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Nd:YAG capsulotomy
Cataract & Refractive Surgery
Key Points
- •Nd:YAG capsulotomy is the treatment for posterior capsular opacification (PCO) - the most common complication after cataract surgery, affecting 20–50% of patients within 2–5 years across all IOL types (5–20% with modern hydrophobic acrylic square-edge IOLs)
- •The laser works by photodisruption (not thermal) at 1064 nm wavelength - Q-switched pulses create plasma and shock waves that mechanically disrupt the posterior capsule
- •Always perform a dilated fundus exam and OCT macula before Nd:YAG to rule out retinal pathology and CME, which may mimic PCO symptoms
- •The Abraham capsulotomy lens (+66D button) is used to focus energy, reduce IOL damage, and stabilise the eye during the procedure
- •Post-procedure IOP check at 1 hour is mandatory; prophylactic apraclonidine 1% is given 30 minutes pre-procedure to prevent IOP spike
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- Definition
- Epidemiology
- Aetiology and causes
- Pathogenesis
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