The YAG laser is a solid-state laser which uses a crystal and emits radiation with a wavelength of approximately 1064 um (infrared range), which leads to photodisruption. This can be used to alter or tear tissue in the eye.
Indication: post-cataract, capsulophimosis, before refractive post-treatment for ametropia following cataract surgery (e.g. Touch UP)
Inform the patient, have a declaration of consent signed
Maximum pupil dilate with Tropicamide eyedrops (Mydriaticum dispersa®) 3x every 10 minutes
The capsulotomy must be at least as large as the pupil in miosis.
Energy: 1-3 mJ (start low and slowly increase until capsule is torn)
Pulse: 1
Mode: fm
Focus:
Pattern: cross/star with magnification shots (no circle -> optically annoying)
Post-operative treatment:
Indication: Primary narrow-angle glaucoma and partner eye prophylaxis, secondary narrow-angle glaucoma (pupillary block), plateau iris syndrome, malignant glaucoma
Inform the patient, have a declaration of consent signed
Narrow the pupil: 1x apraclonidine 1% eyedrops (Iopidine 0.5-1%®) and 1x pilocarpine (Spersacarpine 2%®) within 10 minutes
Superotemporal iridotomy (fewer apertures and fewer ghost image as covered by the upper eyelid)
Energy: 4-7mJ (start low and slowly increase until iris tissue)
Pulse: 3
Mode: fm
Focus: 0 (no defocus) on iris crypts (fewer vessels)
Contact gas: (Volk Irid YAG® /Abraham YAG Iridotomy Lens®)
If blood escapes from the iris tissue, reapply contact gas and apply low pressure for 60 seconds or until bleeding stops
Eye pressure monitoring after 1 hour and gonioscopy to evaluate the angle of the chamber
Post-operative treatment: prednisolone eyedrops 4x/day for 4 days, 2x for 3 days, 2x for 2 days, 1x for 1 day
Indication: Existing glaucoma and malcompliance when applying eye drops (possible as a first-line treatment)
Lowers eye pressure by approximately 20-30% (corresponds to an active ingredient in eye pressure lowering eye drops)
Confluent laser spots in the area of the pigmented trabecular meshwork over 180°-360°
Energy: 0.6-0.9 mJ (deep until bubbles become visible)
Fixed (Ellex®): size 400 um, 3 ns)
Focus: 0 (no defocus) on iris crypts (fewer vessels)
Contact gas: (Volk Irid YAG/Abraham YAG Iridotomy Lens)
Eye pressure check after 1 hour (pressure spikes possible)
The SLT can be repeated after 6 months
Post-operative treatment: alpha agonist eyedrops 1x, prednisolone eyedrops 4x/day for 4 days, 2x for 3 days, 2x for 2 days, 1x for 1 day
Continue to reduce existing glaucoma eyedrops up to 6 weeks after
Sources: Will's Eye Manual
