Nd:YAG laser capsulotomy is indicated for treatment of opaciﬁcation of the posterior capsule resulting in decreased visual acuity or visual function, or both, for the patient. It is not comfortable but most patients find it tolerable. A longitudinal incision is made along the dorsal aspect of the affected joint or joints ( Fig. The major performed anterior capsulotomy technique today is the continuous curvilinear capsulotomy (CCC) in phacoemulsification surgery. Closed capsulotomy does not always work and is not for everyone. A capsulotomy refers to an incision through the capsule. If postoperative pain is a concern (based primarily on the patient’s history of pain after the initial injury or surgery), consideration may be given to postoperative transcutaneous electrical nerve stimulation (TENS) along the appropriate peripheral nerve distribution. Control of postoperative edema during the initial 10 to 14 days after surgery is of great importance ( Fig. The following is an overview of one surgical approach for dorsal MCP joint capsulectomies. The procedure is done under tourniquet control. 68-4C , online). PMID: 4919283 [PubMed - indexed for MEDLINE] MeSH Terms. Abstract 72. Effective edema management minimizes the formation of adhesions, decreases the pressure and resistance to passive joint motion, and favorably influences the orientation of collagen fibers as active and passive ROM exercises are incorporated in the therapy program. A comprehensive, custom-designed rehabilitation program is essential for an excellent, functional outcome. … The edema at this level will generally subside within 2 to 3 weeks. Extension lags were commonly seen after 1-capsulotomy done through the extensor tendon (15/15 or 100%) where flexion was maintained for 5 to 7 days before starting physiotherapy to avoid tendon rupture at the suture line. Unlike the PIP and distal interphalangeal (DIP) joints, which have a consistent degree of stability throughout the arc of motion, the MCP joint has a relatively significant amount of lateral and rotational mobility, which is at its greatest in extension and is relatively eliminated in full flexion. Laseter, , Gorman, and Saunders published the most thorough reviews of therapy after these procedures. When performing cataract surgery, the Surgeon carefully opens the front portion of the capsule in . Xeroform serves as an effective barrier to reduce the likelihood of an infection. Cataract surgery, also called lens replacement surgery, is the removal of the natural lens of the eye (also called "crystalline lens") that has developed an opacification, which is referred to as a cataract, and its replacement with an intraocular lens.Metabolic changes of the crystalline lens fibers over time lead to the development of the cataract, causing impairment or loss of vision. 68-8 , online). Through the years, I have observed a large number of patients with 50 to 60 degrees of passive MCP joint flexion before surgery who ultimately obtained significant improvement in functional use of the hand after the procedure. Dorsal edema is common after MCP joint capsulectomies for the initial 10 to 14 days after surgery. The therapist must have a complete understanding of the extent of surgery performed, any residual limitations to full passive flexion, potential concerns related to joint stability, and any additional surgical procedures (e.g., tenolysis, intrinsic releases). 3. These wounds generally have an uneventful course and heal readily by secondary intention. The lens capsule is a flexible membrane that can cloud over or develop other problems in patients with certain eye diseases. Initiating early controlled motion will aid in the alignment and orientation of the newly forming collagen and will ultimately affect the final arc of motion. 68-1 ). As part of the initial examination, the therapist should have a full understanding of the patient’s goals and objectives for the surgery. It is critical to monitor active and passive ROM, edema with circumferential measurements along the distal palmar flexion crease or along the MCP joints, pain with a visual analog scale or by rating the pain on a scale of 0 to 10, and the wound (size and appearance). The capsule is composed of fibroblasts, collagen, and blood vessels. The sensation of the capsule breaking up is more discomfiting than the pain most of the time. One particularly effective method for controlling postoperative edema in the hand and forearm is a carefully and evenly applied light compressive dressing ( Fig. We report a case of acute retinal detachment seven days after Nd:YAG laser capsulotomy combined with Nd:YAG laser vitreolysis and analyze the cause of this complication. An objective examination should be performed during each treatment session after surgery. The main collateral ligament in particular becomes increasingly taut as the MCP joint reaches 45 degrees of flexion ( Fig. Be the first to answer this question. Other authors have briefly addressed the postoperative therapy. If an extensor tenolysis is needed, the tenolysis would be performed before the capsulectomy. A thorough understanding of the bony and soft tissue anatomy at the MCP joint level is essential for appreciating the surgical procedure and establishing an effective postoperative treatment regimen ( Fig. The main collateral ligaments are redundant in MCP extension and taut in MCP flexion. 68-9 , online). A yttrium aluminum garnet (YAG) capsulotomy is an outpatient laser surgery performed by an ophthalmologist on a patient who has previously had cataract surgery — the removal a cloudy lens from the eye. A number of authors have described their surgical approach for MCP joint dorsal capsulectomies. He asked me to bill 26525 and 26445. 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