Anaesthesia outside operation room: Challenge for anaesthesiologists – Yttrium-aluminium-garnet capsulotomy

• Main Authors: Shobha Ravishankar, Sujatha Vittal, N Kavitha Kalaivani
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Hamdan Medical Journal
• Subjects: general anaesthesia; posterior capsular opacification; yttrium-aluminium-garnet capsulotomy
• Online Access: http://www.hamdanjournal.org/article.asp?issn=2227-2437;year=2020;volume=13;issue=1;spage=36;epage=38;aulast=Ravishankar

Introduction: Secondary capsular opacification is prevalent in children after cataract surgery, but for its treatment in children, few options exist. Poor cooperation precludes the use of neodymium yttrium-aluminium-garnet (Nd: YAG) capsulotomy in children. Surgery in the form of membranectomy is mostly resorted to, in case of a thick visually significant posterior capsular opacification (PCO). However, in case of thin PCO in the visual axis, Nd: YAG capsulotomy could act as a non-invasive alternative. Materials and Methods: Medical records of patients aged 1–16 years who underwent YAG capsulotomy under general anaesthesia between January 2007 and December 2016 were reviewed. Here, we present a case series of 18 eyes that underwent Nd: YAG capsulotomy under general anaesthesia at our centre. Eighteen eyes of 14 patients had undergone the laser procedure. All the patients were administered general anaesthesia in the laser room, and the procedure was performed in the sitting position on the slit-lamp laser delivery system. Results: The mean age at primary surgery for cataract was 2.15 ± 2.4 years. Of the 18 eyes, 1 (5.5%) was a traumatic cataract, all others being congenital cataracts. The mean age at Nd: YAG laser capsulotomy was 4.05 ± 2.38 years. The mean pre-procedural visual acuity was 0.654 ± 0.278 logMAR units and post-procedural visual acuity was significantly better at 0.502 ± 0.55 logMAR units, with P = 0.009. Conclusion: This, to our knowledge, is the largest reported series on patients who have undergone Nd: YAG laser capsulotomy under general anaesthesia. Although controversy exists on the positioning of patients during the procedure under general anaesthesia, we have successfully done 14 patients in the sitting position with no anaesthesia-related complications. Nd: YAG laser capsulotomy could be considered as a non-invasive alternative to membranectomy for PCO in children.