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Evan N. Dunn, Anat Galor, Anna Junk, Sarah Wellik, Jesse Pelletier, Ninel Gregori; Cumulative Probability and Risk Analysis for Nd:YAG Laser Posterior Capsulotomy After Phacoemulsification. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2297.
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To estimate the cumulative probability of Nd:YAG laser posterior capsulotomy after phacoemulsification at a teaching institution and evaluate secondary risk factors.
All patients who underwent cataract extraction with phacoemulsification and intraocular lens (IOL) placement at the Veteran Affairs Hospital in Miami, Florida were retrospectively reviewed. The cumulative probability of Nd:YAG laser posterior capsulotomy (capsulotomy) was calculated using Kaplan-Meier survival analysis and secondary risk factors were evaluated using the Cox proportional hazards regression model.
1354 cataract extractions with phacoemulsification and IOL placement were included in the study with a total of 70 capsulotomies performed and a mean follow-up time of 19.4 months (standard deviation 17 months). The cumulative probability of capsulotomy was 4% at 1 year, 5% at 2 years, 9% at 3 years, 13% at 4 years, and 16% at 5 years. Multivariable analysis demonstrated an increased risk with eyes operated on by a more experienced surgeon (HR 4.32, CI 1.89-9.87, P=0.001), history of ocular trauma (HR 2.34, CI 1.13-4.83, P=0.02), and sulcus IOL (HR 2.57, CI 1.32-4.99, P=0.005). Older age was associated with less risk (HR 0.97, CI 0.95-0.99, P=0.007) of capsulotomy.
Cumulative probability of Nd:YAG laser posterior capsulotomy increased yearly after cataract extraction. PCO development is more likely in high risk cataract surgery, reserved for more experienced surgeons in this teaching institution. Surgeon awareness to the risk factors that correlate with posterior capsulotomy may allow for more thorough pre-operative disclosure and enhance patient satisfaction.
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