Indications

Posterior capsular opacification, fibrosis, or wrinkling of posterior capsule causing a decrease in visual acuity after cataract extraction.

Preoperative Procedure

Examine patient to determine degree of visual loss caused by posterior capsule.

For example:

1. Judge clarity of fundus view with direct ophthalmoscope.

2. Measure acuity with potential acuity meter or brightness acuity test if needed.

3. Optional: Perform fluorescein angiography to rule out cystoid macular edema.

4. If pupil is small, dilate with tropicamide 1%. Before dilating eye, examine posterior capsule carefully, identifying and diagramming landmarks for reference when centering the capsulotomy.

5. Measure baseline intraocular pressure. In glaucoma patients, may pretreat with a topical β-blocker (e.g., Timoptic 0.5%) or α agonist (Iopidine 1% or brimonidine tartrate 0.15%) to blunt any postlaser spike in intraocular pressure (IOP).

Instrumentation

Nd:YAG laser

Contact lens (e.g., Abraham-YAG lens)

Operative Procedure

1. Apply topical anesthetic (e.g., proparacaine).