive tension on the capsule, leading to linear capsule tears. Porwal et al performed Nd:YAG laser anterior capsulotomy before cataract surgery to relieve pressure within the capsule [9]. In recent years, with the development of femtosecond laser-assisted cataract surgery (FLACS), many ophthalmologists have begun using femtosecond laser instead of manual capsulorrhexis [10].…”

Intraocular lens selection in diabetic patients: How to increase the odds for success

“…Most anterior capsulotomies can be achieved satisfactorily with the use of needle cystitome or capsulorhexis forceps depending on the surgeons’ preference. The Argentinian Flag sign can be further prevented by closed-chamber decompression of intumescent lenses using focal Nd:YAG laser disruption of the anterior capsule immediately before taking in the patient for surgery, or manual or automated vacuum applied after a needle puncture of the anterior capsule, and/or the use of a two-stage or vacuum rhexis technique[ 18 - 20 ]. The use of laser capsulorhexis or precision-pulse capsulotomy devices can help to achieve capsulotomies that are more consistent, however, the benefits of their effects have not been proven in diabetic patients[ 21 ].…”