YAG capsulotomy
K.P.SHANTHA SORUBARANI
What is PCO ??
• Posterior capsular opacification is
opacification / whitening of posterior
capsule
Why it occurs ?
• Due to proliferation of lens epithelial cells
from the equator across the posterior
capsule
In which type of patient / surgery it
is common?
• Depends on type of IOL (material & edge)
• Patient factors
When it occurs ?
• Time interval between surgery and
occurrence of PCO varies – months to
years
Types of PCO
• Fibrous Type:
Multiple layers of lens epithelium
( fibrous metaplaisia ) migrates and becomes
opaque
• Elschnig Type:
Migration of equatorial epithelial
cells with formation of small pearl like
opacities.
• Mixed type
Before YAG
Other conditions for which we do
laser here???
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YAG pigment dispersion
YAG membranolysis
YAG vitreolysis
YAG anterior capsulotomy ( phimosis
relaxation )
• Capsular Bag Distension Syndrome
How Nd- YAG laser works ??
• Principle called - Photo disruption
• Very intense laser energy is focused into
a small area for a very short period of
time producing a hole in the opacity
Indications
• Decreased vision – Due to PCO, Pigments
or precipitates on IOL, Capsular phimosis
• Monocular diplopia or glare.
• PCO preventing clear view of fundus
required for diagnostic and therapeutic
purposes.
Contraindications
• Absolute:
- Inadequate visualization of
posterior capsule (eg ) Corneal
scars , corneal edema.
- An un co-operative patient.
• Relative:
- Known / suspected CME.
- Active intraocular inflammation.
- High risk for RD. – High myopes
Pre – laser assessment
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Visual acuity
Retinoscopy
Slit lamp assessment of opacification
IOP
Fundus evaluation -Direct ophthalmoscopy
and indirect – if needed
Preparation of patients
• Describe the purpose and nature of
procedure in detail in his/ her own
language
• Dilate the pupil to about 4 to 5mm
facilitating visualization of posterior
capsule ( except in vitreolysis – instill
pilomine )
Preparation of patients
• Tell the patient that the procedure is
- PAINLESS
- Maintenance of STEADY FIXATION
• No Anesthesia is required
• If a contact lens is used, administer one
drop of 4% lignocaine in the eye to be
treated
Technique
• Can be done with or without a contact lens.
• Use the smallest amount of energy possible
with which the posterior capsule can be cut.
- YAG Posterior capsulotomy - 1.3- 2.5 mJ ( post )
- YAG pigment dispersion
– 0.4 – 0.8 mJ (ant )
- YAG membranolysis
- 0.8- 1.3 mJ (ant )
- YAG vitreolysis
- 0.8 mJ (ant )
- YAG anterior capsulotomy
-1.3- 1.7 mJ (ant )
( varies depending upon density of PCO)
Size of posterior capsulotomy
• The capsulotomy should be as large as
the size of pupil in ambient light.
After YAG
Fibrous PCO
Elsching’s PCO
Timing
• A YAG Laser posterior capsulotomy is
not done less then 6 months after surgery
• The procedure is only performed when
visual acuity significantly diminishes due to
posterior capsule opacification
• Others
Post YAG treatment
• After the Nd YAG laser capsulotomy ,
1% apraclonidine is administered topically to
control spikes in IOP
• Topical ab–steriod four times for-1week
• Frequency increased depending upon cases
• Anti glaucoma / diamox if needed
• If done along with suture removal – NSAIDAntibiotic combination
Post YAG treatment
• After ½ to 1 hour, repeat refraction and
IOP (if needed)
• Patient is reviewed as per doctor s advice
Complications
• Elevation of IOP
- Use less energy in glaucoma patients
- Pre and Post YAG Brimonidine
- Check IOP in glaucoma cases
• Damage to IOL – pitting
- Check anterior / posterior
- More if fibrous PCO / poor focusing/ un co
operative patients
Complications
• Cystoid macular edema
• Retinal Detachment – rare , definite risk
in myopia patients
- use less energy in myopes
THANK YOU