YAG Laser Capsulotomy (Posterior Capsulotomy)
Secondary cataracts are the most common complication after cataract surgery, and YAG laser capsulotomy is a fast, safe and effective treatment. It uses a special, precisely tuned laser to slice through clouded tissue that affects your vision after cataract surgery. That clears the way for light traveling through your eye, restoring your vision.
YAG laser capsulotomy (also known as posterior capsulotomy) is a quick, simple follow-up procedure that uses a special laser to treat posterior capsule opacification (PCO). Also known as secondary cataracts, PCO is when your vision is getting cloudy again after a previous cataract surgery.
YAG stands for yttrium aluminum garnet, an artificial gemstone that’s a key part of how the laser works. The laser fires precise pulses of energy that slice through the posterior capsule but shouldn’t significantly disrupt other tissues at the front or back of your eye. The cuts let the capsule surface open up slightly so light can pass through without the cloudy capsule surface in the way.
YAG laser capsulotomy usually doesn’t require any preparation on your part. Your eye specialist will schedule you to come to their office for this outpatient procedure. Right before your surgery, your eye specialist will also give you eye drops to numb your eyes and dilate your pupils. Once the drops take effect, you’ll be ready for the laser part of the procedure.
At the start of your YAG laser capsulotomy, your eye specialist will have you sit in a chair and position the laser in front of you. They’ll tell you to keep your eyes on a single point ahead of you.
- Laser programming. Your eye specialist will set up the laser so it fires in a set pattern.
- Lens use (optional). Some eye specialists will also use a special lens that they’ll hold against the surface of your eye. The lens will have some kind of lubricating gel or liquid on it, so there won’t be any friction between the lens and your eye surface. Your eye will also be numb at this point, so the lens touching your eye won’t cause any pain or discomfort. You may notice some pressure from the touch of the lens, but nothing more. If your eye specialist is holding that special lens to your eye, the laser beam will pass through it on the way to your eye.
- Laser activation. Once your eye specialist is ready, they’ll activate the laser, which sends out invisible pulses of energy. The laser’s frequency is too high for you to see. You also won’t feel anything in your eye, but you may hear a sound from the laser. When the laser is firing, you may notice some strange color changes in your vision, but these are normal and should stop after a few minutes.
The above steps take less than 10 minutes. Once your provider finishes using the laser, the procedure is over and you can go home.
YAG laser capsulotomy has the following advantages:
- It’s safe. Complications are uncommon, and they’re usually minor and treatable. Complication rates have also declined in recent years thanks to a growing understanding of ways to avoid PCO.
- It’s effective. Research shows that between 83% and 96% of people who have YAG laser capsulotomy have improvements in their sight. One small study from 2022 found that 99% of people who had this procedure reported an improvement in their sight.
- It’s an outpatient procedure. You don’t have to stay in the hospital after this procedure. Ophthalmologists can do it in clinic settings.
- There’s little to no pain or discomfort. Your eye is numb so you won’t feel any pain or discomfort during the procedure itself. Afterward, the most you should expect is minor discomfort or soreness. If you do have pain, that’s something you should tell your eye specialist about as soon as possible.
- It’s much less invasive than other approaches. Eye surgery is the only other way to do a posterior capsulotomy, and that approach is much more invasive. Using a laser to do posterior capsulotomy accomplishes the same goal without having to actually operate on your eyeball.
Complications aren’t common after YAG capsulotomy, and the ones that are more likely to happen are usually mild and treatable.
It’s common to notice an increase in eye floaters (myodesopsias) soon after the laser procedure, but those usually last only a few days. There’s limited research on how often this happens, and experts use specific laser-firing patterns to minimize the odds of this happening.
Other, less common complications can include:
- Uveitis.
- Macular holes.
- Cystoid macular edema and corneal edema.
- Retinal detachment.
- Retinal tearing.
When should I see or call my healthcare provider?
Your eye care specialist may schedule you for follow-up visits after your laser capsulotomy, but usually, your next annual eye visit will suffice.
If you experience any of these symptoms, seek emergency care:
- Eye flashes (photopsias).
- A large number of floaters (seeing some floaters after this procedure is normal, but if they appear suddenly and in large numbers, that’s a sign you need medical attention).
- A blind spot or dark curtain covering part of your vision (these may or may not expand).
- Sudden vision loss.
Conditions like retinal detachments, which are medical emergencies, can cause these symptoms. Without immediate care, the conditions causing these symptoms could cause permanent vision loss in the affected eye.
References
- American Academy of Ophthalmology EyeWiki. Posterior Capsule Opacification (https://eyewiki.aao.org/Posterior_Capsule_Opacification). Updated 7/9/2024. Accessed 8/28/2024.
- Biffi E, Gulmiri A, Patel B. Advanced Ocular Procedures. In: Reilly J, Gaiser H, Young B, eds. Clinical Procedures for Ocular Examination. 5th ed. McGraw Hill; 2024.
- Chen O, Greenfield LR, Raikar DH, et al. A Reevaluation of the Complication Rates and Follow-up Protocol of Nd:YAG Laser Capsulotomy. Invest. Ophthalm Vis Sci. 2023 June;64(8):3318.
- Lighthizer N, Johnson S, Holthaus J, et al. Nd:YAG Laser Capsulotomy: Efficacy and Outcomes Performed by Optometrists (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10662619/). Optom Vis Sci. 2023 Oct;100(10):665-669. Accessed 8/28/2024.
- McHugh J, Pringle E. Lasers in Ophthalmology. In: Riordan-Eva P, Augsburger JJ, eds. Vaughan & Asbury’s General Ophthalmology. 19th ed. McGraw-Hill Education; 2017.
- Moshirfar M, Milner D, Patel BC. Cataract Surgery (https://www.ncbi.nlm.nih.gov/books/NBK559253/). 2023 Jul 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Accessed 8/28/2024.
- Sabbagh L. PCO: What’s Wrong With Doing a YAG? (https://www.reviewofophthalmology.com/article/pco-whats-wrong-with-doing-a-yag) Review of Ophthalmology. 2018 May:34-38.
- The Ophthalmic News and Education (ONE) Network® of the American Academy of Ophthalmology. Nd:YAG Laser Posterior Capsulotomy (https://www.aao.org/education/current-insight/ndyag-laser-posterior-capsulotomy-3). Published 11/4/2013. Accessed 8/28/2024.
- Ursell PG, Dhariwal M, O’Boyle D, Khan J, Venerus A. 5 year incidence of YAG capsulotomy and PCO after cataract surgery with single-piece monofocal intraocular lenses: a real-world evidence study of 20,763 eyes (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182577/). Eye (Lond). 2020 May;34(5):960-968. Accessed 8/28/2024.
- Zhang AY, Kumar D, Tripathy K. Laser Principles in Ophthalmology (https://www.ncbi.nlm.nih.gov/books/NBK582153/). 2023 Aug 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Accessed 8/28/2024.
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