Eyeworld

C JULY 2023 | EYEWORLD | 37 or plaques of fibrosis on the capsule. Those can't be removed at the time of cataract surgery, so those patients require a YAG fairly quickly because once the cataract is gone and the new lens is in, it's cloudy, Dr. Robert Weinstock said. "I'm not a fan of doing a posterior capsulotomy at the time of cataract surgery," he said. "I think it introduces the potential for vitreous to come through into the anterior segment, and the YAG is so safe and easy. In my opinion, it's easier to stage the procedures." Dr. Robert Weinstock said that he will tell patients after surgery that the capsule was opacified, and the safest move is to let the eye heal for a month or so, then do the YAG capsulotomy. Dr. Robert Weinstock noted that a lot of lenses in the premium cataract surgery arena are sensitive to PCO. The performance of these lenses can be degraded by small amounts of PCO, whereas patients might not notice as much with a monofocal. "Some surgeons are turning to earlier YAGs in the premium IOL patients to improve the performance of the IOL," he said. The other thing to note is even with the best biometry and the best surgical tech- nique, there are still cases of patients who are off target after surgery. When these patients have paid for premium cataract surgery, your goal is to get them out of glasses, and sometimes you must come back and do a surface ablation to fine tune the vision. Dr. Robert Weinstock said he typically likes to do the YAG capsulotomy first because there can be small changes of the refraction after the YAG. "There can be minor changes to the lens position after you release some of the tension on the posterior capsule," he said. "In my mind, it's best to do the YAG capsulotomy first, let the eye heal for a couple weeks, then bring the patient back, refract them, and move on to PRK or LASIK to fine tune the vision and reduce any residual refractive error." For the routine YAG, it's standard, he said. When you don't put a contact lens on the eye, you need more ener- gy. The contact lenses focus the energy, and you need less energy. But if you crank up the energy and don't put the contact lens on, it's just as effective, he explained. "There are cases where we see contraction of the anterior capsule coming over the optic, and sometimes it's even squeezing the lens and causing it not to be in the right location inside the eye," he said. "If you use the YAG to make little nicks in the anterior capsule, it can release the tension of the cap- sule and let the lens [settle into] a more natural position." Dr. Robert Weinstock cautioned against doing a YAG too early, particularly in patients having problems with multifocals or EDOF lenses. The issue could be neuroadap- tation, he said, but some jump to doing a YAG early. The patient might end up needing the lens explanted, depend- ing on how they adapt, he said. "It's a more complicated continued on page 38 Your Trusted Source for Sterile Tissue Allografts Stephens is a proud distributor of Optigraft,™ the premium choice for glaucoma and corneal applications including: tube shunt and valve coverage, trabeculectomy support, corneal perforations, and tectonic support. ■ Variety of precut sizes and thicknesses ■ Ready to use without re-hydration or rinsing ■ Terminally sterilized, up to two-year shelf life ■ Clear cornea for optimal cosmesis TM stephensinst.com/optigraft Toll Free ( USA ) 800.354.7848 | info@stephensinst.com | stephensinst.com © 2023 Stephens Instruments. All rights reserved. I N S T R U M E N T S | S I N G L E U S E | D R Y E Y E | B I O L O G I C S

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