Impact of Evolving Cataract Surgery Techniques and Technologies on Nd: YAG Posterior Capsulotomy Trends: 1980–2012
Purpose
To estimate the cumulative probability of Nd:YAG laser posterior capsulotomy after primary cataract extraction in a defined American population; and to estimate long-term trends of Nd:YAG posterior capsulotomy as affected by surgical technique, intraocular lens (IOL) optic material, IOL design, patient gender and age at time of surgery.
Methods
The resources of the Rochester Epidemiology Project were used to perform a population-based, retrospective analysis of all Olmsted County, Minnesota residents who had a Nd:YAG posterior capsulotomy following primary cataract surgery between January 1, 1980 and December 31, 2012. Cases of ocular trauma and those indicated for improved vitreoretinal procedure visualization were excluded. The cumulative probability of Nd:YAG posterior capsulotomy over the 32-year study period was calculated using Kaplan-Meier estimate. Potential risk factors for Nd:YAG posterior capsulotomy included IOL material, design, edge, surgery technique, patient age and gender were analyzed using Cox proportional hazards model.
Results
A total of 2,471 Nd:YAG posterior capsulotomies were identified after 17,335 cataract surgeries performed in 12,253 patients. The overall cumulative probability of Nd:YAG posterior capsulotomy was 2.6% (95% confidence interval [CI], 2.4%-2.9%) at 1 year, 19.5% (CI, 18.8%-20.3%) at 10 years, and 22.6% (CI, 21.4%-23.7%) at 20 years after cataract surgery. Adaptation of new phacoemulsification techniques combined with using foldable, acrylic, square-edged IOLs has lowered the probability of YAG capsulotomy to 1.6% (CI, 1.3%-2.0%) at 1 year and 8.6% (CI, 7.5%-9.6%) at 10 years after cataract surgery (P<0.001).
Conclusion
Our retrospective, population-based study documented a significant reduction in long-term Nd:YAG posterior capsulotomy rates following adaptation of phacoemulsification combined with using acrylic IOL optic material and square-edge optic design.