Exceed your vision Microsurgery & Laser Centre
  • Lasers
    Lasers - YAG, Diode

YAG Laser Posterior Capsulotomy for Cataracts

The most common complication of adults having standard extracapsular surgery or phacoemulsification for cataracts is clouding of the part of the lens covering (capsule) that remains after surgery, called posterior capsule opacification. If the cloudiness affects your vision, you may choose to have a laser treatment called Nd:YAG posterior capsulotomy to correct this problem.

A laser (Nd:YAG laser) is used to cut a hole in the clouded back lining of the lens capsule to allow light to pass through the membrane to the retina at the back of the eye.

What To Expect After Laser

Nd:YAG laser posterior capsulotomy is an outpatient procedure. It does not require anesthesia, and it is painless. The person may wait in the outpatient surgery area or the doctor's office after the procedure so that he or she can have the pressure in the eye (intraocular pressure) checked. Intraocular pressure (IOP) is the pressure caused by the fluid inside the eye that helps keep the shape of the eye.

laser

Why It Is Done

After cataract surgery, some people notice cloudiness (sometimes called aftercataract) after several months or years. In some people, it can become very dense and cause as much or more vision loss as the original cataract. The decision to have this procedure is based on

  • Vision problems are affecting your work or lifestyle.
  • Glare caused by bright lights is a problem.
  • You cannot pass a vision test required for a driver's license.
  • You have double vision.
  • The difference in vision between your two eyes is significant.
  • You have another vision-threatening eye disease.
improving vision

How Well It Works

Nd:YAG laser posterior capsulotomy reduces glare and improves vision. It lets light pass through cloudy regions of the lens capsule that may develop after cataract surgery.

risk

Risks

The most common complication of Nd:YAG laser posterior capsulotomy is short-term increased pressure inside the eye.

    Other risks include:
  • Detachment of the nerve layer at the back of the eye (retinal detachment).
  • Swelling of the center of the retina (macular edema).
  • Damage or displacement of the intraocular lens.
  • Bleeding into the front of the eye.
  • Swelling of the clear covering of the eye (corneal edema).
laser

What To Think About

It is common to have a new floater in the eye after this Laser.

Diode Laser

Photocoagulation uses light to coagulate tissue. When energy from a strong light source is absorbed by tissue and is converted into thermal energy, coagulation necrosis occurs with denaturation of cellular proteins as temperature rises above 65 degrees C.

Since the Diabetic Retinopathy Study, technology evolved from using a diffuse Xenon arc to using well-focused laser in photocoagulating retinal tissue in high risk proliferative diabetic retinopathy. Presently, laser retinal photocoagulation is a therapeutic option in several retinal and eye conditions.

Effective retinal photocoagulation depends on how well light penetrates the ocular media on its way to the retinal tissue and how well the light is absorbed by pigment in the target tissue. In retinal tissue, light is absorbed by melanin, xanthophyll or hemoglobin. Melanin absorbs green, yellow, red and infrared wavelengths; xanthophyll (in the macula) absorbs blue but minimally absorbs yellow or red wavelengths; hemoglobin absorbs blue, green and yellow with minimal red wavelength absorption.

Indications

Indications for retinal photocoagulation include the following:

  • Panretinal photocoagulation in proliferative diseases such as proliferative diabetic retinopathy and venous occlusive diseases (see image below) Panretinal photocoagulation in venous occlusive eye diseases.
  • Focal or grid photocoagulation for macular edema from diabetes or branch vein occlusion
  • Treatment of threshold and high-risk prethreshold retinopathy of prematurity
  • Closure of retinal microvascular abnormalities such as microaneurysms, telangiectasia and perivascular leakage
  • Focal ablation of extrafoveal choroidal neovascular membrane
  • Creation of chorioretinal adhesions surrounding retinal breaks and detached areas
  • Focal treatment of pigment abnormalities such as leakage from central serous chorioretinopathy
  • Treatment of ocular tumors
Pan-Retinal Photocoagulation (PRP)

Pan-Retinal Photocoagulation (PRP)

Pan-Retinal Photocoagulation (PRP) is a form of treatment used for proliferative retinopathy including diabetic retinopathy and vascular occlusion retinopathy. Proliferative diabetic retinopathy is characterized by a growth of abnormal blood vessels within the retina as a result of ischemia (lack of oxygen). These abnormal blood vessels can leak profusely, causing serious damage to the retina and hemorrhaging into the vitreous.

