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. 2023 Jun 3;11(2):82.
doi: 10.3390/diseases11020082.

Factors Associated with Reclosure of Posterior Capsule Aperture by Flat Opacifications with Pearls after Nd:YAG Laser Posterior Capsulotomy

Akiko Ota  1 , Ichiro Ota  2 , Shu Kachi  2 , Goichiro Miyake  2 , Fuminori Haga  2 , Kensaku Miyake  2 , Mineo Kondo  1 , Kumiko Kato  1
Affiliations

Factors Associated with Reclosure of Posterior Capsule Aperture by Flat Opacifications with Pearls after Nd:YAG Laser Posterior Capsulotomy

Akiko Ota et al. Diseases. .

Abstract

In this retrospective case series, we investigated factors associated with posterior capsule aperture (PCA) reclosure following neodymium-yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy. The study encompassed patients who underwent cataract surgery with intraocular lens (IOL) implantation or a combined vitrectomy, cataract surgery, and IOL implantation between 2009 and 2022. PCA reclosure was observed in 22 eyes of 17 patients: 45% (10 eyes) underwent the triple procedure, and 55% (12 eyes) received cataract surgery with IOL implantation. In our clinic, 14% of patients were given IOLs with a 4% water content, while 73% (13 eyes) of those experiencing PCA reclosure had IOLs with a 4% water content. The mean interval between Nd:YAG capsulotomies was notably shorter than that between the initial cataract surgery and the first Nd:YAG laser capsulotomy. We also identified five stages of PCA reclosure progression. In conclusion, IOL water content may be linked to PCA reclosure, and the time to recurrence is shorter with each successive reclosure. Further research is needed to verify these findings and uncover additional contributing factors.

Keywords: Elschnig pearls; Nd:YAG laser capsulotomy; posterior capsule aperture; posterior capsule opacification; re-opacification; reclosure; water content of IOL.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Statistical analyses of the interval between each Nd:YAG laser capsulotomy. (A) The interval between the first Nd:YAG laser capsulotomy and the second Nd:YAG capsulotomy (YAG-2) was significantly shorter than the mean interval between the initial cataract surgery and the first Nd:YAG laser posterior capsulotomy (YAG-1). (B) YAG-2 and the mean interval between the second Nd:YAG capsulotomy and the third Nd:YAG laser capsulotomy (YAG-3) was significantly shorter than YAG-1.
Figure 2
Figure 2
The upper panel shows images of the anterior segment taken by the retroillumination method and the lower panel by the direct illumination method. (A) Stage 0: Absence of lens epithelial cell (LEC) proliferation around the borders of the capsulotomy. (B) Stage 1: Development of Elschnig pearls around the border of the capsulotomy, but no opacifications on the intraocular lens (IOL). (C) Stage 2: Development spinous opacifications on the peripheral border of the IOL, but no opacification over the visual axis. (D) Stage 3: Development of mesh-pattern opacifications with pearl-like opacifications over the IOL on the visual axis. (E) Stage 4: Progression of the opacification with the presence of pearl formation and fibrosis all over the IOL.
Figure 3
Figure 3
Reclosure of the posterior capsule aperture after Nd:YAG laser treatment in a representative case. (A) Fifteen months after the Nd:YAG laser treatment for a posterior capsule opacification (PCO). Stage 3: development of a mesh-pattern opacification with flat pearls over the IOL including on the visual axis. (B) Immediately after the Nd:YAG laser treatment for the reclosure of a posterior capsule aperture (PCA). (C) One month after the Nd:YAG laser treatment for the reclosure of PCA. Stage 1: Development of Elschnig pearls around the border of the capsulotomy but no opacifications on the IOL. (D) Five months after the Nd:YAG laser treatment for a PCA. Stage 4: Progression of the opacification with flat pearl formation and fibrosis all over the IOL. (E) Immediately after the Nd:YAG laser treatment for a closed PCA.
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