Unnecessary capsulotomy due to a missed diagnosis of Vitreous opacities : Unnecessary capsulotomy due to a missed diagnosis of Vitreous opacities Scott Geller MD Fort Myers Florida
I have no commercial relationships or financial interests : I have no commercial relationships or financial interests Scott Geller MD Fort Myers Florida this is considered an off label use
Small Case Series : Small Case Series retrospective analysis of 10 patients
2007 - 2009
all had complaints of blurred vision not resolved after laser capsulotomy Scott Geller MD Fort Myers Florida
usual complaint to ophthalmologist: : usual complaint to ophthalmologist: ‘my vision gets blurred’
‘when I read it gets blurry’
‘something’s blurring my vision Scott Geller MD Fort Myers Florida
Patient parameters : Patient parameters age range 53 - 76
co-morbidities: 1 prior RD w scleral buckle
6 R eyes 4 L eyes
2 multi-focal implants
all had well done laser capsulotomies Scott Geller MD Fort Myers Florida
Slide 6: all patient 20/30 or better acuity
patient has no other obvious corneal, retinal, or optic nerve pathology
patient does not express typical eye floater complaints or symptoms
Ophthalmologist assumes there must be some capsular problem Scott Geller MD Fort Myers Florida
Slide 7: Ophthalmologist performs a capsulotomy
Patient reports no improvement in symptoms
Patient is subjected to the ‘usual’ battery of unnecessary tests
Patient referred/seeks opinion of other specialists.....often with no firm answer
Slide 8: patient loses faith in treating ophthalmologist
finally gets a definitive diagnosis
patient told ‘live with it’
extreme frustration because MD doesn’t appreciate severity of patient’s problem Scott Geller MD Fort Myers Florida
Materials and Methods ten cases : Correct diagnosis: patient history is key
Patients often can not articulate the exact nature of the symptoms
Physician can guide the patient in the history Materials and Methods ten cases Scott Geller MD Fort Myers Florida
Slide 10: Is the blur intermittent or constant ?
What makes the symptoms better?
Can patient duplicate symptoms merely by moving the head or eyes? Scott Geller MD Fort Myers Florida
Materials & Methods : Accurate history
Undilated initial evaluation by MD
Demonstration of worst acuity with opacity in visual axis- explain so patient understands
Evaluate vitreous with Goldmann Lens
Sophisticated devices are not needed Materials & Methods Scott Geller MD Fort Myers Florida
Slide 12: Lasag Microruptor II Yag laser
Fundamental ( vs. Multi ) Mode
Lasag/Haag- Streit CGV contact glass
Initial energy 300 - 400 pulses 4-5 mJ
1 drop Pred Acetate, Fibruprofin gtts. 8x/d Scott Geller MD Fort Myers Florida
Treatment Parameters : Treatment Parameters average number of sessions: 4.4
average total pulses: 1554
total power input: 5488 mJ
average power/pulse: 3.5 mJ Scott Geller MD Fort Myers Florida
Results of 10 Patients : Results of 10 Patients No complications
Results are subjective
3 Grades: mild, moderate, significant Scott Geller MD Fort Myers Florida
Key to Accuracy & Success : Key to Accuracy & Success Listen to the Patient !! Scott Geller MD South Florida Eye Foundation Fort Myers Florida