Unnecessary
capsulotomy due to a
missed diagnosis of
Vitreous opacities
Scott Geller MD
Fort Myers Florida
I have no commercial
relationships or
financial interests
this is considered an off label use
Scott Geller MD
Fort Myers Florida
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:
• ‘my vision gets blurred’
• ‘when I read it gets blurry’
• ‘something’s blurring my vision
Scott Geller MD Fort Myers Florida
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
all patient 20/30 or better acuity
patient has no other obvious
corneal, retinal, or optic nerve
pathology
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patient does not express typical
eye floater complaints or
symptoms
Ophthalmologist assumes there
must be some capsular problem
Scott Geller MD Fort Myers Florida
• 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
• 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
Scott Geller MD Fort Myers Florida
• 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
Scott Geller MD Fort Myers Florida
• 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
• 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
• No complications
• Results are subjective
• 3 Grades: mild, moderate, significant
Scott Geller MD Fort Myers Florida
Key to Accuracy &
Success
Listen to the Patient
!!
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Scott Geller MD South Florida
Eye Foundation Fort Myers
Florida