[Nd-YAG laser capsulotomy in intraocular lenses with reversed optics]

From a clinico-anatomical point of view the implantation of IOLs with reversed optics approximates natural conditions and has many advantages. The distance between the endothelium or the pigment epithelium of the iris and the front surface of the lens is greater. The refracting surface of the lens is nearer to the nodal point and aniseikonia is reduced. However, it is still not known whether YAG laser treatment to open the posterior capsule is possible under these conditions. The present authors used the pulsed OPL3 neodymium-YAG laser ( Meditec ) to treat 45 eyes for secondary opacification of an intact posterior capsule after planned extracapsular cataract extraction. (A: 15 eyes with reversed-optic IOLs, B: 15 eyes with other types of IOL, C: 15 eyes with extracapsular aphakia). After performing a central capsulotomy with a mean of 44 shots, visual acuity increased immediately (mean improvement in visual acuity determined before and one week after YAG laser treatment - A:6 Snellen lines, B: 3 Snellen lines, C: 5 Snellen lines). In no eye was the post-laser visual acuity lower than before laser treatment. Even though the eyes were treated prophylactically with timolol 0.25% for 3 days, intraocular pressure - measured on the first postoperative day - increased insignificantly (mean: A: 1 mmHg, B and C: 2 mmHg). In 9 cases a mild iritis was observed, while 2 eyes had a hemorrhage of the iris vessels. Symptoms resolved within five days after laser treatment in all cases. The study demonstrates that Nd-YAG laser capsulotomy can be performed in patients with reversed optic IOLs without any disadvantage as compared to other types of IOL.