1. YAG capsulotomy
K.P.SHANTHA SORUBARANI

2. What is PCO ??
Posterior capsular opacification is opacification / whitening of posterior capsule

3. Why it occurs ?
Due to proliferation of lens epithelial cells from the equator across the posterior capsule

4. In which type of patient / surgery it is common?
Depends on type of IOL (material & edge)
Patient factors

5. When it occurs ?
Time interval between surgery and occurrence of PCO varies – months to years

6. 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

7. Before YAG

8. Other conditions for which we do laser here???
YAG pigment dispersion
YAG membranolysis
YAG vitreolysis
YAG anterior capsulotomy ( phimosis relaxation )
Capsular Bag Distension Syndrome

9. 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

10. 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.

11. 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

12. Pre – laser assessment Visual acuity Retinoscopy
Slit lamp assessment of opacification
IOP
Fundus evaluation -Direct ophthalmoscopy and indirect – if needed

13. 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 )

14. 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

15. 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 mJ ( post )
- YAG pigment dispersion – 0.4 – 0.8 mJ (ant )
- YAG membranolysis mJ (ant )
- YAG vitreolysis mJ (ant )
- YAG anterior capsulotomy mJ (ant )
( varies depending upon density of PCO)

16. Size of posterior capsulotomy
The capsulotomy should be as large as the size of pupil in ambient light.

17. After YAG
Elsching’s PCO
Fibrous PCO

18. 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

19. 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 – NSAID- Antibiotic combination

20. Post YAG treatment
After ½ to 1 hour, repeat refraction and IOP (if needed)
Patient is reviewed as per doctor s advice

21. 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

22. Complications Cystoid macular edema
Retinal Detachment – rare , definite risk in myopia patients
- use less energy in myopes

23. THANK YOU