This document summarizes information about Nd:YAG laser capsulotomy procedures. It discusses the laser used, how it works, preoperative assessment, procedure goals and techniques, potential complications, and ways to manage issues like capsulorrhexis contracture and retained lens cortex. The key points are that Nd:YAG laser capsulotomy can treat posterior capsule opacification, careful preoperative evaluation is important, the goal is to create capsulotomy flaps in the periphery to avoid fragments, and complications may include elevated pressure, inflammation, or retinal issues if not performed properly.

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.

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

11.  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.

14.  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.

15.  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.

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

18.  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.

19. 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.

21.  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.

24.  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.