Eyeworld

36 | EYEWORLD | JULY 2023 ATARACT C 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 proce- dure 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 use a topical anesthetic because the procedure is not painful, there's nothing touching the eye when doing the procedure, and no incisions are made. "I do tell the patients they will be blurry for 30–60 minutes or longer after the laser, but by that evening or the next day, their vision will clear up significantly," she said. "I warn patients that it might make their floaters more noticeable." The techniques that have been developed to prevent opacification are great, Dr. Robert Weinstock said. For example, the square-edge lenses are proven to reduce the migration of lens epithelial cells, which are often the source of the opacification. Good cortical cleanup with I/A and polishing of the capsule is another technique that can slow the process of capsular opacification, he said. However, even with these options, the majority of patients will ultimately need a YAG capsulotomy. There are some patients who have fibrosis of the capsule itself during cataract surgery. Sometimes you can polish off some of the opac- ity at the posterior capsule. Other times patients have had previous surgery, like retina surgery, and there is scarring in the vitreous and posteri- continued from page 35 Anterior capsule phimosis requiring an anterior capsule YAG Open posterior capsule after YAG capsulotomy Source (all): Robert Weinstock, MD 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 fre- quently 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

• Blank Page
• Blank Page (1)