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Yag capsulotomy



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Yag capsulotomy

  1. 1. Presented By Dr Rohit Rao
  2. 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. 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. 4.  Active lens epithelial proliferation;  Transformation of lens epithelial cells into fibroblasts with contractile elements  Collagen deposition.
  5. 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. 6. Preoperative Assessment  All patients require a complete ophthalmic history and examination before treatment.
  7. 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. 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. 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. 10.  Elevated intraocular pressure,  CME,  Retinal detachment,  IOl damage,  Endophthalmitis,  Iritis,  Vitritis,  Macular holes,  Corneal edema
  11. 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. 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. 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. 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.