|
 
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| CASE REPORT |
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| Year : 2023 | Volume
: 3
| Issue : 2 | Page : 337-338 |
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Vitreous prolapse with intraocular lens decentration – An uncommon complication following neodymium-yttrium aluminum garnet laser capsulotomy: A case report
Madhu Kumar, Tudymol Devasia, Simakurthy Sriram, Ashok Kanakamedala, Jayamadhury Gudimetla, IM Sumanth
Department of Vitreoretina, Sankara Eye Hospital, Guntur, Andhra Pradesh, India
| Date of Submission | 05-Aug-2022 |
| Date of Acceptance | 03-Jan-2023 |
| Date of Web Publication | 28-Apr-2023 |
Correspondence Address:
Tudymol Devasia
Kadamthodu House, Industrial Estate Nagar P.O., Changanacherry - 686 106 Kottayam, Kerala
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_1926_22
Vitreous prolapse and intraocular lens decentration following neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy is rare. We report a case of a patient who developed blurring of vision, due to vitreous prolapse and decentration of the intraocular lens, following Nd:YAG laser capsulotomy for posterior capsular opacification (PCO), which was restored to complete visual recovery with surgical management. The report aims to highlight the importance of precise focusing, usage of minimum optimal power required, and appropriate sizing of Nd:YAG laser posterior capsulotomy. Although Nd:YAG laser posterior capsulotomy is a safe procedure for treating PCO, it is not free from complications.
Keywords: IOL decentration, vitreous prolapse, YAG capsulotomy
How to cite this article:
Kumar M, Devasia T, Sriram S, Kanakamedala A, Gudimetla J, Sumanth I M. Vitreous prolapse with intraocular lens decentration – An uncommon complication following neodymium-yttrium aluminum garnet laser capsulotomy: A case report. Indian J Ophthalmol Case Rep 2023;3:337-8 |
How to cite this URL:
Kumar M, Devasia T, Sriram S, Kanakamedala A, Gudimetla J, Sumanth I M. Vitreous prolapse with intraocular lens decentration – An uncommon complication following neodymium-yttrium aluminum garnet laser capsulotomy: A case report. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Jun 2];3:337-8. Available from: https://www.ijoreports.in/text.asp?2023/3/2/337/374915 |
Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser is a solid state laser and has a wavelength of 1064 nm. It works with photodisruption mechanism. Nd:YAG laser posterior capsulotomy is the treatment of choice for posterior capsule opacification (PCO), which is a noninvasive, effective, easy, and relatively safe procedure.[1] Vitreous prolapse with intraocular lens (IOL) decentration is an uncommon complication of the Nd:YAG posterior capsulotomy.
| Case Report | |  |
A 58-year-old female patient underwent uneventful phacoemulsification with in-the-bag implantation of foldable IOL in her left eye in 2016. Postoperative recovery was uneventful, and the patient attained a visual acuity of 6/6 in the operated eye. She presented to us 5 years later in December 2021 with blurring of vision in the left eye following YAG capsulotomy done 4 months ago at another hospital.
