The YAG laser is a solid-state laser which uses a crystal and emits radiation with a wavelength of approximately 1064 µm (infrared range), which leads to photodisruption. This can be used to alter or tear tissue in the eye.
Indication: posterior capsule opacification, capsular phimosis, before refractive touch-up for residual ametropia after cataract surgery (e.g. Touch Up)
Inform the patient and have the consent form signed
Maximally dilate the pupil with tropicamide eye drops (Mydriaticum dispersa®) 3x every 10 minutes, if necessary using Mydriasert
In known glaucoma or endothelial damage (e.g. Fuchs endothelial dystrophy): apraclonidine (e.g. Iopidine® 1%) or brimonidine (e.g. Alphagan® 2mg/ml) or dorzolamide (e.g. Dorzo-Vision® 2%) eye drops once during preparation
Energy: 1-3 mJ (start low and slowly increase until the capsule is torn)
Pulse: 1
Mode: fm
Focus:
Pattern: cross/star with enlarging shots (no circle -> optically disturbing)
The capsulotomy must be at least as large as the mesopic pupil.
Post-operative treatment:
Check-up after 1 week with autorefraction and tonometry
If applicable, combined with YAG capsulotomy of the fellow eye (direct dilation)
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Progressive contraction of the anterior capsulorhexis after cataract surgery with:
Inform the patient and have the consent form signed
Maximally dilate the pupil with tropicamide eye drops (Mydriaticum dispersa®) 3x every 10 minutes, if necessary using Mydriasert
In known glaucoma or endothelial damage (e.g. Fuchs endothelial dystrophy): apraclonidine eye drops (e.g. Iopidine 1%) or brimonidine eye drops (e.g. Alphagan 2mg/ml) or dorzolamide (e.g. Dorzo-Vision 2%) once during preparation
Energy: 2-3 mJ (start low and slowly increase until the fibrotic anterior capsule is torn)
Pulse: 1
Mode: fm
Focus:
Pattern: place at least 3 radial relaxing incisions in the fibrotic anterior capsule. If tension is present, the phimosis tears posteriorly and the optical axis enlarges.
The capsulotomy must be at least as large as the mesopic pupil.
Check-up after 1 week with autorefraction and tonometry; further treatment may be necessary. If applicable, combined with treatment of the fellow eye (direct dilation)
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Indication: primary angle-closure glaucoma and prophylaxis of the fellow eye, secondary angle-closure glaucoma (pupillary block), plateau iris syndrome, malignant glaucoma
Inform the patient and have the consent form signed
Constrict the pupil: apraclonidine 1% eye drops (Iopidine 0.5-1%®) once and pilocarpine (Spersacarpine 2%®) eye drops once within 10 minutes
Energy: 4-7mJ (start low and slowly increase until the iris tissue is torn through)
Pulse: 3
Mode: fm
Focus: 0 (no defocus) on an iris crypt (fewer vessels)
Contact lens: (Volk Irid YAG®/Abraham YAG Iridotomy Lens®)
Perform the iridotomy superotemporally (fewer glare and ghost images, as it is covered by the upper lid) until penetration into the posterior chamber (transillumination)
If bleeding occurs from the iris tissue, reapply the contact lens and apply gentle pressure for 60 seconds or until hemostasis
Intraocular pressure check after 1 hour and gonioscopy to assess the angle
Post-operative treatment: prednisolone eye drops 4x/day for 4 days, 2x for 3 days, 2x for 2 days, 1x for 1 day
Indication: existing primary open-angle glaucoma and poor compliance with eye drop application (possible as first-line treatment)
Lowers intraocular pressure by approximately 20-30% (equivalent to one active ingredient of a pressure-lowering eye drop)
Energy: 0.6-0.9 mJ (deep, until "champagne bubbles" become visible) (less energy with more pigmentation)
Fixed (Ellex): size 400 um, 3 ns)
Focus: 0 (no defocus) on an iris crypt (fewer vessels)
Contact lens: (Latina SLT Gonio Laser Lens, Goldmann 3-mirror contact lens, Ritch Trabeculoplasty Lens)
Confluent laser spots over the pigmented trabecular meshwork, 50-100 spots over 180°-360°
Intraocular pressure check after 30-60 minutes (pressure spikes possible)
Post-operative treatment: alpha-agonist eye drops (e.g. Alphagan) 1x, prednisolone eye drops (e.g. Pred Forte) 4x/day for 4 days, 2x for 3 days, 2x for 2 days, 1x for 1 day
Continue existing glaucoma eye drops until 6 weeks, then reduce
Follow-up with the referring physician after 4-6 weeks
Repetition: SLT can be repeated if the effect wanes. No maximum number of repetitions is defined; clinical evidence for efficacy is available for up to three SLT treatments.
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Laser device: Ellex laser (Ultra Q Reflex, Ultra Q Reflex Neo, Tango Reflex, Tango Reflex Neo)
Contact lens: Volk Singh Mid-Vitreous, Ocular Karickhoff Off-Axis Vitreous
Energy: 3-4 mJ, titrate up to max. 10 mJ (the more posterior, the more energy needed)
Vitreous opacities
Relative contraindication (treat with caution)
Absolute contraindications
Tropicamide eye drops 3x and phenylephrine eye drops 2x, oxybuprocaine eye drops 2x (alternating every 3-5 minutes)
1. Use on-axis (coaxial) and off-axis illumination to identify and localize the opacity and to adjust the intensity of the red reflex
2. Decide whether the opacity lies within the safety zone
Recommendations: no restrictions necessary; black spots, especially in the lower visual field, correspond to air bubbles that resolve within a few days.
Post-operative treatment: Yellox eye drops 2x/day / Nevanac 3mg eye drops 1x/day / Nevanac 1mg eye drops 3x/day for 1 week
Intraocular pressure measurement 30 minutes after treatment
Follow-up after 3-7 days, repeat treatment if necessary (multiple treatments are usually required)
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