CATARACT EWAP SEPTEMBER 2023 9 Anterior capsule phimosis requiring an anterior capsule YAG. Open posterior capsule after YAG capsulotomy. Source (all): Robert Weinstock, MD with precision so that we could guide how large of an opening we were going to create.” He said he’s seen very few complications in the past 15–20 years. “Prior to that, when I was doing cataract surgery, I used to spend a lot of time during the case vacuuming the posterior capsule,” he said. “I started thinking it was foolish to do this when there are so few complications post - YAG. “It used to be difficult when I would see a patient who had a posterior capsular cataract because many of them did not come off the posterior capsule,” Dr. Stephen Weinstock said. “They could require needling of the posterior capsule and/or a second procedure, with a higher risk profile and worse outcomes. When the YAG was invented, it was like a breath of fresh air because we didn’t have to worry about going back into the eye. It was a paradigm shift in our approach to cataract surgery,” he said. “I think this was one of the great advancements in surgery, and it led to other types of lasers being developed for glaucoma and other conditions.” Alanna Nattis, DO, uses the YAG laser frequently in her practice. “I do several per week, whether on my own patients or those referred after having cataract surgery several years ago,” she said. “It’s a successful and straightforward procedure for our patients and very gratifying because it restores vision to what it was right after they had cataract surgery.” She said the literature indicates that about 20–50% of patients will have PCO after surgery. A lot of surgeons polish the posterior capsule, and that can help prevent PCO, but sometimes it doesn’t, she said. “I like to explain to patients that it’s almost like scar tissue has formed, and it can make the vision blurry. It can give them glare and halos, and if that happens, we can do a laser procedure to help clear the central visual axis again,” she said, adding that it only takes a few minutes to do the procedure, and she does not use a contact lens with the YAG laser. “I aim the laser at the posterior capsule and try to make a large symmetric opening in the central visual axis of the posterior capsule with as little energy and as few shots as possible,” she said. While the YAG laser procedure is not high risk, Dr. Nattis noted that there is a small risk of retinal injury and retinal detachment. “That is not common today with the lasers that we have, [but] I do always counsel my patients about that, especially in those who have had prior retinal detachments.” Dr. Nattis said she doesn’t
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