YAG laser capsulotomy techniques

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I've read that there are 2 YAG laser capsulotomy techniques used to treat PCO after cataract surgery:

Cruciate and Circular.

For those who have had this procedure, did the surgeon discuss these with you beforehand?

Were you able to choose which technique you would prefer?

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11 Replies

  • Edited

    Here are some terms to search for your YAG laser PCO treatment searches:

    "hinged capsulotomy "

    "inverted U-shaped"

    I think they are both terms for the same thing. I think that is a third option, but that may be the same as modified circular or inverted-U. Let us know if that adjusts your thinking.

    I would not want Cruciate. I have not had PCO, so it has not come up for me.

    • Edited

      Thanks trilemma! I also found an article Comparison of two Nd:YAG laser posterior capsulotomy: cruciate pattern vs circular pattern with vitreous strand cutting published in 2018.

  • Edited

    I have some early indications of PCO in both of my eyes, and had an initial consult with a laser specialist at the suggestion of my optometrist. The specialist did not agree with the need to do YAG at this time, and also did not agree on which eye was worse. Net result was that the decision has been postponed for a year.

    .

    We never got to the point of discussing the YAG procedure. From what I know the cruciate method is more likely to damage the lens depending on the material. It is not recommended with the silicone material used with the LALs. In more standard lenses it may depend on the experience of each specialist and how confident they are in achieving the objective without damaging the IOL. That aside, from what I know the cruciate methods is more likely to be successful in addressing the impacts of PCO without creating issues with the edges of the capsule interfering with vision. The risk of damage to the standard lenses can likely be well managed by carefully focusing the laser on the capsule rather than the lens.

    .

    When the time comes for me I will go with the recommendation of the laser specialist.

  • Edited

    Thanks Ron. So you were referred to a laser specialist rather than your cataract surgeon?

    • Posted

      Yes, it was my preference to see the laser specialists and had an appointment with them for other reasons.

    • Posted

      Is that an option in Canada or are the yags there done by laser specialists rather than cataract surgeons? I ask because the 2 friends I know who have had yag both had it done by their surgeons.

    • Edited

      Not sure. My story is a bit complicated. I got a referral from my surgeon to see the laser specialist to investigate the possibility of reducing my irregular astigmatism after cataract surgery. It turned out to be a no go. But the laser specialist identified that I may have keratoconus. For that reason I had a follow up scheduled with him to determine if the condition was stable or not. During that time I had a regular eye exam by my optometrist who said I have PCO developing in one eye, and recommended I get a YAG procedure. So, I told him I had an appointment scheduled with the laser specialist and asked if they could do it. He said yes, as they would have the necessary laser to do it in their clinic. When I went to the appointment the laser specialist confirmed that my keratoconus was stable and said I had PCO developing in both eyes, but it was not at the point where he would recommend having YAG. So now that decision is postponed until November or so this year.

      .

      And if that is not complicated enough I have decided to switch optometrists for my annual diabetic eye exam and refraction check. My current one has not been doing dilated exams, and I think that is necessary. This new optometrist used to work for the laser specialist so I will double check with him as to whether or not they are the best suited to do the YAG, or if there are any better options. The laser clinic in addition to Lasik and PRK do lens exchanges and cataract surgery.

  • Posted

    Of course the surgeon will it discuss it with you. Both techniques have their pros and cons and there are journal articles to that effect. It will basically come down to which technique the surgeon prefers to use.

    I remember someone said here that you really want to be perfectly still when it is done.

    • Posted

      I don't know how sophisticated YAG lasers are compared to ones used for Lasik or PRK, but some of those lock in on the image of the eye and self compensate for reasonable eye movement during the procedure.

  • Edited

    I got the cruciate pattern. I didn't have any problems from the procedure. I looked exactly where the doctor told me to look and held very still.

  • Posted

    Thanks Karen, that's good to know. Since I've posted my question, I've read many earlier posts about YAG and it seems that many report problems ... To be honest, it seems more frightening than cataract surgery itself!

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