1.
Presented By
Dr Rohit Rao

2.
 NEODYMIUM:YTTRIUM-ALUMINUM-GARNET
(Nd:YAG) laser
 Solid-state laser
 Wavelength of 1064 mm
 Results in ionization, or plasma formation acoustic
and shock waves that disrupt tissue.

3.
• Hydrodissection-associated cortical cleanup
• In-the-bag IOL fixation
• Capsulorhexis diameter slightly smaller than IOL optic
• IOL material :
– Hydrogel IOLs are associated with highest rate of PCO.
– PMMA is intermediate and
– Silicone and acrylic optic material is the lowest.
• IOL optic geometry with a square, truncated edge

4.
 Active lens epithelial proliferation;
 Transformation of lens epithelial cells into fibroblasts
with contractile elements
 Collagen deposition.

5.
 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.

6.
Preoperative Assessment
 All patients require a complete ophthalmic history
and examination before treatment.

7.
 The goal is to achieve flaps based in the periphery
inferiorly.
 Free-floating fragments should be avoided
 Cutting in a circle ("can-opener" style) tends to create
large fragments.
 "vitreous floater" of residual capsule may bother the
patient.

8.
 In aphakic eyes, deliberate focus anterior to the
capsule has been advocated as a mechanism for
opening the capsule while leaving the anterior hyaloid
intact.

9.
 The capsulotomy should be as large as the pupil in
isotopic conditions, such as driving at night, when
glare from the exposed capsulotomy edge is most
likely.
 A small opening might be preferred for a patient at
high risk of retinal detachment.

10.
 Elevated intraocular
pressure,
 CME,
 Retinal detachment,
 IOl damage,
 Endophthalmitis,
 Iritis,
 Vitritis,
 Macular holes,
 Corneal edema

11.
 Most common, usually transient,
 Associated with preexisting glaucoma, large
capsulotomy size, lack of a PCIOL, sulcus fixation of
PCIOL, higher laser energy, myopia, and preexisting
vitreoretinal disease.
 Apraclonidine, timolol, levobunolol, or other beta-
adrenergic antagonists are administered 1 hour before
the procedure and again following the procedure.

12.
Cystoid Macular Edema
 CME develops in 0.55% to 2.5% of eyes following
Nd:YAG laser posterior capsulotomy.
 CME may occur between 3 weeks and 11 months after
the capsulotomy.
Retinal Detachment
 Retinal detachment may complicate Nd:YAG laser
posterior capsulotomy in 0.08% to 3.6% of eyes.
 Myopia, a history of retinal detachment in the other
eye, younger age,and male sex are risk factors
following Nd:YAG laser posterior capsulotomy.

13.
 Capsulorrhexis is 4mm or smaller.
 Contracture of anterior capsule opening by lens
epithelial cells due to myofibroblastic differentiation.
 Pupillary obstruction,
 Zonules stress
 Risk of ZD and IOL decentration.
 Avoided by keeping capsulorrhexis to 5mm or greater
 Laser photodisruption of rhexix margin(2–3mJ
pulses)
 Deliberate anterior defocusing of laser prevents IOL
damage.

14.
 Retained cortex
 Slowly resorb
Or
 Dense fibrotic sheet
 Minimal amount of energy used (2mj).
 Emulsify the hydrated cortex, creating lens
“milk.”
 Liquefied material will clear within 24hrs.
 May cause inflammation and increased iop.