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N. Hirnschall et al. Influencing factors for morphological changes of Elschnig pearls after Nd:YAG capsulotomy Nino Hirnschall 1, 2, Thomas Neumayer 3,

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Presentation on theme: "N. Hirnschall et al. Influencing factors for morphological changes of Elschnig pearls after Nd:YAG capsulotomy Nino Hirnschall 1, 2, Thomas Neumayer 3,"— Presentation transcript:

1 N. Hirnschall et al. Influencing factors for morphological changes of Elschnig pearls after Nd:YAG capsulotomy Nino Hirnschall 1, 2, Thomas Neumayer 3, Michael Georgopoulos 3, Oliver Findl 1, 2 1 VIROS Institute, Hanusch Hospital, Vienna, Austria 2 Moorfields Eye Hospital, London, UK 3 Department of Ophthalmology, AKH, Vienna, Austria Financial disclosure: none

2 N. Hirnschall et al. Aim To assess the influence of the following factors on Elschnig pearls and the YAG-opening: Nd:YAG capsulotomy settings: –number of shots –YAG-Energy –total Energy Morphological changes: –number of newly appearing pearls –size and shape changes of Elschnig pearls

3 N. Hirnschall et al. Methods Design: prospective observational study Patients with pronounced regeneratory posterior capsule opacification (rPCO) were included in a continuous cohort Five digital retroillumination images were taken 10 minutes before YAG-capsulotomy, and 10 minutes, 1 week, 2 weeks and 1year after YAG-capsulotomy in a standardized fashion by two experienced examiners. PreYAG 1w2w PostYAG Nd:YAG-capsulotomy 1a

4 N. Hirnschall et al. Methods Analysis: all image-series were analyzed with a dedicated image analysis software that allows tracing of single Elschnig pearls from image to image

5 N. Hirnschall et al. Alltogether 2452 pearls in 20 eyes of 19 patients were observed. In the first week after Nd:YAG-capsulotomy 6 new pearls appeared per eye (range: 0-18) with a mean size of 3000µm 2 (range: 4000 – 9000). Results 1 year after YAG One year after Nd:YAG- capsulotomy pearl formations at the capsulotomy margin were found in 84% of eyes (mean: 3.9 pearls per eye, range: 0-17). pearl formation at the capsulotomy margin

6 N. Hirnschall et al. Results Mean laser energy level of 1.5mJ was used for the YAG- capsulotomy (range: 1.1mJ to 2.4mJ) No correlation between the laser settings and morphological changes of Elschnig pearls, or the YAG-opening Correlation of YAG energy and changes of the YAG-opening 3210 Changes of the YAG opening1 week after Nd:YAG capsulotomy 400 300 200 100 0 Total Nd:YAG energy r= 0.29 mm 2 mJ

7 N. Hirnschall et al. 11x increase in size 3x stable (±5%) 6x decrease in size 20 YAG-openings: 1 week2 weeks 1 year % Change of the YAG-opening in the first year after Nd:YAG capsulotomy

8 N. Hirnschall et al. Example: Decrease (6 cases) 2 weeks after YAG 1 year after YAG

9 N. Hirnschall et al. Early pearls - prognostic factor r = 0.834, p < 0.05 Number of appearing pearls n = 20 eyes Number of pearl strings per eye after 1 year The correlation between number of appearing pearls in the first week after capsulotomy and pearl formations at the capsulotomy- margin one year later was high.

10 N. Hirnschall et al. Conclusion  The appearance of new pearls in the first week after Nd:YAG-capsulotomy seems to be a prognostic factor for the long-term outcome concerning number of pearl formations at the capsulotomy margin. Pearl strings can cause glare, impede peripheral retinal examination and may necessitate secondary enlargement of the capsulotomy opening.

11 N. Hirnschall et al.

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