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YAG Capsulotomy

What is YAG Laser Capsulotomy?

The natural lens of our eye is placed in an elastic-like capsule or bag which holds it in place. YAG Laser Capsulotomy is a procedure in which an eye doctor makes use of a laser beam to create a little hole in this capsular bag. This allows light to pass through and thus restores clear vision.

 

What is posterior capsular opacity (PCO)?

When cataract surgery is performed, the front part of the capsule is opened so that the opaque lens can be removed from inside it. After this, the artificial lens (called intraocular lens) is placed within the capsular bag. The back of the capsule (called the posterior capsule) holds the intraocular lens and acts as a protective barrier for the back of the eye. Hence, this is left intact during cataract surgery. However, in some people, a few years after cataract surgery, the normally transparent capsule may produce cloudy cells and eventually develop opacity. This is called posterior capsule opacity or PCO.

 

Which factors affect posterior capsular opacity formation?

Apart from meticulous surgery techniques, rate of opacification declines with increasing age. PCO formation rates are more after traumatic cataract surgery. Hydrogel intra ocular lenses (IOLs) are usually known to cause the highest rate of posterior capsule opacities. The rates with Polymethylmethacrylate (PMMA) lenses are intermediate while silicone and acrylic optic materials have the lowest rates. IOL optic geometry with a square, truncated edge prevents PCO formation.

 

When does one require YAG capsulotomy?

The posterior capsular opacity can develop months or years after a cataract surgery due to scarring. Scarring is a normal healing response of our body after any injury (accidental or intentional like a surgery cut). This scar can cause blurry vision, just like the original cataract did. This is a common myth where you hear people wrongly alleging that their cataract “came back” after their cataract surgery. If this clouding of the posterior capsule causes interference in your vision, or causes doubling of vision or glare while driving, your eye doctor may advise opening this cloudy capsule.

 

What are the prerequisites of YAG capsulotomy?

Detail ophthalmic evaluation with best corrected visual acuity both eyes, IOP measurement and retina evaluation to rule out macular edema or retinal holes or tears is done prior to decision of YAG capsulotomy.

 

How long is the procedure ?

On your appointment for Yag capsulotomy, dilating drops are instilled twice in the concerned eye in the gap of 10 minutes till your pupil is dilated. The patient is seated comfortably and the stool, table, and chin rest are properly adjusted. The patient may tend to move behind during the treatment. To prevent this, a strap passes behind the patient's head from the headrest. The eye surgeon's visualization is usually enhanced in a darkened room. A drop of topical anaesthesia is instilled in that eye and the focusing lens is applied over that eye to proceed with capsulotomy

• No pain is felt during the procedure.

•  You may hear a small popping or clicking sound, but you are expected to maintain steady fixation.

•  The procedure is completed in a matter of minutes.

 

When will my vision normalize again?

You can swiftly resume most of your routine activities, but your vision might be blurry. As your eye heals after the procedure, the shape of your eyes, and hence your glasses number will keep changing. Considering how costly getting so many new lenses will be, it is advisable to wait for at least six weeks before you get new spectacles made according to your revised spectacle numbers.

 

What are the potential risks of YAG capsulotomy?

The risk of complication is very rare. Some patients develop high eye pressures, some may develop inflammation. To prevent these complications, steroid and pressure lowering drops are routinely prescribed to the patients after the procedure. Some patients may develop swelling in the retina called macular edema for which steroid drops are given after the procedure as a preventive measure.

Retinal detachment is the gravest risk of all.  The first symptom of retinal detachment is that of a black curtain falling over the eye. This can affect one’s side vision from any direction. Appearance of flashing lights may also be associated with the occurrence of retinal detachment. If you encounter any of these symptoms, make sure to contact your eye doctor immediately.