Bhargava R, Kumar P, Prakash A, Chaudhary KP. Estimation of mean ND: Yag laser capsulotomy energy levels for membranous and fibrous posterior capsular opacification. Nepal J Ophthalmol. 2012 Jan-Jun;4(1):108-13. doi: 10.3126/nepjoph.v4i1.5861. PubMed PMID
Posted by on Wednesday, 24th June 2015
Abstract
INTRODUCTION:
Posterior capsule opacification (PCO) is a visually-disabling complication of cataract surgery.
OBJECTIVE:
To estimate energy levels for capsulotomy in various subtypes of PCO (membranous, fibrous and fibro-membranous).
MATERIALS AND METHODS:
A total of 215 patients with PCO were randomly selected and evaluated for Nd: Yag laser capsulotomy, after a quiet post-operative course of 3 months.The ocular area was arbitrarily divided into three zones: YAG zone (3mm), Optical zone (6mm) and the peripheral zone (12mm). A colour code was assigned to the subtype of PCO in these zones: fibrous green and membranous blue. The type of PCO in each quadrant of YAG zone was estimated in percentage.
RESULTS:
The statistic mean values of initial energy levels were 1.80 mJ for membranous PCO, 3.17 mJ for fibrous PCO and 2.73 mJ for fibro-membranous PCO. The mean summated energy levels for membranous PCO was 22.80 mJ for membranous PCO, 80.06 mJ for fibrous PCO and 80.48 mJ for fibro-membranous type.
CONCLUSION:
Colour coding is extremely helpful for quantification of the type of PCO and in deciding the initial energy level necessary to create capsulotomy. Fibro-membranous PCO required more summated energy despite a lower starting energy. Therefore, we recommend firing the initial shot in fibrous portion in case of fibrous-membranous type of PCO.
Rate It
Bhargava R, Kumar P, Phogat H, Chaudhary KP. Neodymium-yttrium aluminium garnet laser capsulotomy energy levels for posterior capsule opacification. J Ophthalmic Vis Res. 2015 Jan-Mar;10(1):37-42. doi: 10.4103/2008-322X.156101. PubMed PMID: 26005551; PubM
Posted by on Wednesday, 24th June 2015
Abstract
PURPOSE:
To study factors affecting laser energy levels required for neodymium: yttrium aluminium garnet (Nd: YAG) laser capsulotomy and to evaluate whether any correlation exists between applied laser energy levels and complications.
METHODS:
The present study examined 474 consecutive patients for a number of factors including age, type of posterior capsule opacification (PCO), material and fixation of intraocular lens (IOL) and complication rates, versus energy levels used for Nd: YAG laser capsulotomy.
RESULTS:
Mean patient age was 55.6 ± 8.7 years and mean follow up period was 22.9 ± 4.5 months. IOL biomaterial (KW ANOVA; P = 0.173) and patient's age (P = 0.246) did not significantly influence total laser energy requirement for capsulotomy. However, total laser energy levels were significantly higher (KW ANOVA; P < 0.001) with fibro-membranous and fibrous subtypes of PCO. Complications such as IOL pitting, intraocular pressure (IOP) elevation, uveitis, retinal detachment (RD) and cystoid macular edema (CME) were significantly more common when higher energy levels was used. The mean total energy in patients with RD was 77.7 ± 17.7 mJ as compared to 43.4 ± 26.9 mJ in the rest of the cohort. RD was more common in patients with higher axial length [n = 7 (63%)] (P < 0.001).
CONCLUSION:
Type of PCO significantly influenced laser energy levels required for capsulotomy, whereas IOL biomaterial and fixation did not. Complications such as IOL pitting, uveitis, IOP elevation, RD and CME was significantly more common when total laser energy was higher. It is recommended that the lowest possible single pulse laser energy be used for capsulotomy to minimize complications.
KEYWORDS:
Intraocular Lens; Laser Capsulotomy; Posterior Capsule Opacification
Rate It
Bhargava R, Kumar P, Sharma SK, Sharma S, Mehra N, Mishra A. Peeling and aspiration of elschnig pearls! An effective alternative to Nd:YAG laser capsulotomy! Indian J Ophthalmol. 2013 Sep;61(9):518-20. doi: 10.4103/0301-4738.119449. PubMed PMID: 24104714;
Posted by on Wednesday, 24th June 2015
Abstract
To evaluate the efficacy of peeling and aspiration of Elschnig pearls. Retrospective study in a medical college hospital. Records of 217 eyes which underwent surgical peeling and aspiration for membranous PCO between 2006 and 2009, was reviewed. Peeling and aspiration was fashioned with a blunt tipped 20G cannula after stabilizing anterior chamber with anterior chamber maintainer. Post-operative vision and complications were analyzed. Mc Nemar and Chi square tests. The mean age was 56.84 years. 85.71% patients achieved best corrected visual acuity (BCVA) of 20/20 at 3 m. Recurrence of pearls, uveitis and cystoid macular edema were the most common causes of reduced vision. Peeling and aspiration of pearls seem to be a viable alternative to Neodymium yttrium garner aluminium (Nd: YAG) laser capsulotomy for membranous PCO.
Rate It
Bhargava R, Kumar P, Sharma SK, Kaur A. A randomized controlled trial of peeling and aspiration of Elschnig pearls and neodymium: yttrium-aluminium-garnet laser capsulotomy. Int J Ophthalmol. 2015 Jun 18;8(3):590-6. doi: 10.3980/j.issn.2222-3959.2015.03.2
Posted by on Wednesday, 24th June 2015
Abstract
AIM:
To compare surgical peeling and aspiration and neodymium yttrium garnet laser capsulotomy for pearl form of posterior capsule opacification (PCO).
