YAG Laser Capsulotomy

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What Is YAG Laser Capsulotomy?

A YAG laser capsulotomy is a type of laser eye surgery that uses a Yttrium-Aluminum Garnet (YAG) laser to improve a patient’s vision after cataract surgery. This procedure treats a common complication of cataract surgery in which the patient experiences cloudiness on part of their eye lens, a condition called posterior capsule opacification (PCO). 

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PCO is when scar tissue forms behind a lens implant. This complication occurs in 5 to 50 percent of cataract surgery cases, and YAG laser capsulotomy is recognized as the standard treatment for this condition.

In addition to treating posterior capsule opacification, the YAG laser is sometimes used to treat a LASIK surgery complication called epithelial cell ingrowth. This condition occurs when there is an increase in epithelial cells that obscure vision.

A YAG capsulotomy is one of the most commonly performed surgical procedures. While a YAG laser capsulotomy is generally a non-invasive and safe treatment with a high success rate, it still carries the risk of complications.

Indicators for YAG Laser Capsulotomy

The decision to have this procedure is based on the same criteria as the decision to have the original cataract surgery. The criterion includes:

  • Vision problems are affecting work or lifestyle
  • Glare caused by bright lights
  • Inability to pass a vision test required for a driver's license
  • Double vision
  • A marked difference in vision between the two eyes
  • Presence of another vision-threatening eye disease

A YAG laser capsulotomy procedure is not needed unless vision loss, caused by the lens capsule's clouding, is seriously affecting the person's vision and lifestyle.

YAG Procedure: Step-By-Step

During a YAG procedure, an eye doctor will apply a topical anesthetic (eye drops) to prevent the patient from feeling pain. The doctor will use a YAG laser beam to cut a hole in the lens capsule's clouded back lining. The laser passes through the front of the eye and the new lens implant, called an intraocular lens (IOL). The laser does not harm the eye. 

When the laser reaches the posterior capsule in the back of the eye, it makes a tiny opening in the scar tissue so light can enter the eye again. The new hole allows light to enter and ensures that the posterior capsule can still hold the lens implant in place.

A YAG laser capsulotomy is an outpatient procedure. The patient may wait in the outpatient surgery area or the doctor's office for 1 to 2 hours after the treatment to have the pressure in the eye (intraocular pressure) checked. Patients should not feel any pain after the surgery.

Patients are usually prescribed topical steroids or non-steroidal anti-inflammatory drugs (NSAIDs) to prevent cystoid macular edema and postoperative inflammation.

It will usually take 1 or 2 days to see as clearly as possible. Patients should be able to return to work or their routine the day after surgery.

A YAG procedure will typically include routine follow-up appointments to monitor the eye pressure and check for any complications. 

Does YAG Surgery Improve Vision?

The majority of patients with significant PCO experience clear vision after YAG laser capsulotomy. Most patients will notice an improvement in their vision as early as the next morning after the procedure.

Although rare, some patients experience vision problems after a YAG laser procedure. Patients should call their eye doctor right away if they experience blurry vision or if their eyesight worsens, as these are signs of serious complications.

Is YAG Capsulotomy Safe?

While YAG capsulotomy is generally considered safe, it does lead to complications in some cases. 

Common mild side effects after a YAG capsulotomy include:

  • Macular edema, or a buildup of fluid in the central area of the retina.
  • An increase in floaters that appear as black or gray specks or strings that drift across the eyes.
  • An increase in intraocular pressure (IOP)

These symptoms are generally manageable and non-life-threatening. 

In some circumstances, a YAG capsulotomy can lead to severe complications that include:

  • Retinal detachment (RD)
  • Corneal edema or swelling of the clear covering of the eye
  • Damage in the intraocular lens (IOL)
  • Retinal hemorrhage or bleeding into the front of the eye
  • Glaucoma 
  • Iritis or inflammation of the iris
  • Corneal injury
  • Vitritis or inflammation of the vitreous cavity
  • Pupil blockage
  • Hyphema
  • Cystoid macular edema
  • IOL dislocation
  • Exacerbation or spreading of endophthalmitis
  • Aqueous Misdirection Syndrome
  • Macular hole
  • Secondary closure of capsulotomy aperture

As with cataract surgery, it is crucial to weigh the risks and possible benefits of laser capsulotomy before deciding to have YAG surgery.

How Much Does YAG Laser Capsulotomy Cost?

The cost of a YAG Laser Surgery ranges from a few hundred dollars to almost $1500.

YAG is considered medically necessary and covered by insurance when performed following cataract extraction.

Resources
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Aslam, Tariq M, and Niall Patton. “Methods of assessment of patients for Nd:YAG laser capsulotomy that correlate with final visual improvement.” BMC ophthalmology vol. 4 13. 23 Sep. 2004, doi:10.1186/1471-2415-4-13 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC521490/

Brennan, Kristine. “Shutting the Door on Epithelial Ingrowth.” Review of Ophthalmology, 12 June 2018, www.reviewofophthalmology.com/article/shutting-the-door-on-epithelial-ingrowth

Bunting, H., Laganowski, H. Routine follow-up after YAG laser capsulotomy for posterior capsule opacification. Eye 20, 1449–1450 (2006). https://doi.org/10.1038/sj.eye.6702315 

Chun, Adam G. “Comparison Of Incidence Of Cystoid Macular Edema Following Nd: YAG Capsulotomy In Postoperative Treatment With Topical Steroids Versus Non-Steroidal Anti-Inflammatory Drugs.” Investigative Ophthalmology & Visual Science, The Association for Research in Vision and Ophthalmology, 22 Apr. 2011, https://iovs.arvojournals.org/article.aspx?articleid=2357044

Heltzer, James M. “How Quickly Does YAG Improve Vision?” American Academy of Ophthalmology, 14 Feb. 2018, www.aao.org/eye-health/ask-ophthalmologist-q/how-quickly-does-yag-improve-vision

“How Much Does a YAG Laser Surgery Cost Near Me?” MDsave, www.mdsave.com/procedures/yag-laser-surgery/d482f8cd

Karahan, Eyyup et al. “An Overview of Nd:YAG Laser Capsulotomy.” Medical hypothesis, discovery & innovation ophthalmology journal vol. 3,2 (2014): 45-50 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346677/

Koviak, Kathleen. “Posterior Capsule Opacification.” Michigan Medicine, University of Michigan Health System, Mar. 2015, www.med.umich.edu/1libr/Ophthalmology/Cornea/PosteriorCapusleOpacification.pdf

“Learning About YAG Laser Capsulotomy.” MyHealth.Alberta.ca Government of Alberta Personal Health Portal, https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zy1450

Nd:YAG Laser Posterior Capsulotomy After Cataract Surgery. www.healthlinkbc.ca/health-topics/hw36757

Raj, Shetal M et al. “Post-operative capsular opacification: a review.” International journal of biomedical science : IJBS vol. 3,4 (2007): 237-50 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3614664/

Wilkinson, C P. “Approximately How Much Does a YAG Procedure Cost?” American Academy of Ophthalmology, 13 Feb. 2018, www.aao.org/eye-health/ask-ophthalmologist-q/yag-cost

“YAG Capsulotomy: How a YAG Laser Works.” Veterans Health Library...Your Source for Health Information, www.veteranshealthlibrary.va.gov/142,83465_VA

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