•Nd:YAG capsulotomy punctures the opacified posterior capsule by mechanical rupture of capsular tissue caused by shock waves originating from optical breakdown.
INDICATIONS:
•Visually significant PCO.
•Anterior capsulorrhexis contracture causing capsular phimosis.
DELIVERY PATTERNS:
1) CRUCIATE PATTERN:
•The first spot is placed superiorly and peripherally at the 12 o’clock position.
•Further spots are then placed inferiorly, extending toward 6 o’clock.
•Then to complete the cross, one has to extend from the center to 3 and 9 o’clock.
•It is preferable to place spots across tension lines, as this will result in the largest sized opening.
2) CHRISTMAS-TREE PATTERN:
•Start at 12 o’clock and sweep down toward 4:30 and 7:30, avoiding the central capsule and the risk for potential central lens damage.
•Free-floating fragments are best avoided.
3) CAN-OPENER METHOD:
•Laser capsulotomy is done along the circumference of the optic.
•It has the advantage to prevent potential damage to IOL in visual axis, but cut capsular fragment might obscure the visual axis.
4) INVERTED-U METHOD:
•Capsular fragment remains attached to inferior part of opening.
•But it is associated with the problem of early visual recovery.
POST PROCEDURE CARE:
•Anti-glaucoma agents to reduce the IOP spike.
•Topical steroids can be given to reduce inflammation.
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