CATARACT 8 EWAP SEPTEMBER 2023 Following cataract surgery, patients may experience blurry vision. A posterior capsulotomy with the YAG laser is often employed by physicians as a solution to help patients achieve their desired vision. “A YAG capsulotomy has to be one of the most commonly performed procedures for a cataract and refractive surgeon,” said Robert Weinstock, MD. “Fortunately, it’s a safe, easy, and efficient technology.” Prior to YAG capsulotomies and the invention of the YAG laser, this was a much more challenging condition because it required going back into the eye and doing a surgical procedure, with the risk of infection. In addition, when you rip the capsulotomy, it’s not controlled, vitreous can come forward, and there can be PVD and retinal detachment, Dr. Robert Weinstock said. “I think the YAG was one of the greatest inventions in the history of ophthalmology,” he said. “It has made our lives so much better having the technology.” Dr. Robert Weinstock noted that his father, Stephen Weinstock, MD, was one of the first surgeons in the U.S. to have a YAG laser. “When I started practicing 20 years ago, he taught me how to become an artist with the YAG.” We’re trained to put this Contact information Nattis: asn516lu@gmail.com Robert Weinstock: rjweinstock@yahoo.com Stephen Weinstock: smweye@gmail.com Making Practice Perfect for Posterior capsulotomy: History of using the YAG laser and best practices by Ellen Stodola Editorial Co - Director This article originally appeared under the title “Posterior capsulotomy: history of using YAG laser and best practices” in the July 2023 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. contact lens on the eye, use low power, and punch out the capsule. “But for standard YAGs, [my father] taught me that you don’t need to put a lens on the eye. You can use higher power and do a couple of shots with the laser, and it splits it open without creating a big, punched out posterior capsule that floats around in the vitreous,” he said. “We use higher power with less shots now, which is much faster. … It’s become a much less invasive procedure. This makes it more efficient and takes only a couple of seconds.” Dr. Stephen Weinstock discussed his experience with YAG, noting that he estimates around 30–40% of patients develop PCO and need a YAG capsulotomy, no matter the precautions taken during surgery. It’s difficult to get 100% of lens epithelial cells removed during a cataract procedure, he said. Earlier YAG capsulotomies were more traumatic and less refined, he said. It wasn’t as powerful or fine-tuned, and there were slightly more complications (the main complication was lens dislocation into the vitreous). “Physicians were trying to figure out how to reduce the need for posterior capsulotomy,” Dr. Stephen Weinstock said. “As the laser was refined, I found that it was much easier to perform it PCO in a patient with a multifocal IOL needing a YAG to improve vision. Source: Robert Weinstock, MD
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