J Korean Ophthalmol Soc.  2015 Jun;56(6):868-874. 10.3341/jkos.2015.56.6.868.

Incidence and Risk Factors of Nd:YAG Capsulotomy in Adult Cataract Patients under 50 Years of Age According to Different Age Groups

• Kim EY
• Kim SY
• Lee YC
• Kim SY

• KMID: 2339151
• DOI: http://doi.org/10.3341/jkos.2015.56.6.868

Abstract

PURPOSE
To evaluate the risk factors and incidence of neodymium-doped yttrium aluminium garnet (Nd:YAG) posterior capsulotomy due to posterior capsular opacification in adult cataract patients under 50 years of age according to different age groups.
METHODS
We retrospectively studied 280 eyes that received phacoemulsification and intraocular lens implantation. The total observation period was 26.2 months on average. The subjects were divided into 3 different age groups, 20's, 30's and 40's to evaluate the incidence of posterior capsulotomy. Risk factors based on gender, age, type of cataract, type of intraocular lens (IOLs), axial length, existence of diabetes mellitus, history of ocular trauma, atopic dermatitis and refractive surgery were also investigated using statistical analysis.
RESULTS
The incidence of posterior capsulotomy was 13.9% (39 of 280 eyes) and statistically significant differences were not observed based on age (7.7% in the 20's group, 13.8% in the 30's group and 14.4% in the 40's group, p=0.595). We divided subjects into 3 different groups based on axial length, below 22 mm, 22 to 26 mm and over 26 mm; posterior capsulotomy was performed in 0% (0/2), 7.2% (12/166) and 24.1% (27/112) of the patients, respectively, showing the longer axial length resulted in statistically significant increase in the incidence of posterior capsulotomy (p=0.036). The incidence of posterior capsulotomy was higher in females than in males (p=0.006). Correlations among posterior capsulotomy and type of cataract, type of IOLs and existence of diabetes mellitus, history of ocular trauma, atopic dermatitis and refractive surgery were not statistically significant.
CONCLUSIONS
The difference in the incidence of Nd:YAG laser posterior capsulotomy according to age was not statistically significant in adult cataract patients under 50 years of age. We showed that longer axial length resulted in higher risk of posterior capsulotomy.

Keyword

Axial length; Nd:YAG laser capsulotomy; Posterior capsular opacification

MeSH Terms

Adult*
Cataract*
Dermatitis, Atopic
Diabetes Mellitus
Female
Humans
Incidence*
Lens Implantation, Intraocular
Lenses, Intraocular
Male
Phacoemulsification
Posterior Capsulotomy
Refractive Surgical Procedures
Retrospective Studies
Risk Factors*
Yttrium
Yttrium

Reference

References

1. Steinert RF, Puliafito CA, Kumar SR, et al. Cystoid macular edema, retinal detachment, and glaucoma after Nd:YAG laser posterior capsulotomy. Am J Ophthalmol. 1991; 112:373–80.

2. Stark WJ, Worthen D, Holladay JT, Murray G. Neodymium: YAG lasers. An FDA report. Ophthalmology. 1985; 92:209–12.

3. Liesegang TJ, Bourne WM, Ilstrup DM. Secondary surgical and neodymium-YAG laser discissions. Am J Ophthalmol. 1985; 100:510–9.

4. Schaumberg DA, Dana MR, Christen WG, Glynn RJ. A systematic overview of the incidence of posterior capsule opacification. Ophthalmology. 1998; 105:1213–21.

5. Ursell PG, Spalton DJ, Pande MV, et al. Relationship between intraocular lens biomaterials and posterior capsule opacification. J Cataract Refract Surg. 1998; 24:352–60.

6. Oner FH, Gunenc U, Ferliel ST. Posterior capsule opacification after phacoemulsification: foldable acrylic versus poly (methyl methacrylate) intraocular lenses. J Cataract Refract Surg. 2000; 26:722–6.

7. Milazzo S, Turut P, Artin B, Charlin JF. Long-term follow-up of three-piece, looped, silicone intraocular lenses. J Cataract Refract Surg. 1996; 22(Suppl 2):1259–62.

8. Jamal SA, Solomon LD. Risk factors for posterior capsular pearling after uncomplicated extracapsular cataract extraction and pla-no-convex posterior chamber lens implantation. J Cataract Refract Surg. 1993; 19:333–8.

9. Nishi O, Nishi K. Preventing posterior capsule opacification by creating a discontinuous sharp bend in the capsule. J Cataract Refract Surg. 1999; 25:521–6.

10. Apple DJ, Solomon KD, Tetz MR, et al. Posterior capsule opacification. Surv Ophthalmol. 1992; 37:73–116.

11. Ravalico G, Tognetto D, Palomba M, et al. Capsulorhexis size and posterior capsule opacification. J Cataract Refract Surg. 1996; 22:98–103.

12. Verbruggen KH, Rozema JJ, Gobin L, et al. Intraocular lens centration and visual outcomes after bag-in-the-lens implantation. J Cataract Refract Surg. 2007; 33:1267–72.

13. Majima K. Cell biological analysis of the human cataractous lens: implication of lens epithelial cells in the development of after-cataract. Ophthalmic Res. 1995; 27:202–7.

14. Wormstone IM, Liu CS, Rakic JM, et al. Human lens epithelial cell proliferation in a protein-free medium. Invest Ophthalmol Vis Sci. 1997; 38:396–404.

15. Dholakia SA, Vasavada AR, Singh R. Prospective evaluation of phacoemulsification in adults younger than 50 years. J Cataract Refract Surg. 2005; 31:1327–33.

