ACADEMIC RESEARCH IN MODERN SCIENCE
International scientific-online conference
148
TREATMENT OPTIMIZATION AFTER ND: YAG CAPSULOTOMY
USING COMBINATION THERAPY
Nigmatjonova Nozima
Doctor of ophthalmology in the private clinic "Nazar"
https://doi.org/10.5281/zenodo.15575160
Relevance.
Nd:YAG laser capsulotomy remains the most common treatment for
secondary cataract, performed on millions of patients worldwide each year.
Although effective, the procedure can be accompanied by complications such as
transient ophthalmic hypertension, inflammation, and cystic macular edema,
which reduce visual outcome. With the growing elderly population and the
expansion of outpatient care, standardization of medication management after
capsulotomy is particularly relevant. The lack of uniform protocols, variability of
approaches, and the emergence of new drugs, including rock inhibitors,
emphasize the need to develop personalized treatment regimens based on
evidence-based medicine.
Purpose of the study.
To compare the efficacy of different regimens for drug prophylaxis of
complications after Nd:YAG capsulotomy in patients with secondary cataract.
Materials and methods of the study.
The study was conducted at Nazar Clinic between 2022 and 2024. 40
patients (41 eyes) with diagnosed secondary cataract who underwent Nd:YAG-
laser capsulotomy were included. Patients were randomized into two groups:
the first group received standard steroid therapy (dexamethasone 0.1%), the
second group received a combination regimen with a roc-inhibitor (netarsudil
0.02%) and a fixed combination of NSAIDs and GCS. Intraocular pressure,
presence of inflammation in the anterior chamber and cystic macular edema, as
well as visual acuity before and 30 days after the intervention were evaluated.
Control was performed using non-contact tonometry, slit lamp and OCT of the
macula.
Results of the study.
During the observation of 40 patients undergoing Nd:YAG capsulotomy, it
was found that the use of personalized combination therapy provides better
prophylactic effects compared to the standard regimen. In the group receiving
dexamethasone alone, a transient increase in intraocular pressure ≥5 mmHg
during the first 24 hours was observed in 23.8% of eyes. While in the group of
combined therapy with the addition of roc-inhibitor and NSAIDs this figure was
ACADEMIC RESEARCH IN MODERN SCIENCE
International scientific-online conference
149
only 5%, indicating a significant risk reduction (p<0.05). In patients receiving
the extended regimen, clinical signs of inflammation in the anterior chamber
(precipitates, fibrin) were registered less frequently and were less pronounced.
By day 7, 95% of eyes in the combined group had completely resolved the
reaction compared to 76% in the control group.
Cystic macular edema according to OCT data at day 30 was recorded in two
cases in the standard therapy group and was not detected in any case among
patients receiving combination treatment. Mean visual acuity increased from
0.39± 0.09 to 0.63± 0.07 in the monotherapy group and from 0.41± 0.10 to 0.69±
0.06 in the combined approach group (the difference is statistically insignificant,
p>0.05), but the speed of visual rehabilitation and subjective improvement were
observed faster in patients of the second group. No side effects and
complications related to drug treatment were registered.
Thus, the extended drug regimen demonstrated higher clinical efficacy in
the prevention of hypertensive and inflammatory complications after laser
capsulotomy, which confirms the feasibility of its application in risk groups and
in outpatient practice.
Conclusion.
The results of this study showed that combined drug therapy, including a
rock inhibitor and a fixed combination of non-steroidal and steroidal anti-
inflammatory agents, provides more effective prevention of complications after
Nd:YAG-laser capsulotomy in patients with secondary cataract compared to
standard steroidal monotherapy. This approach allows to significantly reduce
the frequency of transient increase in intraocular pressure, decrease the severity
of the inflammatory response and prevent the development of cystic macular
edema. Application of personalized treatment schemes at the stage of
postcapsulotomy management contributes to faster visual rehabilitation and
increases the safety of the procedure. The obtained data substantiate the
necessity of revision of approaches to drug prophylaxis and introduction of
standardized protocols in ophthalmic practice.
References:
1.
Wormstone IM. Posterior capsule opacification: a cell biological
perspective. Exp Eye Res. 2002;74:337–347.
2.
Nakazawa M, Ohtsuki K. Apparent accommodation in pseudophakic eyes
after implantation of posterior chamber intraocular lenses. Am J Ophthalmol.
1983 Oct;96(4):435–8. PMID: 6624824.
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International scientific-online conference
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3.
Aron-Rosa D, et al. Use of the neodymium-YAG laser to open the posterior
capsule after lens implant surgery: a preliminary report. J Am Intraocul Implant
Soc. 1980;6(4):352–4.
4.
Fankhauser F, et al. Clinical studies on laser radiation efficiency in the
anterior eye segment. Int Ophthalmol. 1981;3(3):129–39.
5.
Yanoff M, Duker JS. Posterior Capsule Opacification. In: Kohnen T, Koch
DD, eds. Ophthalmology. 4th ed. Elsevier; 2014:407–11
