Present

1. Prepared by
Ghofran Ahmed Metwally
M.B.B.Ch (2013), Tanta University
Resident of Ophthalmology
Suez general hospital
Evaluation of Changes in Anterior Segment Parameters after
Nd:YAG Laser Capsulotomy for Posterior Capsule
Opacification

2. ‫ال‬ ‫استخدام‬ ‫بعد‬ ‫للعين‬ ‫االمامي‬ ‫القطاع‬ ‫قياسات‬ ‫في‬ ‫التغيرات‬ ‫تقييم‬
‫ليزر‬ ‫ياج‬
‫للعدسة‬ ‫الخلفي‬ ‫الغشاء‬ ‫عتامه‬ ‫لعالج‬

4. Acknowledgement
Thanks are due to ALLAH for all of his blessings
including his facilitations to produce this work in its
final image.

5. I will never be able to express my deepest gratitude to Professor.DR.
Mohsen Saad Badawy, Professor of Ophthalmology, Faculty of
Medicine-Suez Canal University for all the time and effort he spent in
supervision, guidance and encouragement until this work was carried
out.
Supervision committee

6. I would like to express my great appreciation to DR. Mohammed Abd
El Hamid Mohammed, lecturer of Ophthalmology-Faculty of
Medicine, Suez Canal University for his supervision, encouragement,
kind support, guidance and advice.

9. Posterior capsular opacification (PCO)
 PCO referred to as ‘secondary cataract’ or ‘after cataract’, develops over
the clear posterior capsule few months to few years after an uneventful
cataract surgery.
 PCO is the most common long-term complication of cataract surgery.
 The incidence of PCO ranges from 50% to <5% over the first 3 years in
eyes undergoing uncomplicated cataract surgery.

10. PCO within the central 3 mm zone of the posterior capsule cause :
1. Decreased visual acuity (VA).
2. Loss of contrast sensitivity .

11. Mixed Fibrous pearl
Types:
The PCO has two forms, fibrous and pearl. Sometimes a combination of
both is also found .
1 2 3

12. Pathogenesis:
The development of PCO is a very dynamic process and involves
three basic phenomena:
1. Proliferation.
2. Migration.
3. Differentiation of residual LECs.

13. Risk Factors:
Several systemic and ocular associations are influencing the development of PCO.
Systemic risk factors :
• Diabetic patients
• Patients with myotonic dystrophy

14. Ocular risk factors :
1. Myopic eyes .
2. Eyes with uveitis .
3. Patients with retinitis pigmentosa .
4. Traumatic cataract.
5. Congenital cataract .
6. Higher rate of PCO after femtosecond laser–assisted cataract surgery.

15. Prevention
Surgical
technique
IOL design IOL material Chemical
agents

16. Treatment :
The standard treatment for PCO is (Nd: YAG) laser posterior capsulotomy,
which has a success rate of more than 95 % .
(Visulas YAG III)

17. Complications of (Nd: YAG) laser posterior capsulotomy :
All complications are strongly associated to energy level and number of pulses.
1-Transient Elevation of Intraocular Pressure (IOP).
2-Cystoid Macular Edema (CME).
3-IOL Marking/Pitting.
4-Acute Glaucoma.
5-Anterior Hyaloid Face Rupture.
6-Rhegmatogenous Retinal Detachment.

18. Aim of the work
To study possible changes in refraction, intra-ocular-pressure due to
changes in anterior segment parameters after Nd: YAG laser
capsulotomy for posterior capsule opacification.

19. They include :
I. Anterior chamber depth (ACD).
II. Anterior chamber angle (ACA).
III. Anterior chamber volume (ACV).
IV. Central corneal thickness (CCT).
V. Pupil diameter.
Anterior segment parameters :

20. Evaluation of anterior segment parameters
High-frequency
ultrasound
biomicroscopy (UBM)
Anterior segment
optical coherence
tomography (AS-
OCT)
Orbscan scanning–
slit topography
The Pentacam-
Scheimpflug.

21. The Pentacam-Scheimpflug
The most precise method to document light scattering and biometry of
the anterior eye segment. It is slit image photography according to
Scheimpflug principle, Rotating Scheimpflug imaging technology is
used by instruments such as the Pentacam.

22. Patients &
Methods

23. Sample size and sampling technique:
Sample size calculation
The sample size was calculated using the following equation:
N=
So the sample size was 33.
after adding 10% dropout, it was calculated to be 36 eyes.

24. 1. All patients with significant visual loss due to PCO after phacoemulsification
cataract extraction(2 lines less than post-operative VA on Snellen chart ).
2. Clear and healthy cornea.
3. Round regular reactive pupil.
4. Patients who had undergone phacoemulsification surgery with in the bag
insertion of foldable hydrophobic acrylic one piece IOL.
5. Patients aged from 18 to 70 years old.
Inclusion criteria:

25. 1. Patient with complication during cataract surgery or during the
postoperative period: e.g. severe uveitis, or macular edema.
2. Corneal pathology; severe corneal edema, and scarring.
3. Glaucomatous patient.
4. History of contact lens use (refractive or cosmetic) within 2 days of the
procedure
Exclusion criteria:

26. examination protocol:
Measurements were done before and 1 month after YAG laser capsulotomy
• Recording of best corrected visual acuity (BCVA), BCVA sphere ,BCVA
cylinder and spherical equivalent.
• Measurement of intraocular pressure by Goldman applanation
tonometry (Haag-Streit, Bern, Switzerland) .
• Measurement of anterior segment parameters by Pentacam rotating
Scheimpflug camera.

