EyeWorld Asia-Pacific June 2012 Issue

35 EWAP CATARACT/IOL June 2012 thing that I warn patients about, which is floaters—transient debris that is the remnants of the capsule floating around,” he said. “I think that is the number one problem.” These, he finds, usually dissipate on their own. More customary complications have not been an issue. “The classic complications cited for YAG are cystoid macular edema and retinal detachment,” Dr. Packer said. “I’ve never seen either one in my career.” He thinks these may have been a product of earlier-generation lasers that used more energy. Likewise, Dr. Packer doesn’t see pressure spikes. “I don’t treat with any drops and I don’t see the patient back for 2 weeks,” he said. “So I’ve never seen either of those.” Michael S. Berlin, MD , director, Glaucoma Institute of Beverly Hills, Calif., USA, and professor of clinical ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, Calif., USA, credits the fact that PCO is being treated sooner and is much less dense with the declining amount of pressure spikes that he also sees. “We are releasing a lot less foreign material into the eye, so we’re creating a lot less inflammation,” Dr. Berlin said. “By doing so, we’re decreasing drastically the amount of post-op pressure spikes in the appropriate hands.” One new complication that he does come up against is lens pitting. This he thinks may have to do with less consistent pulse- to-pulse outputs of the newer lasers as well as 2-D targeting systems that don’t account for lens vignetting. “One must be very careful with settings with the current generation of YAG lasers and with the lenses used to make sure that we don’t displace the focal points to create photodisruption more anterior than we anticipate causing lens pitting,” Dr. Berlin said. Overall, Dr. Safran thinks that the reality has changed for patients who are now undergoing YAG capsulotomy. “A patient may go online and say, ‘I don’t want that laser because I read about it, it can cause retinal detachment, macular edema, and glaucoma,’” he said. “The new reality is that those risks are pretty low, at least lower than they used to be.” EWAP Editors’ note: Dr. Berlin has financial interests with Alcon (Fort Worth, Texas, USA/Hünenberg, Switzerland), a very small opacity that wouldn’t affect a patient with a monofocal, but it can affect someone with a multifocal,” he said. “The need for a laser occurs at a much earlier rate with multifocals and the accommodating IOL.” With the Crystalens, in addition to enhancing the quality and range of vision, performing a YAG can also help block the occurrence of z-syndrome. “This is basically a capsular contraction syndrome where the capsule can get fibrosed and start to contract and make the lens move in position,” Dr. Trattler said. “Performing a YAG capsulotomy can help to prevent that condition from occurring.” Declining complications When it comes to complications such as retinal detachment, cystoid macular edema, and pressure spikes, Dr. Trattler finds these are rare. “I think that the risk of those complications is exceptionally low,” he said. “I don’t think that the data currently supports that there’s an increased risk of those complications occurring in patients—that may have been related to other factors in the past.” Mark Packer, MD , clinical associate professor of ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Ore., USA, credits the factors put forth some time ago by David Apple, MD, and his group as reducing the amount of posterior capsule opacification (PCO). This includes things such as the use of square-edged lenses, making the CC smaller than the optic of the lens and completely overlying it so that there are 360 degrees of overlap of the anterior capsule on the optic, careful cortical cleaning and hydrodissection. He sees all of these as having become part-and- parcel of modern technique and helping to minimize the amount of PCO, which was known to clog the bag with a lot of floating debris. The main complication that Dr. Packer contends with after YAG is floaters. “There is really only one Merck (Whitehouse Station, NJ, USA), and Santen (Emeryville, Calif., USA). Dr. Safran has financial interests with Bausch + Lomb, Heidelberg Engineering (Carlsbad, Calif., USA), and Lenstec (St. Petersburg, Fla., USA). Drs. Packer and Trattler have no financial interests related to this article. Contact information Berlin: +1-310-855-1112, Berlin@ucla.edu Packer: +1-541-687-2110, mpacker@finemd.com Safran: +1-609-896-3931, safran12@comcast.net Trattler: +1-305-598-2020, wtrattler@earthlink.net