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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. Scott Geller MD Fort Myers Florida. this is considered an off label use. Small Case Series.

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Unnecessary capsulotomy due to a missed diagnosis of Vitreous opacities

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  1. Unnecessary capsulotomy due to a missed diagnosis of Vitreous opacities • Scott Geller MD Fort Myers Florida

  2. I have no commercial relationships or financial interests • Scott Geller MD Fort Myers Florida this is considered an off label use

  3. 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

  4. 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

  5. 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

  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

  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

  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

  9. 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 Scott Geller MD Fort Myers Florida

  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

  11. 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 Scott Geller MD Fort Myers Florida

  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

  13. 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

  14. Results of 10 Patients • No complications • Results are subjective • 3 Grades: mild, moderate, significant Scott Geller MD Fort Myers Florida

  15. Key to Accuracy & Success • Listen to the Patient !! Scott Geller MD South Florida Eye Foundation Fort Myers Florida

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