27. Pentacam rotating Scheimpflug camera (Oculus HR Germany).
• Measurements were done before and 1 month after YAG laser
capsulotomy (in a separate session ).
• Measurements were obtained under standard dim light conditions.
• All Pentacam analyses were performed by the researcher.
• All of the measurements were taken in non-dilated condition

28. Study procedures
Pentacam rotating Scheimpflug camera (Oculus HR Germany).

29.  Data was analyzed using a SPSS version 20.0 for windows ( statistical
package for social sciences) program.
 Paired sample t-test was used to compare dependent variables.
 P value was considered significant at p value less than 0.05 level.

30. Results &
Discussio
n

31. This study included 36 eyes of 22 patients :
•Female patients represent 20 eyes (55%).
•Male patient represent 16 eyes (45%).
45%
55%
0 0
Gender
MALE
FEMALE
Demographic data of studied patients:

32. 4.55
3.98
3.6
3.7
3.8
3.9
4
4.1
4.2
4.3
4.4
4.5
4.6
ACD
ACD
BEFORE AFTER
1) Anterior chamber parameters:
 The ACA:
The value of p is 0.8 which is statically insignificant at p value P<0.05.
 The ACV:
The value of p is 0.87 which is statically insignificant at p value P<0.05.
 The ACD:
The value of p is 0.0025which is statically significant at p value P<0.05. *

33. 2) Intra ocular pressure parameter:
The value of p is 0.64 which is statically insignificant at p value P<0.05.
3) Pupil diameter parameter:
The value of p is 0.27 which is statically insignificant at p value P<0.05.
4) Central corneal thickness parameter:
The value of p is 0.413 which is statically insignificant at p value P<0.05
523.6
516.58
512
514
516
518
520
522
524
526
CCT
BEFORE
AFTER

34. 5) Refraction parameters:
The BCVA :
The value of p is <0.0001which is statically significant at p value P<0.05. *
The BCVA sphere :
The value of p is 0.003 which is statically significant at p value P<0.05. *
The BCVA cylinder :
The value of p is <0.0001which is statically significant at p value P<0.05. *
The BCVA spherical equivalent:
The value of p is 0.59 which is statically insignificant at p value P<0.05.

35. BCVA
0.53
0.77
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
BCVA
BEFORE AFTER
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35
BCVA
befor after

37. Female patient aged 52years old. She had cataract surgery 2 years ago on her left eye.
she needed YAG laser capsulotomy.
The anterior segment parameters before the procedure were :ACA 36 °
ACV 159 mm3
ACD 3.31 mm
CCT 547 μm
PD : 2.93 mm
IOP 14 mm Hg
Refraction -2, -1.5 / 160 °
S.E -2.75
BCVA 0.5 logMAR

38. The anterior segment parameters after the procedure by 1 month were :
ACA 35.4°
ACV 160 mm3
ACD 3.25 mm
CCT 532 μm
PD 3.31mm
IOP 15mm Hg
Refraction -1.5, -0.75 / 160°
S.E -2.0
BCVA 0.8 logMAR

39. Male patient aged 57years old had bilateral cataract extraction operation 3 years ago, he needed YAG
laser capsulotomy for his right eye .
The anterior segment parameters before the procedure were :
ACA 37.7 °
ACV 199 mm3
ACD 3.89 mm
CCT 567 μm
PD 3.16 mm
IOP 12 mm Hg
Refraction -1, -2 / 30
S.E -2
BCVA 0.5 logMAR

40. The anterior segment parameters after the procedure by 1 month were as follow
ACA 41.1°
ACV 219 mm3
ACD 3.81 mm
CCT 558 μm
PD 3.22 mm
IOP 11 mm Hg
Refraction -.5, -1 / 30°
S.E -1
BCVA 0.7 logMAR

41. Conclusion
 There was a true shallowing of the anterior chamber or anterior displacement of the
hydrophobic acrylic one piece IOL.
 Spherical equivalents did not change after capsulotomy, whereas cylindrical and spherical
errors decreased, Which led to improvement in the best corrected visual acuity.
 CCT decreased insignificantly most probably due to anti glaucoma dugs used
postoperative.
 There was no statically significant difference in ACV, ACA, IOP and pupil size.

43. limitations :
 Lack of correlations between the used power, capsulotomy size and changes
of anterior segment parameters.
 Short term evaluation of anterior segment parameters at one month interval
only.

44. In the future studies we recommend that:
More prolonged follow up of anterior segment parameters at 3 months
interval.
Further studies to detect correlations between the used power , capsulotomy
size and changes of anterior segment parameters .