Type of Surgery
Last updated: 02/17/2009
One risk of laser capsulotomy is damage to the intraocular implant. Factors that determine the extent of damage to the IOL include the inherent resistance of a particular IOL to damage by the laser, the amount of energy used in the procedure, the position...
of the IOL within the lens capsule, and the focusing accuracy of the surgeon. The thicker the opacification of the lens capsule, the greater the amount of energy needed to remove it. The accuracy of the surgeon is improved when there is less opacification on the lens capsule.
In addition, during laser capsulotomy the IOL can be displaced into the eye's vitreous. This happens more often in eyes with a rigid implant, rather than with acrylic or silicone IOLs, and also if a larger implant is used. If the posterior capsule ruptures during extraction of the primary cataract, risk of lens displacement is also increased. Displacement risk is also increased if the area over which the laser capsulotomy is done is large. The most serious complication of a capsulotomy would be IOL damage so extensive that extraction would be required. This is a rare complication.
Another risk of this surgery is the re-formation of Elschnig's pearls over the opening created by the capsulotomy. This occurs in up to 80% of patients within two years of laser capsulotomy. Most of time, these PCOs will resolve over time without treatment, but 20% of patients will require a second laser capsulotomy. This secondary opacification by Elschnig pearls represents a spatial progression of the opacification that caused the initial secondary cataract.
Other risks to take into account when considering a posterior capsulotomy are macular edema, macular holes, corneal edema, inflammation of the iris, retinal detachment, and increased pressure in the eye, as well as glaucoma. These risks escalate with increased laser energy and with increased size of the capsulotomy area. Retinal detachments are usually treated with removal of the vitreous behind the lens capsule. Macular edema is treated by application of topical anti-inflammatory drops or intraocular steroid injections. Steroids control iritis (inflammation of the iris), either topically or intraocularly. Macular holes are also treated by removal of the vitreous (the substance that fills the main area of the eyeball), followed by one to three weeks of facedown positioning. Elevated intraocular pressure and glaucoma are treated with anti-glaucoma drops or glaucoma surgery, if necessary.
Finally, increased glare at night may result when the size of the capsulotomy is smaller than the diameter of the pupil during dark conditions.
Laser posterior capsulotomy, or YAG laser capsulotomy, is a noninvasive procedure performed on the eye to remove the opacification (cloudiness) that develops on the posterior capsule of the lens of the eye after extraction of a cataract. This differs from the anterior capsulotomy that the surgeon makes during cataract extraction to remove a cataract and implant an intraocular lens (IOL). Laser posterior capsulotomy is performed with Nd:YAG laser, which uses a wavelength to disrupt the opacification on the posterior lens capsule. The energy emitted from the laser forms a hole in the lens capsule, removing a central area of the opacification. This posterior capsule opacification (PCO) is also referred to as a secondary cataract.
Approximately 56% of all patients achieve results of 20/20 or better and over 90% achieve 20/40 or better (which is good enough to drive without corrective lenses in most regions).1 Those with moderate to high myopia (greater than 7 diopters) have a lesser chance of achieving that result. As technique and technology improve, the results continue to improve.
From: Eye Surgery Education Council
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