Preoperative anterior capsulotomy with YAG laser in white cataracts evaluated with UBM 'looking around the Argentinian flag sign'

Session Details

Session Title: Cataract Surgery Special Cases I

Session Date/Time: Sunday 14/09/2014 | 14:30-16:30

Paper Time: 14:42

Venue: Boulevard G

First Author: : T.Jaeschke ARGENTINA

Co Author(s): :    A. Fernandez Mendy   S. Barreyro   J. Leiro        

Abstract Details

Purpose:

To present a case series of white intumescent cataract that underwent anterior capsulotomy, immediately prior to phacoemulsification with Nd: Yag laser with biometric analysis by UBM Vumax before and after Yag Laser.

Setting:

Pedro Lagleyze Hospital, Buenos Aires, Argentina.

Methods:

Many surgical strategies were described to prevent the development of Argentinian flag sign on white tension cataracts. Using a YAG laser assisted technique we try to minimize the risks of developing this unfortunate event during capsulorhexis. Performing a preoperative anterior capsulotomy by YAG - laser shot in this type of cataract, we could decrease the intralenticular tension, evacuate the anterior cortical fluid into the anterior chamber and prevent leakage of the capsulorexis, and so finally perform phacoemulsification without major risks. All patients were evaluated with UBM Vumax before and after YAG laser, measuring anterior chamber depth and lens thickness. No author has commercial interests related to the content of the publication. 15 patients with intumescent white cataracts were selected, 12 were assessed by UBM Vumax measuring anterior chamber depth and lenticular thickness. Furthermore, characteristics of echogenicity and sphericity of cataractous lenses were determined. All patients underwent one shot of 2.8 MJ Yag Laser in the center of the anterior capsule and after 10 minutes were re-evaluated biometrically. Immediately after, phacoemulsification was performed. Trypan blue was placed through an accessory incision (23G) before the main incision was made in order to maintain good pressure inside the eye, and anterior chamber was filled with viscoelastic. Later capsulorhexis was perform using utrata forceps in the traditional way. The surgeries were performed by residents of second and fourth year of Pedro Lagleyze Eye Hospital, Autonomous City of Buenos Aires.

Results:

In all Yag laser capsulotomy performed in this type of cataracts white endocapsular fluid evacuation into the anterior chamber was visualized. All capsulorexis were made circular and continuous. No complications or difficulties arose. On average, intumescent white cataracts PRE YAG had a thickness of 5.17mm (3.62mm - 6.40mm) and anterior chamber depth of 2.30mm (1.65mm - 3.42mm). POST YAG average thickness was 4.48mm (3.35mm - 5.73mm) and anterior chamber depth of 2.67mm (1.97mm - 3.52mm). The average reduction in thickness was 12.9% and increased the anterior chamber in 17.6 %.

Conclusions:

We believe the Vumax UBM examination in intumescent white cataracts is mandatory, allowing an adequate preoperative evaluation, thereby greatly help in deciding which cases are good candidates for treatment with preoperative capsulotomy with YAG laser in order to reduce the risk of leakage or sign of capsular Argentinian flag. The lenticular thickness and anterior chamber depth and the ultrasound characteristics (sphericity and content), are highly predictive data to define risk in this type of white cataracts. Lens thicknesses greater than 450um, anterior chamber depths less than 250um, iridocorneal angle reduction, lenticular heterogenicity content and a marked ballooning of the crystalline lens are indirect factors suggest intracapsular increased tension. In our experience we can say that the technique described above, is an excellent alternative to meet the challenge that this type of cataracts provide, in order to avoid complications during capsulorhexis.

Financial Interest:

NONE