Minimizing YAG Capsulotomy complications
Posted by Prof. R. Bellucci on Nov 28, 2018 2:19:22 PM
Ophthalmologists have dealt with delayed complications associated with YAG capsulotomy since the first YAG procedure in 1980. In fact, the search for treatment options and methodologies that help prevent YAG complications is a long sought-after goal in vision care, together with treatment options for cataracts and presbyopia.
For patients who trust their vision care specialists to provide the best options for their situation, reducing the risk of YAG capsulotomy complications and of other post-surgery problems is vital. For this reason, researchers and medical companies strive to deepen the understanding of YAG capsulotomy complications in the field, and also to explain the risk factors associated with the procedure based on individualized case scenarios in patient histories and expectations.
Common YAG Capsulotomy complications
In the past, complications associated with YAG capsulotomy included:
- Retinal detachment
- Cystoid macular edema
- Intraocular lens damage
- Posterior capsule opacification (PCO)
Today, posterior capsule opacification (PCO) continues to be one of the most prevalent and common complications of cataract surgery, with the onset of complications based on the size and energy involved in the capsulotomy procedure. According to a 2014 report, PCO occurs at a rate of
- 20.7% at approximately 2 years after surgery
- 28.5% at approximately 5 years after cataract surgery
Additional YAG Capsulotomy complications
Based on patient histories or associated conditions, additional complications of YAG capsulotomy may include:
- Intraocular lens damage or pressure
- Retinal hemorrhage
- Vitreous prolapse
- Corneal injury
- Cystoid macular edema
- Retinal detachment
- IOL this location
- Endophthalmitis (or exacerbation)
Since the early 1990s, technological improvements have focused on reducing contrast sensitivity and glare following the procedure. These in addition to other complications associated with YAG laser capsulotomy procedures such as retinal detachment and retinal edema.
Potential long-term complications that result from posterior capsule opacification are of greatest concern. Such complications are commonly caused by leaving the capsule intact, which increases the risk of decreased contrast sensitivity, visual acuity, and glare.
Statistics indicate that post-cataract complications and PCO rates ranging from 11.4% to 43% typically occur within a year after surgery. Common post-cataract PCOs are further subdivided into two groups: fiber-optic PCO and regeneratory PCO. The latter is the more common of the two and results from epithelial cells migrating along the posterior capsule behind the intraocular lens. Further studies have determined that sharp optic edges may inhibit cell migration due to firmer linear contact with the posterior capsule. Manufacturers providing sharp optic edge IOLs have shown reduced incidences of PCO.
YAG Capsulotomy for secondary cataracts
Due to ever-advancing technologies, techniques, and lens materials, complications in YAG capsulotomies are not as prevalent as they were in the past. However, procedures are not free of complications. Patients expect full value for their money following surgery. In the case of multifocal implanted lenses, this means high-quality vision in all distances and a resolution for various vision problems that include the cloudiness associated with cataracts.
Surgeons practice YAG capsulotomy in case of secondary cataracts. However in the case of multifocal implanted lenses, secondary cataracts are treated earlier as the lens is more susceptible to small cloudiness even in the beginning of the lens epithelial cells proliferation.
Patients expect multifocal lenses surgery results to last for the long term and maintain quality vision over time. Therefore, laser treatment that follows closely after the surgery is in contrast to their expectations. Ophthalmologists and surgeons naturally seek to avoid patient dissatisfaction.
Solutions with Full Range lenses
Modifications of the optic edge of intraocular lenses and their impact on potential PCO following cataract surgery has promoted the viability, safety and preference of IOLs as a surgical solution for the treatment of cataracts. A 2017 report mentions that posterior capsule opacification following cataract surgery may be avoided by allowing the posterior lens capsule to remain intact following the removal of lens contents. This technique leaves a barrier between anterior and posterior eye segments to reduce the risk of posterior segment complications post-surgery. It can also reduce the risk of aforementioned cystoid macular edema and retinal detachment compared with previous techniques that included intra-capsular cataract extraction.
Full Range lenses prevent proliferation of lens epithelial cells, thereby reducing the risk of secondary cataracts. Hanita’s FullRange lenses combine additional features such as PCO reduction, 360° square edges, and wide angle capsular bag with a square edge that is 72% sharper than competing lenses developed in the industry today. This gives surgeons and ophthalmologist access to a unique solution that reduces PCO occurrences drastically (by as much as 40%) in comparison with other intraocular lenses.
Hanita’s FullRange lenses have also been noted to contribute to low percentages of the YAG capsulotomy rates after five years (approximately 2.2%) based on a study involving 276 patients. Reduced YAG rates are perceived to be the result of the sharp, square edges of the FullRange lenses, which enable a 360° of overlap on the anterior capsule. This also reduces the amount of floating debris left over from exterior capsule opacification.
Patients deserve the best in techniques and procedures in vision care. By catering to their needs and expectations, especially in terms of the results and costs, surgeons can achieve higher satisfaction rates. In order to find ways to reduce complications associated with YAG capsulotomy, there is a need to review current techniques, and also explore new methodologies that reduce and prevent secondary cataracts. Visit our website for more information regarding our FullRange lenses and how they can help prevent or minimize the need for YAG capsulotomy.