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• W4232000513 abstract "We reviewed our database of human eyes obtained postmortem containing posterior chamber intraocular lenses (IOLs). There were 5416 total IOLs, including 814 foldable IOLs, at the time of the article. We specifically looked for instances in which a Nd:YAG posterior capsulotomy may have been done in the absence of posterior capsule opacification (PCO). This search was based on the fact that we knew that some surgeons have reported very high rates of laser treatment, (50% and above). We were pleased to note in our database of foldable IOLs that there was little evidence of what we had defined as a “financial capsulotomy.” Only rarely did we find a clear capsule without PCO that had been subjected to the laser. We did not subject the older (pre-1995) eyes to an extensive study as we did with the more modern foldable IOLs, but we did have an impression that Nd:YAG procedures on apparently clear capsules were more common pre-1995. Reimbursement for the Nd:YAG laser procedure was about $700 per treatment in the early 1990s. What might be considered to be inappropriate treatment was rarely seen after about 1995, corresponding to a trend towards lower reimbursement down to approximately $220. According to the most recent data received from an AAO circular in August 2001, the reimbursement today is approximately $220. As we commenced our analyses of autopsy globes about 4 years ago, we were indeed concerned about what Dr. Ramsey correctly noted, namely: “the presence of a capsulotomy does not guarantee there was a visually significant posterior capsule opacification.” At that time, when the number of cases in the database was relatively small, we were concerned that a high incidence of unnecessary capsulotomies would represent a flaw in our research mode. Fortunately this was not the case. The number of specimens has now increased greatly, from over 3257 eyes (279 with foldable lenses) in 1997 to 7431 eyes (1334 with foldable lenses) as of August 2001. This marked increase in numbers helps us gain an ever increasing degree of confidence regarding the significance of our findings. The more time that passes and the larger number of specimens accessioned, the lower the chance of error. We have never been able to determine via requests from eye banks the dates of IOL implantation. Therefore, we have not been able to discern the length of time each IOL was in each patient’s eye. However, we now have 6 years of follow-up, and the numbers (percent Nd:YAG rates) obtained for each IOL are now stabilizing, so this is now of less importance. For example, the Nd:YAG capsulotomy rate of the three-piece Alcon AcrySof model MA60BM, (Alcon, Fort Worth, TX) clearly ranks at present as the leader in terms of low PCO and Nd:YAG capsulotomy rates. It has now stabilized in the single digits. The Nd:YAG rate for another popular IOL style, the Allergan (Irvine, CA) SI40 (also the Array multifocal) has stabilized in the lower teens (approximately 12%). This stabilization gives us confidence that the numbers are accurate over a long period. It also demonstrates that a given lens type both prevents PCO and also may function to delay a PCO’s onset. A previous study, (Auffarth GU, Beischel CJ, Wesendahl TA, Apple DJ. Soemmerings Ring Bildung nach Kataraktoperation und HKL Implantation [Abstract]. Eine Studine von 827 Autopsieaugen. Klin Monatsbl Augenheilkd 1995;206(Suppl. 1):1–12) has indicated that formation of a Soemmering’s ring, and hence PCO, tends to peak at about 5 years postoperatively. PCO rates should therefore stabilize about that time—which we are indeed observing. We strongly believe that PCO can be reduced to single digits if the surgical and PCO factors noted in our “Eradication” article are utilized by the surgeon. It is possible that efforts to reduce this complication may have been less intense when reimbursement was high. A lower reimbursement, indeed a movement towards bundling of the cataract and the Nd:YAG laser capsulotomy procedures together in the future, appears to have and will continue to have a stimulatory effect to help decrease the incidence of this complication. In the future, as more and more surgeons move towards IOL refractive procedures, for example, clear leans extraction, as well as accommodative lenses and the like, a decrease in PCO will be absolutely mandatory. For example if, after a clear lens extraction a PCO ensues, it may require an Nd:YAG capsulotomy. Thereafter the incidence of retinal detachment increases significantly. This would be unacceptable for patients undergoing a refractive procedure. The reduction in the incidence of PCO has been one of the most significant accomplishments in our specialty since Ridley’s original implant.1Apple D.J Sims J.C Harold Ridley and the invention of the intraocular lens.Surv Ophthalmol. 1995; 40: 279-292Abstract Full Text PDF Scopus (118) Google Scholar This reduction occurred quietly as lenses and techniques were improved, creating what we have termed a “quiet revolution.”2Apple D.J Ram J Peng Q The fiftieth anniversary of the intraocular lens and a quiet revolution.Ophthalmology. 1999; 106 ([editorial]): 1-2Google Scholar Many ophthalmologists are now discarding their extra Nd:YAG lasers, and use of this procedure is now a rarity in many ophthalmologists’ practices. This will without doubt open the gate towards safer refractive IOL surgery and its variations." @default.
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• W4232000513 date "2002-04-01" @default.
• W4232000513 modified "2023-09-30" @default.
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• W4232000513 doi "https://doi.org/10.1016/s0161-6420(02)01002-3" @default.
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