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Dr Rohit Rao
Wavelength of 1064 mm
Results in ionization, or plasma formation acoustic
and shock waves that disrupt tissue.
• 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
Active lens epithelial proliferation;
Transformation of lens epithelial cells into ﬁbroblasts
with contractile elements
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
All patients require a complete ophthalmic history
and examination before treatment.
The goal is to achieve flaps based in the periphery
Free-floating fragments should be avoided
Cutting in a circle ("can-opener" style) tends to create
"vitreous floater" of residual capsule may bother the
In aphakic eyes, deliberate focus anterior to the
capsule has been advocated as a mechanism for
opening the capsule while leaving the anterior hyaloid
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
A small opening might be preferred for a patient at
high risk of retinal detachment.
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
Apraclonidine, timolol, levobunolol, or other beta-
adrenergic antagonists are administered 1 hour before
the procedure and again following the procedure.
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
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.
Capsulorrhexis is 4mm or smaller.
Contracture of anterior capsule opening by lens
epithelial cells due to myofibroblastic differentiation.
Risk of ZD and IOL decentration.
Avoided by keeping capsulorrhexis to 5mm or greater
Laser photodisruption of rhexix margin(2–3mJ
Deliberate anterior defocusing of laser prevents IOL
Dense fibrotic sheet
Minimal amount of energy used (2mj).
Emulsify the hydrated cortex, creating lens
Liquefied material will clear within 24hrs.
May cause inflammation and increased iop.