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Nd YAG Laser Capsulotomy

Laser capsulotomy is a procedure used to restore full sight in cases where the lens capsule of the eye becomes cloudy in the first few years after surgery for cataracts – a so-called ‘after-cataract.’ The lens capsule is now almost always left in place during cataract surgery to hold the replacement lens. This cloudiness is referred to medically as posterior capsule opacification (PCO), referring to the capsule of the lens slowly becoming opaque. This occurs in 40% to 50% of patients who have had cataract removal surgery, but unfortunately there is no indication at the time of removal who will and who won’t go on to develop this condition.

The full name for this treatment is Nd-YAG Laser Capsulotomy. The bit of alphabet soup at the beginning describes the makeup of the optical crystal this sort of laser uses. It is primarily composed of the elements yttrium and aluminum plus the mineral garnet (YAG). To this is added a very small amount of the rare earth element called neodymium, Nd. Those who have never heard of this element, nor of yttrium, are most assuredly not alone! These are ‘trace’ elements only used in specialized industrial and medical applications.

In laser capsulotomy, a hole is made in the middle of the cloudy lens capsule with the laser. This allows light to fall onto the retina at the back of the eye without any interference. As with cataract removal itself, whether to undergo laser capsulotomy or not depends on the extent to which a person’s visual cloudiness affects their day-to-day activities. It can be scheduled around the patient’s calendar and needs. It is a painless procedure.

Following laser capsulotomy, a short term increase in the internal pressure of the eye is the most common complication. Macular edema – a swelling at the middle of the retina – can also occur. The most serious complication, occurring to approximately one in fifty laser capsulotomy patients, is retinal detachment. This can lead to blindness if not treated quickly and is therefore a medical emergency. Certain other eye conditions can affect the outcome of the procedure, which the eye doctor will be aware of. For the great majority of patients, laser capsulotomy restores clear sight with no major complications.

Nd-YAG lasers are used in several other medical procedures, including an operation for glaucoma (a serious swelling of the eye), for removal of skin cancers, skin hair or spider veins, and as a treatment for enlarged prostate (benign prostatic hypertrophy, BPH). Japanese researchers are even studying their potential to be used in cars instead of spark plugs! These devices clearly have a multitude of beneficial uses in addition to laser capsulotomy.

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