Pan-Retinal Photocoagulation treatment uses a laser to destroy small areas of the peripheral retina. As shown in the picture above, several hundred spots will be placed in a circle around the mid-periphery of the retina. This reduces the over-all oxygen demanded by the retina, allowing oxygen to be better utilized by the area of the retina responsible for central vision. The treatment also prevents the growth of abnormal blood vessels within the retina. Multiple studies have shown PRP to be very effective in treating proliferative diabetic retinopathy and stabilizing or improving vision. Studies have also shown that over 50% of proliferative diabetic retinopathy cases left untreated lead to blindness, where as only 5% of treated cases lead to blindness.

The doctor or an assistant will place several drops in the eye to dilate and numb the eye, preparing it for the laser. Once the local anesthetic drop takes effect, the doctor will have you place your chin on the chin-rest and have you keep your forehead against the forehead-rest. Once in the proper position, a lens will be placed on the front of your eye, which is used to focus the laser precisely on the retina. Through-out the procedure, it is important that you keep your head still.
In some patients, the contact lens can cause irritation and/or discomfort. During the procedure, there may be a small pinching sensation with each laser spot. Depending on the amount of laser performed, you may also experience a headache after the procedure. Taking ibuprofen or acetaminophen is usually sufficient to help with this headache.
Some patients experience a slight irritation after the procedure from the lens being placed on the eye; however, this usually recedes quickly. You won’t see out of the eye for approximately 3-4 hours if you has anesthetic given behind the eye (the anesthetic has to wear off before the vision returns). As stated before, it is important that you do not move during the procedure. If you do, there is a possibility that the laser will affect a portion of your vision that it was not intended to (i.e. your central vision). Laser treatment causes light sensitivity, loss of peripheral vision in the area treated with laser, and some glare. Though the use of pan-retinal photocoagulation reduces the risk of vision loss due to diabetes, there is still a possibility that the disease will continue to get worse, causing further vision loss and blindness.

The problems after laser treatment are very small. If you have pain in the eye, take ibuprofen or acetaminophen. Should you experience an increase in flashes or floaters, or the sensation of a black curtain coming across your vision please call you doctor immediately. Likewise if you experience significant pain, redness, or a large drop in vision contact your doctor immediately.

No. You can return to your normal activities the same day as your laser treatment and do not need to take any prescription eye drops afterward. You can shower and watch TV without any harm to your eye.

Diode CycloPhotocoagulation (DCP)

Diode CycloPhotocoagulation (DCP)

Diode CycloPhotocoagulation or DCP, is an exciting development in the management of glaucoma.It is performed on an outpatient basis. In this procedure, the ciliary body of the eye, which creates fluid, is treated with a laser. This reduces fluid production that in turn, reduces intra-ocular pressure. The ciliary body is a small gland running around the circumference of the eye located behind the iris.

It can also be performed on those patients who had SLT or ALT laser procedures, glaucoma filtration surgery or other surgical procedures that were not successful at controlling intra-ocular pressure.

DCP has proven to be an effective way to reduce intra-ocular pressure. Studies have shown that the majority of patients have their glaucoma medications reduced or completely eliminated after the procedure and are no longer at risk of loss of vision from glaucoma.

Realistic expectations

Realistic expectations:

The effect of the surgery may wear off over time, but the majority of patients have their pressure reduced and many can eliminate their need for glaucoma medications

Back to top