16. Kim TW, Yu YS, Kim SJ, et al. The effect of Nd: YAG laser capsulotomy for posterior capsular opacity after PC-IOL implantation in children. J Korean Ophthalmol Soc. 2005; 46:847–52.

17. Apple DJ, Mamalis N, Brady SE, et al. Biocompatibility of implant materials: a review and scanning electron microscopic study. J Am Intraocul Implant Soc. 1984; 10:53–66.

18. Linnola RJ, Holst A. Evaluation of a 3-piece silicone intraocular lens with poly (methyl methacrylate) haptics. J Cataract Refract Surg. 1998; 24:1509–14.

19. Knight-Nanan D, O'Keefe M, Bowell R. Outcome and complications of intraocular lenses in children with cataract. J Cataract Refract Surg. 1996; 22:730–6.

20. Yoo YS, Yang JW, Lee YC, Kim SY. Incidence and risk factors of Nd:YAG capsulotomy in adult cataract patients younger than 50 years of age. J Korean Ophthalmol Soc. 2013; 54:1339–44.

21. Kim HT, Lee JY, Chung SK. Change of anterior chamber depth after phacoemulsification with posterior chamber intraocular lens implantation in high myopia. J Korean Ophthalmol Soc. 1998; 39:1427–32.

22. Curtin BJ. The myopias: basic science and clinical management. 1st ed.Philadelphia: Harpercollins College Div;1985.

23. Vasavada AR, Chauhan H, Shah G. Incidence of posterior capsular plaque in cataract surgery. J Cataract Refract Surg. 1997; 23:798–802.

24. Argento C, Nuñez E, Wainsztein R. Incidence of postoperative posterior capsular opacification with types of senile cataracts. J Cataract Refract Surg. 1992; 18:586–8.

25. Hayashi K, Hayashi H, Nakao F, Hayashi F. Posterior capsule opacification after cataract surgery in patients with diabetes mellitus. Am J Ophthalmol. 2002; 134:10–6.

26. Chung ES, Park SJ, Lee JH. Clinical results of silicone foldable intraocular lens implantation: diabetics vs nondiabetics. J Korean Ophthalmol Soc. 1998; 39:1176–82.

27. Zaczek A, Zetterström C. Posterior capsule opacification after phacoemulsification in patients with diabetes mellitus. J Cataract Refract Surg. 1999; 25:233–7.

28. Nagata T, Watanabe I. Optic sharp edge or convexity: comparison of effects on posterior capsular opacification. Jpn J Ophthalmol. 1996; 40:397–403.

29. Schmidbauer JM, Escobar-Gomez M, Apple DJ, et al. Effect of haptic angulation on posterior capsule opacification in modern foldable lenses with a square, truncated optic edge. J Cataract Refract Surg. 2002; 28:1251–5.

30. Hollick EJ, Spalton DJ, Ursell PG, et al. The effect of poly-methylmethacrylate, silicone, and polyacrylic intraocular lenses on posterior capsular opacification 3 years after cataract surgery. Ophthalmology. 1999; 106:49–54. discussion 54-5.

31. Cumming JS. Postoperative complications and uncorrected acuities after implantation of plate haptic silicone and three-piece silicone intraocular lenses. J Cataract Refract Surg. 1993; 19:263–74.

32. Kugelberg M, Wejde G, Jayaram H, Zetterström C. Posterior capsule opacification after implantation of a hydrophilic or a hydrophobic acrylic intraocular lens: one-year follow-up. J Cataract Refract Surg. 2006; 32:1627–31.

33. Saeed MU, Jafree AJ, Saeed MS, et al. Intraocular lens and capsule opacification with hydrophilic and hydrophobic acrylic materials. Semin Ophthalmol. 2012; 27:15–8.

34. Kugelberg M, Wejde G, Jayaram H, Zetterström C. Two‐ year fol-low‐ up of posterior capsule opacification after implantation of a hydrophilic or hydrophobic acrylic intraocular lens. Acta ophthalmol. 2008; 86:533–6.

35. Kohnen S, Brauweiler P. First results of cataract surgery and implantation of negative power intraocular lenses in highly myopic eyes. J Cataract Refract Surg. 1996; 22:416–20.

36. Lyle WA, Jin GJ. Phacoemulsification with intraocular lens implantation in high myopia. J Cataract Refract Surg. 1996; 22:238–42.

37. Hayashi K, Yoshida M, Hayashi H. Posterior capsule opacification in myopic eyes. J Cataract Refract Surg. 2006; 32:634–8.

38. Praveen MR, Shah GD, Vasavada AR, et al. A study to explore the risk factors for the early onset of cataract in India. Eye (Lond). 2009; 24:686–94.

39. Kim HT, Lee JY, Chung SK. Change of anterior chamber depth after phacoemulsification with posterior chamber intraocular lens implantation in high myopia. J Korean Ophthalmol Soc. 1998; 39:1427–32.

40. Gavin EA, Hammond CJ. Intraocular lens power calculation in short eyes. Eye (Lond). 2008; 22:935–8.

41. Peng Q, Visessook N, Apple DJ, et al. Surgical prevention of posterior capsule opacification. Part 3: Intraocular lens optic barrier effect as a second line of defense. J Cataract Refract Surg. 2000; 26:198–213.

42. Koeppl C, Findl O, Kriechbaum K, et al. Change in IOL position and capsular bag size with an angulated intraocular lens early after cataract surgery. J Cataract Refract Surg. 2005; 31:348–53.

43. Fava GE, Kline OR Jr. Decentration of posterior chamber lenses. Am IntraOcular Implant Soc J. 1982; 8:247–50.