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[Reflections on Nd:YAG capsulotomy in lens opacity after multifocal lens implantation].

BACKGROUND
Posterior capsule opacification (PCO) after implantation of a multifocal intraocular lens (MIOL) reduces the visual acuity (VAF) for the far, as well as for the near (VAN). There is no report on results and techniques for Nd:YAG capsulotomy in the presence of PCO after MIOL implantation.


PATIENT AND METHODS
Therefore, 31 Nd:YAG capsulotomies in 29 patients with PCO after MIOL implantation were analysed concerning number of expositions, energy, MIOL-damage, results as well as complications after capsulotomy in order to derive individual laser strategies.


RESULTS
Nd:YAG capsulotomy was performed after a mean of 14 (+/- 12.5) months. All capsulotomies resulted in a central opening of the posterior capsule. 42 (+/- 25.1) impulses in mean were necessary at a total energy of 71.7 (+/- 47.8) mJ. An average of 4 hits of the MIOL optic occurred and in 5 cases the MIOL remained undamaged. Three capsulotomies were difficult to perform. In eight cases, a dense PCO was present. All capsulotomies were performed without any immediate complication. In 93.6% VAF and in 96.8% VAN increased postoperatively, while in the remaining cases VA did not increase due to other reasons. In one case intraocular pressure increased after YAG laser treatment for a short period of time. In another case, a retinal detachment occurred 5 months postoperatively. No cystoid macular edema occurred until 6 months postoperatively.


CONCLUSION
Nd:YAG capsulotomy in PCO after MIOL implantation is a relatively safe, non-invasive method to improve visual acuity. After capsulotomy, the optically effective area of the MIOL mainly depends on the diameter of the pupil, the anterior and posterior capsular opening. Therefore, the opening of the posterior capsule should depend on the individual MIOL design and should include the main MIOL portion for the far and near focus. This allows the patient an unaided profit from the multifocality of the IOL postoperatively.