Retinal Detachment after Neodymium : Yttrium - Aluminum - Garnet Laser Posterior Capsulotomy

.....................................................................................................................................................7 1 LIST OF ORIGINAL PUBLICATIONS ............................................................................................9 2 INTRODUCTION ...............................................................................................................................10 3 REVIEW OF LITERATURE ...............................................................................................................12 3.1 CATARACT SURGERY ...............................................................................................................12 3.1.1 Epidemiology of cataract ...........................................................................................................12 3.1.2 General development of cataract surgery ..................................................................................12 3.1.3 Complications.............................................................................................................................13 3.1.4 Evaluation of outcome................................................................................................................15 3.2 POSTERIOR CAPSULE OPACIFICATION (PCO) .....................................................................15 3.2.1 Pathogenesis...............................................................................................................................15 3.2.2 Incidence.....................................................................................................................................18 3.2.3 Prevention...................................................................................................................................18 3.2.4 Treatment....................................................................................................................................20 3.3 ND:YAG LASER POSTERIOR CAPSULOTOMY (LCT) ...........................................................20 3.3.1 Principles of Nd:YAG laser ........................................................................................................20 3.3.2 Complications.............................................................................................................................22 3.3.3 Effects on vitreoretinal structures ..............................................................................................24 3.4 RHEGMATOGENOUS RETINAL DETACHMENT (RD) ..........................................................25 3.4.1 Pathogenesis...............................................................................................................................25 3.4.2 Predisposing factors...................................................................................................................26 3.4.3 Prevention...................................................................................................................................27 3.4.4 Treatment....................................................................................................................................28 3.4.5 Outcome......................................................................................................................................28 3.5 PSEUDOPHAKIC RETINAL DETACHMENT............................................................................30 3.5.1 Special risk factors .....................................................................................................................30 3.5.2 Special characteristics ...............................................................................................................31 3.5.3 Retinal detachment after LCT ....................................................................................................31 3.5.4 Treatment....................................................................................................................................32 3.5.5 Outcome......................................................................................................................................32 4 AIMS OF THE STUDY.......................................................................................................................33 5 PATIENTS AND METHODS ...........................................................................................................34 5.1 PATIENTS......................................................................................................................................34 5.1.1 Retrospective cohort study (I) ....................................................................................................34 5.1.2 Prospective studies (II, III).........................................................................................................34 5.1.3 Cross-sectional study (III)..........................................................................................................35 5.2 METHODS .....................................................................................................................................35 5.2.1 Collection of retrospective data (I-IV) .......................................................................................35 5.2.2 Clinical examination (II-IV) .......................................................................................................38 5.2.3 Nd:YAG laser posterior capsulotomy (II) ..................................................................................38 5.2.4 Patient satisfaction and quality of life (IV) ................................................................................38 5.2.5 Statistical analysis (I-IV)............................................................................................................41 6 RESULTS AND DISCUSSION.........................................................................................................43 6.1 CHARACTERISTICS OF RD AFTER LCT............................................................................................43 6.1.1 Time intervals between cataract extraction, LCT and RD (I, IV) ..............................................43 6.1.2 Risk factors for RD .....................................................................................................................43 6.1.3 Type and extent of RD (I, IV)......................................................................................................43 6.1.4 Type, number and location of retinal breaks (I).........................................................................44 6.2 RETINAL BREAKS ASSOCIATED WITH LCT......................................................................................45 6.2.1 Asymptomatic retinal breaks and RD before LCT (II) ...............................................................45 6.2.2 Retinal breaks after LCT (II)......................................................................................................46 6.2.3 Later retinal breaks (III) ............................................................................................................47 6.2.4 Prospective study of RD after LCT (III) .....................................................................................48 6.3 LONG-TERM OUTCOME OF PSEUDOPHAKIC RETINAL DETACHMENT AFTER LCT............................49 6.3.1 Anatomic outcome (IV)...............................................................................................................49 6.3.2 Objective visual outcome (IV) ....................................................................................................50 6.3.3 Patient-rated functional outcome (IV)........................................................................................50 7 SUMMARY AND CONCLUSIONS ................................................................................................53 8 ACKNOWLEDGEMENTS.................................................................................................................55 9 REFERENCES.......................................................................................................................................56