The barrier function in neodymium-YAG laser capsulotomy.

BACKGROUND

Complications following neodymium (Nd)-YAG laser capsulotomy have been attributed to damage to the capsule and vitreous face.

OBJECTIVES

To measure the disruption of the anterior-posterior extracapsular barrier complex induced by Nd-YAG laser capsulotomy and to determine how it might be minimized, using a fluorophotometer.

DESIGN

Prospective study of 21 eyes undergoing Nd-YAG laser capsulotomy and cross-sectional comparison with 15 pseudophakic eyes with clear capsules.

SETTING

University-based clinical practice.

INTERVENTION

Neodymium-YAG laser posterior capsulotomy per study protocol.

MAIN OUTCOME MEASURE

Change in extracapsular barrier efficiency as measured by fluorophotometry.

RESULTS

Multivariate regression demonstrated that both anterior vitreous disruption and absence of a posterior chamber intraocular lens (aphakia) were significantly correlated with loss of barrier efficiency, whereas capsulotomy size was not. The anterior vitreous was judged to be undamaged in 67% of eyes treated by the study protocol. However, all myopic eyes sustained damage. Opacification of the posterior capsule itself was also associated with mild loss of barrier function even before capsulotomy, compared with the clear-capsule group. Glaucoma occurred more frequently when barrier efficiency was lost postoperatively.

CONCLUSION

Damage to the extracapsular barrier complex by Nd-YAG laser capsulotomy is minimized when the anterior vitreous is preserved. The study treatment protocol may be useful in limiting this damage and in reducing complications.