Refractive impact of the yag laser after cataract surgery Dr. Daniele ARON-ROSA Paris - France.

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Presentation transcript:

Refractive impact of the yag laser after cataract surgery Dr. Daniele ARON-ROSA Paris - France

Most of the coomplications of Yag laser capsulotomy can be avoided 1) By pre and post treating the patient l Indometacine 0.1 from 1 day pre yag to 1 week postop l Apropriate YAG : tem00 short nanosec pulses or better pico or femtosec pulses l second pulses

The shorter the pulses the less side effects l limited : thermal effects l resulting less mouvement of the implant l less seondary en largement of the PC

The YAG capsulotomy causes back ward displacement of the IOL, wisch is significantly higher with plate IOL & large capsulotomies

Backward mouvements were studied by l Aron Rosa 1979 : J. AppPhys 1979 l : J. catarct& refract Surg 1995 l Final O : J catarct refract surg 1999

PC AND IOL BACWARD MVTS l IF the size of capsulotomy mm l mean increase of the AC = 25 micron ( 9 to 55) l the larger the more backward displacement l

VARIATION OF BACKWARD MVTS/ At day 1: 9 to 28 mic for the 3 pieces foldable IOL 15 to 55 mic for the plate IOL

\ NO significant changes for the 3 pieces IOL \ Tendency to move back 16 to 65 microns for the plate IOL AT 5 WEEKS POST YAG

\ Irrelevant for the 3 piecesIOL \ More for the plate IOL : 0.08 to 0.5 SE \ : \ HYPEROPIC SHIFT

\ NDYAG capsulotomy, causes a backward movement of the iol \ precisely measured with he dual beam partial coherent interferometer CONCLUSION: CONCLUSION:

= FOLDABLE OL HAVE A TENDENCY TO MOVE BACWARD Mainly when CCC is narrow

Plate haptics tend to be compressed in the shrinking of the capsule and vault bacward,increasing the capsular tension.After the capsule is realease, e lens vaults bacward even more, and may dislocate into the vitreous if PC is large enough. Plate haptics tend to be compressed in the shrinking of the capsule and vault bacward,increasing the capsular tension.After the capsule is realease, e lens vaults bacward even more, and may dislocate into the vitreous if PC is large enough.

\ Nano or picosec monomode( tem 00)do not generate PC enlargement of PC. \ NANO multimode necessitating more energy to reach OBD, is more deflagrating and causes more enlargement of PC, has more side effects and causes more complications \ idiopathiques \ bilatérales: 60 % idiopathiques The nature of the YAG LASER influences the evolution of the PC SIZE:

\ WITH a good YAG and a reasonabely sized PC AND A 3 PIECES FOLDABLE IOL \ PC will generate minimal refractive changes \ infectieux \ héréditaire –oculaire –associé à des maladies générales CONCLUSIONS

et moi, ne m'oublie pas,! (mes dents sont encore bien)