In the Nd:YAG laser posterior capsulotomy for posterior capsule opacification (PCO), the ideal cruciate pattern of shots creates the opening. Which complication is specifically more common when the YAG energy exceeds 3 mJ per pulse?
- A Corneal decompensation from endothelial cell loss
- B Cystoid macular edema occurring within 24 hours
- C IOL pitting leading to optical aberrations, and rarely IOL fracture ✓
- D Retinal phototoxicity from the laser wavelength
Explanation
Nd:YAG laser creates a photodisruptive plasma-mediated shock wave to open the posterior capsule. When energy exceeds recommended levels (ideally 1-2 mJ per pulse, titrated to 3 mJ maximum), the shock wave is sufficient to pit or crater the posterior surface of the IOL optic, creating optical aberrations (halos, glare) that can be visually significant. In rare cases, very high energy pulses can fracture foldable IOLs (particularly silicone lenses, which are more susceptible). The recommended technique is to use minimum effective energy, focus precisely on the capsule, and use multiple lower-energy spots rather than few high-energy pulses to minimize IOL damage.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.