1. Hayashi Eye Hospital, Fukuoka, Japan
Anterior capsule relaxing incisions with neodymium:YAG laser for patients at high-risk for anterior capsule contraction
Ken Hayashi, MD
Motoaki Yoshida, MD
Shin-ichi Manabe, MD
Hideyuki Hayashi, MD
Hayashi Eye Hospital, Fukuoka, Japan
The authors have no financial interest in the subject matter in this e-poster.

2. Purpose
Our previous study showed that three anterior capsule relaxing incisions created with Nd:YAG laser in the early postoperative period prevent anterior capsule contraction in nonpathologic eyes. This study was designed to evaluate the effect of anterior capsule relaxing incisions on preventing extensive capsule contraction in high-risk eyes, such as those with primary angle closure, pseudoexfoliation syndrome, or diabetic retinopathy.

3. Patients and Methods
Patients: 90 patients scheduled for cataract surgery
1) Primary angle-closure patients
2) Pseudoexfoliation syndrome patients
3) Diabetic retinopathy patients
※ All patients had 3 anterior capsule relaxing incisions in
either eye at 3 days postop. and sham treatment in fellow eye.
Methods:
1) Degree of anterior capsule contraction
① Area of anterior capsule opening (mm2)
② Percentage of opening area (%)
2) Possible complications of anterior capsule relaxing incisions
③ IOL decentration (mm) and tilt (°)
④ Anterior chamber depth (mm)
⑤ Posterior capsule opacification value (CCT)
At 3 days (baseline), and at 1, 3, 6 months after baseline

4. 3 anterior capsule relaxing incisions

5. Patients demographics
　 Capsulotomy　 No-capsulotomy
group 　　　 group 　　　P value
Number or eyes
Age
Left/Right
MRSE (D)
Astigmatism (D)
Axial length
IOL power (D)
MRSE = Manifest spherical equivalent value
*No statistically significant difference　 42
69.6 ± 7.7
41/43
-0.92 ± 0.54
0.89 ± 0.63
23.1 ± 1.3
22.3 ± 3.6
　 　　 42
69.6 ± 7.7
　　 43/41
-1.11 ± 0.77
0.94 ± 0.59
23.0 ± 1.3
22.5 ± 3.4 -
0.8774*
0.1037*
0.5083*
0.8602*
0.9015*

7. Comparison of the mean area of the anterior capsule opening
Capsulotomy 　No-capsulotomy　
group group　　　　　P value
Primary angle closure
　 Baseline
　3 months
　 6 months
Pseudoexfoliation
　Baseline
　 3 months
　6 months
Diabetic retinopathy
26.3 ± 2.9
22.6 ± 3.9
22.0 ± 4.3
26.3 ± 4.1
23.4 ± 6.4
22.7 ± 6.7
27.3 ± 3.5
25.6 ± 5.7
26.2 ± 6.1
26.9 ± 4.0
19.0 ± 5.6
18.6 ± 5.3
26.7 ± 5.4
20.2 ± 8.2
20.1 ± 6.6
27.5 ± 3.4
22.7 ± 6.0
23.0 ± 5.8
0.6100
0.0052*
0.0047*
0.9673
0.0996
0.1955
0.8548
0.0805
0.0632
*Statistically significant difference

9. Comparison of the mean percent reduction in anterior capsule opening area (%)
Capsulotomy No-capsulotomy　　　
group group P value
*Statistically significant difference
Primary angle closure
　 1 month
　3 months
　 6 months
Pseudoexfoliation
　1 month
　 3 monthsz
　6 months
Diabetic retinopathy
8.6 ± 17.1
13.4 ± 16.8
15.2 ± 19.1
3.4 ± 18.1
11.0 ± 22.2
13.0 ± 25.3
0.8 ± 11.6
6.0 ± 19.1
3.8 ± 20.8
16.1 ± 17.4
28.7 ± 20.6
29.8 ± 20.4
10.5 ± 13.6
24.8 ± 26.6
25.0 ± 25.1
8.2 ± 13.6
18.1 ± 17.6
16.5 ± 17.1
0.0428*
0.0050*
0.0105*
0.0573
0.0281*
0.0493*
0.0619
0.0404*
0.0268*

10. Comparison of the IOL decentration and tilt, and anterior chamber depth
Decentration (mm)
　 Baseline
　3 months
　 6 months
Tilt (°)
　Bseline
　 3 months
　6 months
AC depth (mm)
0.18 ± 0.13
0.17 ± 0.09
1.19 ± 0.60
1.36 ± 0.61
1.11 ± 0.52
3.9 ± 0.3
0.18 ± 0.12
0.18 ± 0.10
1.32 ± 0.77
1.32 ± 0.61
1.17 ± 0.56
3.9 ± 0.4
0.9028*
0.5063*
0.6387*
0.3429*
0.6696*
0.2822*
0.4902*
0.7475*
0.9835*
Capsulotomy No-capsulotomy
group 　　　　　　group　　　　　 P value
*No statistically significant difference

11. Capsulotomy
No-capsulotomy

12. Conclusions
Anterior capsule relaxing incisions created with an Nd:YAG laser in the early period after cataract surgery decreased anterior capsule contraction in high-risk patients.
2) The early anterior capsule incisions did not cause adverse events.
3) A preventive anterior capsulotomy should be considered in high-risk eyes, especially those with zonular dehiscence.