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What is lens pitting after YAG capsulotomy?

3 min read

Lens pitting refers to small surface marks or defects on the intraocular lens (IOL) that can occur when the YAG laser beam inadvertently contacts the lens surface during capsulotomy. ¹ These marks result from the laser’s photodisruptive energy creating localised damage at the point of contact. Lens pitting is reported in approximately 1% to 8% of YAG capsulotomy cases, with incidence varying according to laser technique, energy settings, IOL material, and anatomical factors. ³

The mechanism of lens pitting involves the laser focal point being positioned too anteriorly, at the IOL-capsule interface or on the IOL surface itself, rather than being focused within the posterior capsule tissue. This can occur when the posterior capsule lies very close to the posterior surface of the IOL, making precise focusing more challenging, or when higher energy settings are used that extend the zone of photodisruption anteriorly beyond the intended target. ¹

Certain IOL materials are more susceptible to laser damage. Silicone IOLs have a significantly higher incidence of pitting and a lower threshold for laser-induced damage compared to acrylic or polymethylmethacrylate (PMMA) lenses. ³ Studies demonstrate that mean laser energy in eyes with IOL pitting is significantly higher than in eyes without pitting, indicating that both energy selection and focusing precision influence risk. ²

In the vast majority of cases, lens pitting is clinically insignificant. Marks are typically small, peripheral, and do not lie within the central visual axis. Patients experience no visual symptoms, and the defects do not progress over time. Rarely, if pitting occurs centrally, patients may report mild glare or visual disturbances. However, functionally significant visual impairment from lens pitting is exceedingly uncommon, and IOL exchange is virtually never required. ²

References

  1. Bhargava R, Kumar P, Phogat H, Chaudhary KP, Kumar M. Neodymium-Yttrium Aluminium Garnet Laser Capsulotomy Energy Levels for Posterior Capsular Opacification. Journal of Ophthalmic and Vision Research. 2015;10(1):37-42.
  2. Steinert RF, Puliafito CA, Kumar SR, Dudak SD, Patel S. Cystoid macular edema, retinal detachment, and glaucoma after Nd:YAG laser posterior capsulotomy. American Journal of Ophthalmology. 1991;112(4):373-380.
  3. Karahan E, Er D, Kaynak S. An Overview of Nd:YAG Laser Capsulotomy. Medical Hypothesis, Discovery and Innovation in Ophthalmology. 2014;3(2):45-50.

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