A capsulotomy consists of making an opening in the lens
capsule. This procedure is performed either during cataract surgery (anterior
caspulotomy) or after it, in case of opacification of the posterior capsule
(secondary cataract).
The YAG (Light Amplification by Stimulated Emission of
Radiation) laser is a treatment laser that has revolutionized the medical
world, including that of ophthalmology. It emits a light source, close to
infrared, thin and highly concentrated that can treat many eye conditions.
Since the beginning of the 90s, new laser surgical
techniques have appeared. Applied to ophthalmology, they allow visually
impaired patients to regain clear vision and forget the constraints of wearing
glasses or contact lenses. These techniques are very efficient especially for
treatments of myopia, astigmatism, hyperopia and soon presbyopia.
Anterior Capsulotomy - Cataract Surgery
During cataract surgery, the surgeon must make a circular
cut of the anterior capsule of the lens, whose diameter is around 5.5 mm.
Maneuvers to extract the lens are then performed through this opening.
Currently performed manually, the cutting of the anterior lens capsule can be
accomplished in an automated way thanks to the femtosecond laser (femtosecond
laser capsulotomy).
Posterior YAG Laser Capsulotomy:
Secondary Cataract
Secondary cataract is a complication of cataract surgery.
It occurs after the surgery, in a very variable time, from a few weeks to
several years. It corresponds to the progressive loss of transparency of the
lens envelope (capsular bag). This bag is kept during cataract surgery because
it is transparent and above all, serves as a natural support for the artificial
lens implant intended to replace the removed crystalline lens. This loss of
transparency is caused by the proliferation of residual cells of the lens
(these cells of "epithelial" nature have remarkable properties). The
visual symptoms caused by the loss of transparency of the lens are close to
those of the "primitive" cataract. One of the most common
complications of cataract surgery is posterior capsular opacification, which
occurs in 10 to 50% of cases, on average three to five years after surgery.
This complication follows an extracapsular lens extraction surgery. It's an
unpredictable complication. However, the use of hydrophobic acrylic intraocular
implants seems to reduce the incidence of this complication. Capsular
opacification is associated with the proliferation of a postoperative remnant
of epithelial cells of the lens, which migrate along the posterior capsule
towards the optical axis, between the crystalline implant and the posterior
capsule. This results in a decrease in visual acuity. Clinical examination
after pupillary dilation reveals Elshnig pearls, which are characteristic of
capsular opacification. The rest of the examination must be normal in order to
eliminate another cause of visual acuity decline.
The secondary cataract treatment is based on the opening of
the posterior YAG
laser capsule. This gesture is performed under topical
anesthesia (drops), lasts a few minutes and is perfectly painless.
Anti-inflammatory and hypotonizing eye drops should be prescribed to prevent
complications of capsulotomy (inflammation, eye strain, etc.).
Laser
indications in ophthalmology
Laser
surgery (light amplification by stimulated emission of radiation) is intended
to correct vision disorders such as:
- myopia: the image is done not on the retina but ahead of it
- the hyperopia: the focus of the image is behind the retina
- astigmatism: abnormal curvature of the cornea hence the difficulty of seeing objects close together or distant
- the technique does not yet complete satisfaction for presbyopia (the lens loses flexibility: mainly due to age)
- myopia: the image is done not on the retina but ahead of it
- the hyperopia: the focus of the image is behind the retina
- astigmatism: abnormal curvature of the cornea hence the difficulty of seeing objects close together or distant
- the technique does not yet complete satisfaction for presbyopia (the lens loses flexibility: mainly due to age)
The
laser can also treat other eye injuries such as:
- certain retinal pathologies: diabetic retinopathy, macular degeneration, thrombosis-related vascular disease, hypertensive retinopathy
- cataract: congenital or acquired opacity of the lens
- glaucoma: ocular hypertension
- peripheral retinal lesions or treatment preventive retinal detachment
- certain retinal pathologies: diabetic retinopathy, macular degeneration, thrombosis-related vascular disease, hypertensive retinopathy
- cataract: congenital or acquired opacity of the lens
- glaucoma: ocular hypertension
- peripheral retinal lesions or treatment preventive retinal detachment
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