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Outcomes of YAG anterior capsulotomy and surgical capsulectomy in the management of anterior capsular contraction syndrome

Outcome nach anteriorer YAG-Kapsulotomie vs. operativer Kapsulektomie bei anteriorem Kapselkontraktionssyndrom

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Summary

Background

To primarily measure the visual acuity (VA) outcomes and, secondarily, the baseline characteristics and complication rate of YAG anterior capsulotomy (AC, YAGAC) compared to surgical anterior capsulectomy in patients with anterior capsular contraction syndrome.

Material and methods

Retrospective consecutive case series attending the Birmingham and Midlands Eye Centre.

Results

A total of 141 eyes were included (YAGAC: 108 and surgical AC: 33). The surgical AC group had a higher proportion of uveitis than the YAGAC group (eight [24.2%] and two [1.9%] respectively, p < 0.001). In the YAGAC group seven eyes (6.5%) required further laser and one eye (0.9%) needed surgical AC. No patients from the surgical group required further treatment. Median logMAR pre-operative VA was worse in the surgical AC: 0.45 (IQR 0.00–1.19) than in the YAGAC group: 0.12 (interquartile range [IQR] 0.00–0.38, p < 0.001). Both groups had no difference in final VA as the surgical group had a greater VA gain (p = 0.004).

Although the cystoid macular oedema rate was higher in the surgical group (three [9.1%]) than the YAGAC group (one [0.9%], p = 0.040), there was no significant difference in number of complications between the two groups (p = 0.074). No instances of intraocular lens subluxation were recorded in the YAGAC group, while two cases (6.1%) occurred in the surgical group (p = 0.053).

Conclusion

YAGAC and surgical AC lead to good visual outcomes with no differences in final VA between the two groups. The authors also showed low complication rates in both groups. This study will help surgeons in appropriately consenting patients presenting with ACCS when discussing both the YAG and the surgical AC treatment option.

Zusammenfassung

Hintergrund

Die erreichte Sehschärfe, die Ausgangscharakteristika vor und die Komplikationsraten nach Behandlung eines anterioren Kapselkontraktionssyndrom (ACCS) mittels anteriorer YAG-Kapsulotomie (YAGAC [YAG: Yttrium-Aluminium-Granat]) bzw. operativer anteriorer Kapsulektomie (OP) sollten verglichen werden.

Material und Methoden

Es handelt sich um eine retrospektive konsekutive Fallserie am „Birmingham and Midlands Eye Centre“.

Ergebnisse

Insgesamt wurden 141 Augen eingeschlossen (YAGAC: 108, OP: 33). In der Gruppe mit operativer Versorgung war die Uveitisrate höher als in der YAGAC-Gruppe (8 [24,2 %] bzw. 2 [1,9 %], p < 0,001). Nach YAGAC war bei 7 Augen (6,5 %) eine weitere Laserbehandlung und bei 1 Auge (0,9 %) eine operative anteriore Kapsulektomie erforderlich, während kein Patient der OP-Gruppe eine weitere Behandlung benötigte. Der mittlere präoperative logtex MAR (Logarithmus des minimalen Auflösungswinkels) der Sehschärfe der OP-Gruppe war schlechter (0,45, IQR [Interquartilenabstand]: 0,00–1,19) als der der YAGAC-Gruppe (0,12, IQR: 0,00–0,38, p < 0,001). Bei der letztlich erreichten Sehschärfe bestand kein Unterschied zwischen beiden Gruppen, wobei der Zugewinn an Sehschärfe nach OP höher war (p = 0,004).

Obwohl zystoide Makulaödeme nach OP häufiger auftraten (3 [9,1 %] vs.1 [0,9 %], p = 0,040), war die Komplikationsrate zwischen beiden Gruppen nicht signifikant verschieden (p = 0,074). In der YAGAC-Gruppe wurden keine, in der OP-Gruppe 2 Fälle einer Intraokularlinsensubluxation verzeichnet (6,1 %, p = 0,053).

Schlussfolgerung

Das visuelle Outcome ist sowohl nach OP als auch nach YAGAC gut, bei niedrigen Komplikationsraten in und ohne Unterschiede in der endgültig erreichten Sehschärfe zwischen beiden Gruppen. Diese Studie wird Chirurgen helfen, die Einwilligung eines adäquat bezüglich einer Laser- vs. operativen Behandlung aufgeklärten ACCS-Patienten zu erhalten.

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Authors and Affiliations

  1. Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, B18 7QH, Birmingham, UK

    George Moussa FRCOphth, Soon Wai Ch’ng FRCOphth, MBA, Dimitrios Kalogeropoulos MD, MSc, PhD, Jesse Panthagani BSc, MBBS, MRCS, PGCHE, FHEA, FRCOphth, Kim Son Lett FRCOphth, Sreekanth Sreekantam FRCOphth, Imran Masood PGCertMedEd (Health), FEBOphth FRCOphth (London), FEBOS (Glaucoma), Velota C. T. Sung FRCS (Ed), FRCOphth, MSc (Warwick) & Walter Andreatta MSc, FEBO, FRCOphth

  2. Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece

    Konstantinos Katsikatsos MD & Dimitrios Kalogeropoulos MD, MSc, PhD

  3. Kantonsspital Winterthur, Brauerstraße 15, 8400, Winterthur, Switzerland

    Walter Andreatta MSc, FEBO, FRCOphth

Authors
  1. George Moussa FRCOphth
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  2. Konstantinos Katsikatsos MD
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  3. Soon Wai Ch’ng FRCOphth, MBA
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  5. Jesse Panthagani BSc, MBBS, MRCS, PGCHE, FHEA, FRCOphth
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  6. Kim Son Lett FRCOphth
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  7. Sreekanth Sreekantam FRCOphth
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  8. Imran Masood PGCertMedEd (Health), FEBOphth FRCOphth (London), FEBOS (Glaucoma)
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  9. Velota C. T. Sung FRCS (Ed), FRCOphth, MSc (Warwick)
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  10. Walter Andreatta MSc, FEBO, FRCOphth
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Corresponding author

Correspondence to George Moussa FRCOphth.

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Conflict of interest

G. Moussa, K. Katsikatsos, S.W. Ch’ng, D. Kalogeropoulos, J. Panthagani, K.S. Lett, S. Sreekantam, I. Masood, V.C. T. Sung and W. Andreatta declare that they have no conflict of interest in the production of this manuscript. There are no external funders that have played a role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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Moussa, G., Katsikatsos, K., Ch’ng, S.W. et al. Outcomes of YAG anterior capsulotomy and surgical capsulectomy in the management of anterior capsular contraction syndrome. Spektrum Augenheilkd. 36, 117–122 (2022). https://doi.org/10.1007/s00717-021-00502-9

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