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Influencing factors for morphological changes of Elschnig pearls after Nd:YAG capsulotomy

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

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Influencing factors for morphological changes of Elschnig pearls after Nd:YAG capsulotomy

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  1. 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. 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. 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. Nd:YAG-capsulotomy 1a PreYAG 1w 2w PostYAG

  4. 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. 1 year after YAG Results • 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 3000µm2 (range: 4000 – 9000). pearl formation at the capsulotomy margin 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).

  6. 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 mJ 400 300 Total Nd:YAG energy 200 r= 0.29 100 0 mm2 0 1 2 3 Changes of the YAG opening1 week after Nd:YAG capsulotomy

  7. Change of the YAG-opening in the first year after Nd:YAG capsulotomy % 20 YAG-openings: 11x increase in size 3x stable (±5%) 6x decrease in size 1 year 1 week 2 weeks

  8. 1 year after YAG 2 weeks after YAG Example: Decrease (6 cases)

  9. Early pearls - prognostic factor 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. Number of appearing pearls r = 0.834, p < 0.05 n = 20 eyes Number of pearl strings per eye after 1 year

  10. 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. Thank you!

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