Introducing a Modified Nd:YAG Posterior Capsulotomy Technique: case series Study of a Continuous Ascending Linear Shot Pattern

Abstract Background Posterior capsule opacification (PCO) is the most common complication following cataract surgery. Treatment with Nd:YAG laser capsulotomy is the gold standard. We are describing a new technique that has been developed, which has the potential to improve the efficacy and safety of this procedure. Methods The method utilizes multiple continuous ascending linear pattern (CALP) laser shots, beginning at the bottom and forming successive horizontal rows upward. This technique creates a circular capsulotomy with minimal residual cloudiness at the edge of the intraocular lens (IOL) optic. The goal is to ensure complete removal of capsule remnants. Additionally, the reduced energy settings should provide greater control and lower the risk of complications. Results We treated 26 eyes of 23 patients with PCO. The average age was 73 ± 9.8 years. The average total energy used was on average 118.3 mJ. The average pre-treatment best corrected visual acuity (BCVA) was 0.53 on Snellen charts, which improved to 0.61 after the treatment. In 84% of cases, the optical axis was clear at the end of the intervention. Three patients reported subjective floaters, and two eyes required revision. The intraocular pressure increased on average by about 0.86 mmHg after the CALP capsulotomy. We did not observe any complications such as retinal detachment, inflammation, or macular oedema nor any other serious complications Conclusions The presented technique of CALP posterior capsulotomy offers numerous potential benefits, including higher efficiency despite lower energy usage, a larger optical gap, fewer capsule remnants and less subjective complaints. Further studies in a larger number of cases are needed to assess the method thoroughly.