Effect of Nd: YAG Laser Capsulotomy on Intraocular Pressure and Corneal Endothelium in the Early Period

Abstract

Objective: To investigate the changes in intraocular pressure (IOP) and corneal endothelial morphology in neodymium: yttrium-aluminum-garnet (Nd: YAG) laser capsulotomy cases in the early period after the procedure. Material and Methods: Seventy four eyes of 58 patients with posterior capsular opacification were included in the study. The baseline IOP of the patients was compared to the first hour and first-month values after Nd: YAG laser capsulotomy. Also, endothelial cell density (ECD), coefficient of variation (CV), hexagonality rate (HEX), and central corneal thickness (CCT) measurements were analyzed by specular microscopy and compared. Results: Mean age of the patients was 66.84±9.51 years. Mean IOP value was similar at pre-laser and post-laser first hour and first month (p=0.361 and p=0.516, respectively). Mean ECD was significantly decreased at the first hour (1968.31±465.27 cells/mm2) and the first month (1984.72±453.55 cells/mm2) after laser compared to pre-laser (2025.73±470.18 cells/mm2), (p=0.001 and p=0.021, respectively). There was no significant difference between the mean CV, HEX, and CCT values before laser, at the first hour and first month after laser (p>0.05). There was no significant correlation between corneal endothelial loss and total laser energy power at the first hour and first month (r=- 0.046, p=0.699 and r=0.134, p=0.257, respectively). Conclusion: No significant IOP increase was observed after Nd: YAG laser capsulotomy. Not all patients need to use anti-glaucomatous therapy after the procedure. A decrease in the number of corneal endothelial cells was seen after laser. Therefore, this procedure should be applied more carefully in patients with low corneal endothelium count.

Keywords

• Posterior capsular opacification
• Intraocular pressure
• Corneal endothelial morphology
• Nd: Yag laser capsulotomy

Nd: YAG Lazer Kapsülotominin Göz İçi Basınç ve Kornea Endoteli Üzerine Erken Dönemde Etkisi

Abstract

Amaç: Neodymium: yttrium-aluminum garnet (Nd: YAG) lazer kapsülotomi olgularında, işlem sonrası erken dönemde göz içi basınç (GİB) ve kornea endoteli morfolojisindeki değişimi araştırmak. Gereç ve Yöntemler: Çalışmaya arka kapsül kesafeti olan 58 hastanın 74 gözü dahil edildi. Hastaların başlangıç GİB değerleri Nd: YAG lazer kapsülotomiden sonraki ilk saat ve ilk ay değerleri ile karşılaştırıldı. Ayrıca endotel hücre yoğunluğu (EHY), hücre alanının varyasyon katsayısı (VK), hekzagonal hücrelerin yüzdesi (HHY) ve merkezi kornea kalınlığı (MKK) ölçümleri speküler mikroskopi ile analiz edildi ve karşılaştırıldı. Bulgular: Hastaların yaş ortalaması 66,84±9,51 yıldı. Ortalama GİB değeri lazer öncesi ile lazer sonrası birinci saatte ve birinci ayda benzerdi (sırasıyla p=0,361 ve p=0,516). Ortalama EHY lazer öncesine (2025,73±470,18 hücre/mm2) göre lazer sonrası birinci saatte (1968,31±465,27 hücre/mm2) ve birinci ayda (1984,72±453,55 hücre/mm2) anlamlı olarak azaldı (sırasıyla p=0,001 ve p=0,021). Lazer öncesi, lazer sonrası birinci saatte ve lazer sonrası birinci ayda ortalama VK, HHY ve MKK değerleri arasında anlamlı farklılık yoktu (p>0,05). Korneal endotel kaybı ile toplam lazer enerji gücü arasında birinci saatte ve birinci ayda anlamlı korelasyon yoktu (sırasıyla r=-0,046, p=0,699 ve r=0,134, p=0,257). Sonuç: Nd: YAG lazer kapsülotomi sonrası anlamlı GİB artışı izlenmemiştir. İşlem sonrası tüm hastaların anti-glokomatöz tedavi kullanması gerekmemektedir. Lazer sonrası kornea endotel hücre sayısında azalma görülmüştür. Dolayısıyla kornea endotel sayısı düşük olan hastalarda bu işlem daha dikkatli uygulanmalıdır.