METHODS:
A prospective, randomized, double blind, study was done at Rotary Eye Hospital, Maranda, Palampur, India, Santosh Medical College Hospital, Ghaziabad, India and Laser Eye Clinic, Noida India. Consecutive patients with pearl form of PCO following surgery, phacoemulsification, manual small incision cataract surgery and conventional extracapsular cataract extraction (ECCE) for age related cataract, were randomized to have peeling and aspiration or neodymium yttrium garnet laser capsulotomy. Corrected distance visual acuity (CDVA), intra-operative and post-operative complications were compared.
RESULTS:
A total of 634 patients participated in the study, and 314 (49.5%) patients were randomized to surgical peeling and aspiration group and 320 (50.5%) to the Nd:YAG laser group. The mean pre-procedural logMAR CDVA in peeling and neodymium: yttrium-aluminium-garnet (Nd:YAG) laser group was 0.80±0.25 and 0.86±0.22, respectively. The mean final CDVA in peeling group (0.22±0.23) was comparable to Nd:YAG group (0.24±0.28; t test, P=0.240). There was a significant improvement in vision after both the procedures (P<0.001). A slightly higher percentage of patients in Nd:YAG laser group (283/88.3%) than in peeling group (262/83.4%) had a CDVA of 0.5 (20/63) or better at 9mo (P<0.001). On the contrary, patients having CDVA worse than 1.00 (20/200) was also significantly higher in Nd:YAG laser group as compared to peeling group (25/7.7% vs 15/4.7%, respectively). On application of ANCOVA, there was less than 0.001% risk that PCO thickness and total laser energy had no effect on rate of complications in Nd:YAG laser group and less than 0.001 % risk that PCO thickness had no effect on complications in peeling group respectively. Sum of square analysis suggests that in the Nd:YAG laser group, thick PCO had a stronger impact on complications (Fischer test probability, Pr<0.0001) than thin PCO and total laser energy (Fischer test probability, Pr<0.002), respectively; similarly, in peeling group, thick PCO and preoperative vision had a stronger effect on complications than thin PCO, respectively (Fischer test probability, Pr<0.001).The rate of complications like uveitis (P=0.527) and cystoid macular edema (P=0.068), did not differ significantly between both the groups. However, intraocular pressure spikes (P=0.046) and retinal detachment (P<0.001) were significantly higher in Nd:YAG laser group as compared to peeling group. Retinal detachment was more common in patients having degenerative myopia (7/87.5%, P<0.001). Recurrence of pearls was the most common cause of reduction of vision in the peeling group (24/7.6%, P<0.001).
CONCLUSION:
There is no alternative to Nd:YAG laser capsulotomy for fibrous subtype of PCO. For pearl form of PCO, both techniques are comparable with regard to visual outcomes. Nd:YAG laser capsulotomy has a higher incidence of IOP spikes and retinal detachment whereas recurrence of pearls may occur after successful peeling and aspiration. When posterior capsulotomy is needed in patients with retinal degenerations, retinopathies and pre-existing retinal breaks, the clinician should be cautious about increased risks of possible complications of Nd:YAG laser capsulotomy.
KEYWORDS:
Elschnig pearls; capsulotomy; neodymium: yttrium-aluminium-garnet; posterior capsule
Rate It
Kumar P, Bhargava R, Kumar M, Ranjan S, Kumar M, Verma P. The correlation of routine tear function tests and conjunctival impression cytology in dry eye syndrome. Korean J Ophthalmol. 2014 Apr;28(2):122-9. doi: 10.3341/kjo.2014.28.2.122. Epub 2014 Mar 14.
Posted by on Wednesday, 24th June 2015
Abstract
PURPOSE:
To establish the strength of the association between routine tear function tests and conjunctival impression cytology (CIC) and to determine whether they simulate the morphological and cytological changes that occur on the ocular surface in dry eye. What are the sensitivity, specificity and positive predictive values of these tests when CIC is considered the gold standard?
METHODS:
The tear film profile included tear film break up time (TBUT), Schirmer's-1, Rose Bengal scores (RBS), and impression cytology. CIC samples were obtained from the inferior bulbar conjunctiva and stained with periodic acid-Schiff and counter stained with hematoxylin and eosin.
RESULTS:
The mean Schirmer's value was 11.66 ± 5.90 in patients and 17.17 ± 2.97 in controls (p < 0.001). The mean TBUT in participants was 8.88 ± 3.54 and 13.53 ± 2.12 in controls (p < 0.001). Patients had a mean goblet cell density (GCD) of 490 ± 213, while the value for controls was 1,462 ± 661 (p < 0.001). Abnormal CIC was observed in 46.7% cases of dry eye and in 32.8% of controls. The correlation coefficient (L) for Schirmer's was 0.2 and 0.24 for participants and controls, respectively, while TBUT values were 0.26 and 0.38, RBS were 0.5 and 0.5, and GCD was 0.8 and 0.6 in cases and controls, respectively.
CONCLUSIONS:
GCD, RBS, and TBUT were better predictors of morphological and cytological changes in the conjunctiva than Schirmer's in dry eye syndrome. The sensitivity of tear function tests in diagnosing dry eye was TBUT > Schirmer's > RBS, and the specificity was Schirmer's > TBUT > RBS in decreasing order when CIC was considered the gold standard.
KEYWORDS:
Conjunctiva; Goblet cells; Tears
Rate It
Why we are No. 1 › 
Category (
Views ( 8659 ) | User Rating
