Abstract
Purpose :
Although Nd:YAG laser capsulotomy is a safe and effective treatment for posterior capsule opacification, sight-threatening complications such as retinal detachments can arise. However, given improvements in laser technology, we aim to reevaluate the complication rate of the Nd:YAG laser capsulotomy and the follow-up protocols of this treatment.
Methods :
A retrospective chart review was conducted in an academic teaching center and private clinic between January 2015 and January 2021. Patients who underwent Nd:YAG laser capsulotomy were reviewed. Patients were excluded if they did not follow-up within 90 days of the procedure. Study parameters were evaluated prior to the procedure and during the initial follow-up. Parameters included prior ocular history, YAG laser settings, visual acuity, refractive error, intraocular pressure (IOP), and treatment complications. Statistical analysis included two-sample t-test used for continuous variables and Chi-squared test used for categorical variables.
Results :
1214 patients were included. Complication rates occurring after Nd:YAG laser capsulotomy at an average 42 day follow up were: retinal detachment (2, 0.16%), retinal tear (1, 0.08%), macular edema (9, 0.74%), macular hole (4, 0.33%), corneal edema (3, 0.25%), uveitis/iritis (9, 0.74%), and IOP elevation (21, 1.73%). Subgroup analysis of patient with elevated IOP revealed patient with a history of glaucoma were significantly more likely to develop postprocedural IOP spike (p = 0.03). No other past ocular history parameters were associated with an increased risk in post-YAG capsulotomy complications. There was no association with the number of spots applied, energy in the laser, or level of training with an increase in complications. Lastly, there were no significant changes in spherical equivalence following YAG capsulotomy (p = 0.56).
Conclusions :
Sight-threatening complications following Nd:YAG laser capsulotomy are rare. However, patients with a history of glaucoma may warrant a post-laser capsulotomy IOP check due to the increased risk of elevated IOP observed in this group. Follow up appointments to assess post-capsulotomy refraction is not indicated as the refractive status does not change. Considering the low complication rate associated with Nd:YAG laser capsulotomy, routine follow-up may be deferred in most patients.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.