Keywords

• Arka kapsül kesafeti
• Göz içi basınç
• Kornea endotel morfolojisi
• Nd: Yag lazer kapsülotomi

References

1. 1. Auffarth GU, Brezin A, Caporossi A, Lafuma A, Mendicute J, Berdeaux G, Smith AF; European PCO Study Group. Comparison of Nd:YAG capsulotomy rates following phacoemulsification with implantation of PMMA, silicone, or acrylic intra-ocular lenses in four European countries. Ophthalmic Epidemiol 2004; 11: 319–29.
2. 2. Aron-Rosa D, Aron JJ, Griesemann M, Thyzel R. Use of the neodymium-YAG laser to open the posterior capsule after lens implant surgery: a preliminary report. J Am Intraocul Implant Soc 1980; 6: 352–4.
3. 3. Billotte C, Berdeaux G. Adverse clinical consequences of neodymium:YAG laser treatment of posterior capsule opacification. J Cataract Refract Surg 2004; 30: 2064–71.
4. 4. Karahan E, Er D, Kaynak S. An Overview of Nd:YAG Laser Capsulotomy. Med Hypothesis Discov Innov Ophthalmol J 2014; 3: 45–50.
5. 5. Richter CU, Arzeno G, Pappas HR, Steinert RF, Puliafito C, Epstein DL. Intraocular Pressure Elevation Following Nd:YAG Laser Posterior Capsulotomy. Ophthalmology 1985; 92: 636–40.
6. 6. Jahn CE, Emke M. Long-term elevation of intraocular pressure after neodymium: YAG laser posterior capsulotomy. Ophthalmologica 1996; 210: 85–9.
7. 7. Shetty NK, Sridhar S. Study of variation in intraocular pressure spike (IOP) following Nd- YAG laser capsulotomy. J Clin Diagnostic Res 2016; 10:NC09-12.
8. 8. Ari S, Cingü AK, Sahin A, Çinar Y, Çaça I. The effects of Nd:YAG laser posterior capsulotomy on macular thickness, intraocular pressure, and visual acuity. Ophthalmic Surg Lasers Imaging 2012; 43: 395–400.

9. 9. Shani L, David R, Tessler Z, Rosen S, Schneck M, Yassur Y. Intraocular pressure after neodymium:YAG laser treatments in the anterior segment. J Cataract Refract Surg 1994; 20: 455-8.
10. 10. Hu CY, Woung LC, Wang MC, Jian JH. Influence of laser posterior capsulotomy on anterior chamber depth, refraction, and intraocular pressure. J Cataract Refract Surg 2000; 26: 1183–9.
11. 11. Kraff MC, Sanders DR, Lieberman HL. Intraocular Pressure and the Corneal Endothelium After Neodymium- YAG Laser Posterior Capsulotomy. Relative effects of aphakia and pseudophakia. Arch Ophthalmol 1985; 103: 511-4.
12. 12. Kim J, Choi JY, Kwon J, Wee WR, Han YK. Comparison of two Nd:YAG laser posterior capsulotomy: cruciate pattern vs circular pattern with vitreous strand cutting. Int J Ophthalmol 2018; 11: 235–9.
13. 13. Ruiz-Casas D, Barrancos C, Alio JL 2nd, Ruiz-Guerrero M, Muñoz-Negrete FJ. Effect of posterior neodymium:YAG capsulotomy. Safety evaluation of macular foveal thickness, intraocular pressure and endothelial cell loss in pseudophakic patients with posterior capsule opacification. Arch Soc Esp Oftalmol 2013; 88: 415–22.
14. 14. Vaikoussis E, Bisogiannis Z, Margaritis L. Corneal endothelial damage after Nd:YAG laser anterior capsulotomy. An experimental study on rabbits. Doc Ophthalmol 1993; 83: 279-86.
15. 15. Menda SA, Palay D, McLeod S. Endothelial Circles After Nd:YAG Posterior Capsulotomy. JAMA Ophthalmol 2015; 133: 220–2.
16. 16. Rajappa N, Lune A, Radhakrishnan OK, Magdum R, Patil P, Mehta R. Evaluation of corneal endothelium before and after neodymium: yttrium-aluminium-garnet laser capsulotomy in posterior capsular opacification. Sudanase J Ophthalmol 2013; 5: 73–8.
17. 17. Öztürk Y, Göktaş E, Çallı Ü, Çelik Yaprak D, Oral Y, Penbe A. Yoğun Arka Kapsül Kesafeti Olan Hastalarda Nd:YAG Laser Kapsülotomi Sonrası Korneal Endotel Değişiklikleri. Turkiye Klin J Ophthalmol 2019; 28: 75–9.
18. 18. Slomovic AR, Parrish RK 2nd, Forster RK, Cubillas A. Neodymium-YAG Laser Posterior Capsulotomy: Central Corneal Endothelial Cell Density. Arch Ophthalmol 1986; 104: 536–8.