On examination, her best corrected visual acuity was 6/18 in her left eye. Slit-lamp examination of the left eye revealed clear cornea with quiet anterior chamber and inferonasally decentered IOL with vitreous prolapse superotemporally [Figure 1]. Posterior segment examination was within normal limits. The right eye was pseudophakic and within normal limits. | Figure 1: Anterior segment image showing vitreous prolapse superotemporally with inferonasally decentered intraocular lens
Click here to view |
After appropriate investigations, we planned for an anterior vitrectomy for IOL repositioning. The procedure was carried out under local anesthesia. During surgery, we observed spontaneous repositioning of the IOL as soon as the anterior vitreous was removed [Figure 2]. Postoperatively, the patient was started on a short course of topical antibiotics and steroids tapered over a period of 4 weeks. | Figure 2: (a) Intraoperative image showing decentered IOL with vitreous prolapse. (b) Intraoperative image showing spontaneous recentration of the IOL following removal of the prolapsed vitreous without IOL manipulation. (c) Intraoperative image at the end of surgery showing well-centered IOL. IOL: intraocular lens
Click here to view |
At 1 month review, her vision improved to 6/6, N6 with correction. Slit-lamp examination revealed a quite eye with well-centered IOL [Figure 3]. | Figure 3: Anterior segment image at 1-month post-op showing well-centered intraocular lens
Click here to view |
| Discussion | | |
Cataract surgery is one of the most frequently performed surgeries around the globe.[2] PCO is the most common postoperative complication of cataract extraction. In PCO, there is secondary opacification of the posterior capsule due to the migration, proliferation, and differentiation of lens epithelial cells. PCO can cause significant visual symptoms, particularly when it involves the central visual axis.[3] PCO occurs in 20%–50% of patients within 2–5 years of cataract surgery.[4],[5] The treatment of choice for PCO is YAG laser capsulotomy. The complications of YAG laser capsulotomy include damage to the IOL, increased intraocular pressure, iritis, corneal injury, hyphema, vitreous prolapse, pupil blockage, IOL dislocation, vitritis, retinal hemorrhage, cystoid macular edema, retinal detachment, and exacerbation of endophthalmitis.[6]
Vitreous prolapse following YAG capsulotomy occurs when the laser disrupts the anterior vitreous face, causing vitreous prolapse into the anterior segment.[7] There are few case reports mentioning vitreous prolapse following YAG capsulotomy causing pupillary block or angle-closure glaucoma.[8],[9],[10] We are reporting a case of vitreous prolapse causing IOL decentration following YAG capsulotomy and its surgical management. In our case, removal of prolapsed vitreous itself resulted in recentration of the IOL without the need of further IOL manipulation. To the best of our knowledge, this is the first case report of this kind.
| Conclusion | | |
YAG capsulotomy is one of the commonest laser procedures done in ophthalmology. Though rare, vitreous prolapse can occur causing various complications. When performing Nd: YAG laser capsulotomy, it is preferable not to extend the margin of capsulotomy beyond the edge of the optic to avoid vitreous prolapse around the optic. Precise focusing and use of minimum optimal power can minimize this complication to an extent.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Cordero I. Understanding and safely using ophthalmic lasers. Community Eye Health 2015;28:76-7.  |
| 2. | Micieli JA, Arshinoff SA. Cataract surgery. CMAJ 2011;183:1621. |
| 3. | Wormstone IM. Posterior capsule opacification: A cell biological perspective. Exp Eye Res 2002;74:337-47. |
| 4. | Prajna NV, Ellwein LB, Selvaraj S, Manjula K, Kupfer C. The madurai intraocular lens study IV: Posterior capsule opacification. Am J Ophthalmol 2000;130:304-9. |
| 5. | Fong CS, Mitchell P, Rochtchina E, Cugati S, Hong T, Wang JJ. Three-year incidence and factors associated with posterior capsule opacification after cataract surgery: Australian Prospective Cataract Surgery and Age-related Macular Degeneration Study. Am J Ophthalmol 2014;157:171-9.e1. |
| 6. | Karahan E, Er D, Kaynak S. An overview of Nd:YAG laser capsulotomy. Med Hypothesis Discov Innov Ophthalmol 2014;3:45-50. |
| 7. | Aslam TM, Devlin H, Dhillon B. Use of Nd:YAG laser capsulotomy. Surv Ophthalmol 2003;48:594-612. |
| 8. | Goudie C, Tatham A. Advanced glaucoma following Nd:YAG capsulotomy: A case report. BMC Ophthalmol 2018;18(Suppl 1):229. |
| 9. | Dardabounis D, Ioannakis K, Detorakis E, Afendoulidis E, Kozobolis VP. Late onset of acute angle-closure glaucoma following neodymium: YAG laser posterior capsulotomy. Ophthalmic Surg Lasers Imaging 2007;38:56-8. |
| 10. | Li EY, Wu WK, Jhanji V. Pupillary block glaucoma secondary to vitreous prolapse after Nd:YAG capsulotomy. Clin Exp Optom 2011;94:383-4. |
[Figure 1], [Figure 2], [Figure 3]
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