ND-YAG CAPSULOTOMY IN POSTERIOR CAPSULAR OPACIFICATION AFTER IMPLANTATION OF A MULTIFOCAL INTRAOCULAR-LENS

Background Posterior capsule opacification (PCO) after implantation of a multifocal intraocular lens (MIOL) reduces the visual acuity (VAF) for the far, as well as for the near (VAN). There is no report on resu lts and techniques for Nd:YAG capsulotomy in the presence of PCO after MIOL implantation. Patient and Methods Therefore, 31 Nd:YAG capsuloto mies in 29 patients with PCO after MIOL implantation were analysed con cerning number of expositions, energy, MIOL-damage, results as well as complications after capsulotomy in order to derive individual laser s trategies. Results Nd:YAG capsulotomy was performed after a mean of 14 (+/- 12.5) months. All capsulotomies resulted in a central opening of the posterior capsule. 42 (+/- 25.1) impulses in mean were necessary at a total energy of 71.7 (+/- 47.8) mJ. An average of 4 hits of the M IOL optic occurred and in 5 cases the MIOL remained undamaged. Three c apsulotomies were difficult to perform. In eight cases, a dense PCO wa s present. All capsulotomies were performed without any immediate comp lication. In 93.6% VAF and in 96.8% VAN increased postoperatively, whi le in the remaining cases VA did not increase due to other reasons. In one case intraocular pressure increased after YAG laser treatment for a short period of time. In another case, a retinal detachment occurre d 5 months postoperatively. No cystoid macular edema occurred until 6 months postoperatively. Conclusion Nd:YAG capsulotomy in PCO after MIO L implantation is a relatively safe, non-invasive method to improve vi sual acuity. After capsulotomy, the optically effective area of the MI OL mainly depends on the diameter of the pupil, the anterior and poste rior capsular opening. Therefore, the opening of the posterior capsule should depend on the individual MIOL design and should include the ma in MIOL portion for the far and near focus. This allows the patient an unaided profit from the multifocality of the IOL postoperatively.