Nd: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 surgery 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. The Nd:YAG laser is currently considered the best way to remove the back lining of the lens capsule.

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 for 1 to 2 hours 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 maintain the shape of the eye.

Posterior capsular opacification affects about 1 in 4 people within 5 years of having cataract surgery.¹ The cloudiness may develop gradually over several months or years. This is sometimes called aftercataract or secondary membrane. 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 the same criteria as the decision to have the original cataract surgery:

• 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.

The procedure is not necessary unless vision loss caused by clouding of the lens capsule is seriously affecting the person's vision and lifestyle.

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

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).

Nd:YAG laser posterior capsulotomy is not used to prevent clouding of the back lining of the lens capsule (posterior capsule opacification). There is no way to know who will get clouding in the back of the eye after cataract surgery. Certain lenses used in the surgery to remove the cataract may lower this risk and the need for laser surgery later.

As with cataract surgery, it is important to weigh the risks and possible benefits of laser capsulotomy before deciding to have the surgery. About 1 out of 50 people who have laser capsulotomy after cataract surgery develop retinal detachment, which can cause serious vision loss.²

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Citations

1. Schaumberg DA, et al. (1998). A systematic overview of the incidence of posterior capsule opacification. Ophthalmology, 105(7): 1213–1221.

2. Ranta P, et al. (2004). Retinal breaks and detachment after neodymium:YAG laser posterior capsulotomy: Five-year incidence in a prospective cohort. Journal of Cataract and Refractive Surgery, 30(1): 58–66.