Management of Posterior Capsule Opacification
Nd:YAG laser capsulotomy is the definitive treatment for posterior capsule opacification (PCO) when it causes visual impairment that interferes with the patient's functional needs or prevents adequate fundus visualization. 1
Pre-Procedure Requirements
Before performing YAG capsulotomy, you must verify two critical conditions:
- Ensure the eye is completely inflammation-free 1
- Confirm the intraocular lens is stable in position 1
These prerequisites are non-negotiable and must be documented before proceeding.
Indications for YAG Capsulotomy
Standard indications:
- PCO causing vision impairment that does not meet the patient's functional needs 1
- PCO causing critical interference with fundus visualization 1
Earlier intervention is warranted:
- Patients with multifocal IOLs should undergo capsulotomy earlier because PCO has a greater functional impact on vision quality, particularly in low-contrast and glare conditions 1
Critical Contraindication
Never perform prophylactic laser posterior capsulotomy - this is explicitly contraindicated by the American Academy of Ophthalmology 1
Risk Stratification and Complications
Retinal detachment risk:
- 0.29% risk of retinal tear and 0.87% risk of retinal detachment within the first 5 months post-capsulotomy 1
- Eyes with axial length less than 24.0 mm have shown 0% incidence of retinal detachment 1
High-risk patients include those with:
- Axial myopia 1
- Pre-existing vitreoretinal disease 1
- Male gender 1
- Young age 1
- History of vitreous prolapse 1
Post-Procedure Patient Education
Mandatory patient counseling:
- Educate all patients about symptoms of retinal tears or detachment to facilitate early diagnosis 1
- Specifically instruct patients to report new floaters, flashes, or visual field defects immediately 2
- Perform dilated fundus examination if any of these symptoms occur 2
Expected Outcomes
YAG laser capsulotomy is highly effective, with visual acuity improvement achieved in approximately 89% of cases, and the procedure is safe, non-invasive, and does not require hospitalization 3