YAG-laser treatment of secondary cataract with silicone tamponade of the vitreous cavity

BACKGROUND: Silicone tamponade of the vitreous cavity can be indefinitely long due to severe forms of diabetic retinopathy, recurrent hemophthalmos, and recurrent retinal detachment. Prolonged contact of the capsular bag with tamponade agent leads to posterior capsule fibrosis and cataract development, including secondary cataract in pseudophakia, which significantly reduces the visual outcome of surgery. The technique of laser posterior capsulotomy has some peculiarities related to the tight contact of the posterior capsule with the silicone oil. Often the procedure cannot be completed successfully, and surgical dissection of the secondary cataract has to be performed. Repeated surgical procedure also has certain complexities and becomes even more risky, as there is an increased risk of IOL damage, IOL dislocation, and migration of silicone oil into the anterior chamber, which does not allow to improve the functional outcome of the intervention.

AIM: The aim of this study is to develop and present the own modified technique of YAG-laser posterior capsulotomy in eyes after vitrectomy with long-term silicone oil tamponade.

MATERIALS AND METHODS: This study presents the results of treatment of 12 patients (12 eyes), including 2 women and 10 men (16.67% and 83.33%), age from 16 to 60 (42.83 ± 7.89) years with prolonged “light” silicone oil tamponade and secondary cataract. Posterior capsulotomy was performed with YAG-laser using the developed technology. Best-corrected visual acuity before surgery ranged from 0.01 to 0.2 (0.07 ± 0.01), intraocular pressure before surgery ranged from 7 to 20 (11.83 ± 2.21) mm Hg. The term of silicone tamponade was from 4 to 51 (24 ± 6.48) months. The follow-up time for patients operated using this technology ranged from 1 to 60 (27.33 ± 9.95) days.

RESULTS: As a result of treatment, the dissection of the posterior lens capsule was achieved in 12 out of 12 patients (100%). No intraoperative and postoperative complications were observed. Postoperative best-corrected visual acuity ranged from 0.05 to 0.3 (0.13 ± 0.02), and intraocular pressure from 7 to 22 (13 ± 2.37) mm Hg. In all cases, the diameter of the optical area was sufficient and amounted to 3–4 mm, the flap of the posterior capsule was completely separated as a whole fragment.

CONCLUSIONS: The developed method of modified YAG-laser posterior capsulotomy (Patent RU No. 2782725, priority from December 27, 2021) in eyes with a long term silicone oil tamponade is effective and can be used in everyday medical practice. The advantages of the proposed method: high efficacy when performing the procedure in a complex category of patients with no additional procedures required. The procedure is a modification of a routine technology, and does not require additional equipment and training.