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Unnecessary capsulotomy due to a missed diagnosis of Vitreous opacities. Scott Geller MD Fort Myers Florida. I have no commercial relationships or financial interests. Scott Geller MD Fort Myers Florida. this is considered an off label use. Small Case Series.

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unnecessary capsulotomy due to a missed diagnosis of vitreous opacities
Unnecessary capsulotomy due to a missed diagnosis of Vitreous opacities
  • Scott Geller MD Fort Myers Florida
i have no commercial relationships or financial interests
I have no commercial relationships or financial interests
  • Scott Geller MD Fort Myers Florida

this is considered an off label use

small case series
Small Case Series
  • retrospective analysis of 10 patients
  • 2007 - 2009
  • all had complaints of blurred vision not resolved after laser capsulotomy

Scott Geller MD Fort Myers Florida

usual complaint to ophthalmologist
usual complaint to ophthalmologist:
  • ‘my vision gets blurred’
  • ‘when I read it gets blurry’
  • ‘something’s blurring my vision

Scott Geller MD Fort Myers Florida

patient parameters
Patient parameters
  • age range 53 - 76
  • co-morbidities: 1 prior RD w scleral buckle
  • 6 R eyes 4 L eyes
  • 2 multi-focal implants
  • all had well done laser capsulotomies

Scott Geller MD Fort Myers Florida

slide6
all patient 20/30 or better acuity
  • patient has no other obvious corneal, retinal, or optic nerve pathology
  • patient does not express typical eye floater complaints or symptoms
  • Ophthalmologist assumes there must be some capsular problem

Scott Geller MD Fort Myers Florida

slide7
Ophthalmologist performs a capsulotomy
  • Patient reports no improvement in symptoms
  • Patient is subjected to the ‘usual’ battery of unnecessary tests
  • Patient referred/seeks opinion of other specialists.....often with no firm answer
slide8
patient loses faith in treating ophthalmologist
  • finally gets a definitive diagnosis
  • patient told ‘live with it’
  • extreme frustration because MD doesn’t appreciate severity of patient’s problem

Scott Geller MD Fort Myers Florida

materials and methods ten cases
Materials and Methods ten cases
  • Correct diagnosis: patient history is key
  • Patients often can not articulate the exact nature of the symptoms
  • Physician can guide the patient in the history

Scott Geller MD Fort Myers Florida

slide10
Is the blur intermittent or constant ?
  • What makes the symptoms better?
  • Can patient duplicate symptoms merely by moving the head or eyes?

Scott Geller MD Fort Myers Florida

materials methods
Materials & Methods
  • Accurate history
  • Undilated initial evaluation by MD
  • Demonstration of worst acuity with opacity in visual axis- explain so patient understands
  • Evaluate vitreous with Goldmann Lens
  • Sophisticated devices are not needed

Scott Geller MD Fort Myers Florida

slide12
Lasag Microruptor II Yag laser
  • Fundamental ( vs. Multi ) Mode
  • Lasag/Haag- Streit CGV contact glass
  • Initial energy 300 - 400 pulses 4-5 mJ
  • 1 drop Pred Acetate, Fibruprofin gtts. 8x/d

Scott Geller MD Fort Myers Florida

treatment parameters
Treatment Parameters
  • average number of sessions: 4.4
  • average total pulses: 1554
  • total power input: 5488 mJ
  • average power/pulse: 3.5 mJ

Scott Geller MD Fort Myers Florida

results of 10 patients
Results of 10 Patients
  • No complications
  • Results are subjective
  • 3 Grades: mild, moderate, significant

Scott Geller MD Fort Myers Florida

key to accuracy success
Key to Accuracy & Success
  • Listen to the Patient !!

Scott Geller MD South Florida Eye Foundation Fort Myers Florida