YAG-laser Dissection of Opacities of the Posterior Capsule of the Lens as a Possible Predictor of Formation of the “intraocular lens — capsular bag” Complex Dislocations

Purpose — evaluation of the effect of YAG-laser dissection of posterior lens capsule opacities on the stability of the anatomical position of the intraocular lens (IOL) in eyes after phacoemulsification (PE) of uncomplicated age-related cataracts with the initial absence of weakness of the Zinn support.
Patients and methods. The clinical material is presented by 97 patients with a diagnosis of secondary cataract (97 eyes). All patients underwent YAG-laser dissection of posterior capsule opacities. The patients were assessed for the distance from the ciliary body processes to the edge of the intraocular lens at four points (12, 3, 6, and 9 hours) before dissection of the secondary cataract and 2 hours after. Statistical processing of the obtained data was performed in the IBM SPSS Statistics Version 20 program.
Results. The patients’ age ranged from 60 to 75 years (68.0 ± 2.3 years). There were 52 men and 45 women. All patients had previously undergone PE of uncomplicated cataract with implantation of a posterior chamber IOL. In all cases, posterior capsule fibrosis developed within 1 to 5 years after PE (2.5 ± 1.5 years). The “corneal endothelium — anterior surface of the IOL” distance before and after YAG-laser dissection did not differ statistically significant — 4.22 ± 0.34 and 4.20 ± 0.26 mm (p > 0.05). In 20 eyes no changes in the “ciliary body processes — IOL edge” distance were observed after YAG-laser dissection. However, in 77 eyes a statistically significant decrease in the distance “ciliary body processes — IOL edge” at 6 o’clock was revealed: by 0.2–0.4 mm, which was combined with a statistically significant increase in this distance at 12 hours: 2.61 ± 0.21 versus 2.87 ± 0.22 mm (p < 0.05). Subsequent dynamic observation for three years revealed that in 5 eyes, dislocation of the “IOL — capsular bag” complex occurred.
Conclusion. A statistically significant decrease in the distance “ciliary body processes — IOL edge” by 6 hours with a simultaneous increase of 12 hours after YAG-dissection of secondary cataract was revealed. Within three years after YAG-laser dissection of posterior capsule opacities, grade II dislocation of the “IOL — capsular bag” complex was recorded in 5 patients, which amounted to 5 %. In our opinion, YAG-laser dissection is a trigger for weakening of the Zinn support, which can subsequently progress, leading to dislocation of the “IOL — capsular bag” complex. This risk is more pronounced in eyes with significant fibrosis of the posterior capsule against the background of the initial weakness of the ligamentous apparatus of the lens.

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