A new form of damage to PMMA intraocular lenses by Nd: YAG laser photodisruptors

The damage that Nd:YAG laser radiation can cause to plastic (PMMA) IOLs during pseudophakic capsulotomy is well documented in the literature. This damage is the result of direct plasma action on the lens material. We report here another form of damage to PMMA IOLs which is more subtle and does not result from plasma action in the plastic. Even when the irradiance within the IOL is well below the threshold for optical breakdown, the PMMA can be damaged if irradiated by many laser pulses. This subthreshold damage is therefore cumulative. Its importance, likelihood of occurrence and ways to minimise this are considered.