Incidence and risk factors of Nd: YAG capsulotomy after phacoemulsification in non-diabetic and diabetic patients

    loading  Checking for direct PDF access through Ovid

Abstract

Purpose

To estimate the cumulative incidence and identify the risk factors of posterior capsule opacification (PCO) that required Nd:YAG capsulotomy in non-diabetic and diabetic patients.

Methods

Retrospective case-note review of 806 consecutive patients that underwent phacoemulsification and intraocular lens (IOL) implantation, 327 (40.6%) of whom were diabetic.

Results

The cumulative incidence of Nd:YAG capsulotomy were 10.6%, 14.8%, 21.2% and 28.6% in non-diabetic patients; and 9%, 9.4%, 15.3% and 5.3% in diabetic patients after 1, 2, 3 and 4 years, respectively. A multivariate Cox regression analysis showed that, over the follow-up period, diabetes mellitus was associated with a decreased risk of Nd:YAG capsulotomy (hazard ratio [HR] = 0.69; 95% confidence interval [CI] 0.47–0.99; P = 0.047), whereas age of 65 years or younger (HR = 1.58; 95% CI 1.09–2.27; P = 0.02), polymethylmethacrylate (PMMA) (HR = 3.98; 95% CI 1.60–9.95; P = 0.003) or plate-haptic silicone IOLs (HR = 3.75; 95% CI 1.60–8.80; P = 0.002) in comparison with three-piece silicone IOLs, postoperative inflammation (HR = 2.62; 95% CI 1.56–4.42; P < 0.001) and pars plana vitrectomy (HR = 1.85; 95% CI 1.20–2.83; P = 0.005) were associated with an increased risk. Subgroup analysis showed that in non-diabetic patients, male gender (HR = 1.63; 95% CI 1.04–2.57; P = 0.03) was an additional risk factor and in diabetic patients there was no significant association between diabetes type, duration or retinopathy grade and the risk of Nd:YAG capsulotomy.

Conclusion

Although diabetes mellitus appears to be associated with a lower long-term incidence and a decreased risk of Nd:YAG capsulotomy, younger age, pars plana vitrectomy, postoperative inflammation, plate-haptic silicone and PMMA IOLs in addition to male gender in non-diabetic patients appear to be associated with a greater risk. Estimation of the incidence and risk factors of PCO should help in patient counselling and to design methods to reduce or prevent its development.

Related Topics

    loading  Loading Related Articles