Journal of Current Glaucoma Practice

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VOLUME 11 , ISSUE 2 ( May-August, 2017 ) > List of Articles

RESEARCH ARTICLE

Intraocular Pressure Spikes following Neodymium-doped Yttrium Aluminum Garnet Laser Capsulotomy: Current Prevalence and Management in Israel

Asaf Achiron

Citation Information : Achiron A. Intraocular Pressure Spikes following Neodymium-doped Yttrium Aluminum Garnet Laser Capsulotomy: Current Prevalence and Management in Israel. J Curr Glaucoma Pract 2017; 11 (2):63-66.

DOI: 10.5005/jp-journals-10028-1225

License: CC BY 3.0

Published Online: 01-01-2015

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

Aim

The current treatment for posterior capsular opacification (PCO), neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy, may lead to increased intraocular pressure (IOP). Our aim was to survey routines in the management of IOP spikes and to identify the rate of IOP spikes following prophylactic apraclonidine treatment.

Materials and methods

A survey questionnaire among ophthalmologists and a retrospective registry review was used. Patients were administered apraclonidine 0.5% prior to capsulotomy. The IOP was measured before and 1 hour postprocedure.

Results

A total of 71% of responders (n = 45) routinely prescribe topical IOP-lowering medication and 82% routinely measure IOP before or after capsulotomy. The registry analysis included 87 eyes of 75 patients. Mean IOP decreased by 0.9 ± 3.3 mm Hg (p = 0.01, range: −6 to 10) following capsulotomy. No patient reached IOP values above 21 mm Hg following the procedure, with 3.4 and 1.1% of patients demonstrating an IOP elevation of more than 3 and 5 mm Hg respectively. No association was found between number of laser shots, mean laser power, or comorbid conditions, such as diabetes, hypertension, or glaucoma status with posttreatment IOP.

Conclusion

Most ophthalmologists surveyed routinely prescribe prophylactic IOP-lowering medication and measure IOP before or after capsulotomy. Mean IOP remained clinically stable following capsulotomy with prophylactic apraclonidine instillation, and no patient reached IOP values above 21 mm Hg. Differences in laser delivery or comorbid conditions were not associated with posttreatment IOP. Considering that no patient demonstrated a clinically significant IOP spike following prophylactic apraclonidine instillation, perhaps routine measurement of IOP following primary Nd:YAG laser may be reserved for high-risk patients only.

Clinical significance

In this work, we showed the prophylactic effect of apraclonidine 0.5% and suggest that measuring IOP after the procedure is necessary only in certain high-risk cases, possibly helping to reduce workload and patient waiting time and improving quality of service.

How to cite this article

Achiron A. Intraocular Pressure Spikes following Neodymium-doped Yttrium Aluminum Garnet Laser Capsulotomy: Current Prevalence and Management in Israel. J Curr Glaucoma Pract 2017;11(2):63-66.


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  1. Five-year incidence of Nd:YAG laser capsulotomy and association with in vitro proliferation of lens epithelial cells from individual specimens: a case control study. BMC Ophthalmol 2014 Oct;14:116.
  2. Neodymium:yttrium-aluminum-garnet capsulotomy and intraocular pressure in pseudophakic patients with glaucoma. Ophthalmology 2004 Jul;111(7):1393-1397.
  3. Long-term effect of Nd:YAG laser posterior capsulotomy on intraocular pressure. Arch Ophthalmol 2000 Oct;118(10):1334-1337.
  4. Topical 2.0% dorzolamide vs oral acetazolamide for prevention of intraocular pressure rise after neodymium:YAG laser posterior capsulotomy. Arch Ophthalmol 1997 Oct;115(10):1241-1244.
  5. Efficacy of topic ocular hipotensive agents after posterior capsulotomy. Arq Bras Oftalmol 2008 Sep-Oct;71(5):706-710.
  6. Intraocular pressure after ND: YAG laser capsulotomy in pseudophakic patients with glaucoma. Acta Med Croatica 2006 Jan;60(2):109-112.
  7. Brimonidine 0.2% versus apraclonidine 0.5% for prevention of intraocular pressure elevations after anterior segment laser surgery. Ophthalmology 2001 Jun;108(6):1033-1038.
  8. Intraocular pressure change after neodymium:YAG capsulotomy. J Cataract Refract Surg 1997 Jan-Feb;23(1):115-121.
  9. Levobunolol 0.5% and timolol 0.5% to prevent intraocular pressure elevation after neodymium:YAG laser posterior capsulotomy. J Cataract Refract Surg 1997 Sep;23(7):1075-1080.
  10. Effect of 0.2% brimonidine in preventing intraocular pressure elevation after Nd:YAG laser posterior capsulotomy. Ophthalmic Surg Lasers 2000 Jul-Aug;31(4):308-314.
  11. Brinzolamide 1% versus apraclonidine 0.5% to prevent intraocular pressure elevation after neodymium:YAG laser posterior capsulotomy. J Cataract Refract Surg 2006 Sep;32(9):1499-1502.
  12. Apraclonidine and anterior segment laser surgery. Comparison of 0.5% versus 1.0% apraclonidine for prevention of postoperative intraocular pressure rise. Ophthalmology 1995 Sep;102(9):1312-1318.
  13. Brimonidine 0.15% versus apraclonidine 0.5% for prevention of intraocular pressure elevation after anterior segment laser surgery. J Cataract Refract Surg 2005 Sep;31(9):1707-1712.
  14. The effects of Nd:YAG laser posterior capsulotomy on macular thickness, intraocular pressure, and visual acuity. Ophthalmic Surg Lasers Imaging 2012 Sep-Oct;43(5):395-400.
  15. Wait time as a driver of overall patient satisfaction in an ophthalmology clinic. Clin Ophthalmol 2013 Aug;7:1655-1660.
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