Evaluation of Intraocular Pressure, Refraction, Anterior Chamber Depth, Macular Thickness, and Specular Microscopy Post-Neodymium-Doped Yttrium-Aluminum-Garnet Laser in Patients With Posterior Capsular Opacification

Background Cataract is the leading cause of blindness globally, particularly in India. Despite advancements in surgical techniques, postoperative complications remain common, with posterior capsular opacification (PCO) being the most frequent issue. Although neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy is recommended for managing PCO, it is associated with various side effects. This study aimed to evaluate the effects of Nd:YAG laser capsulotomy on intraocular pressure (IOP), visual acuity, anterior chamber depth (ACD), macular thickness, and corneal endothelium in Indian patients. Methodology This prospective, hospital-based study was conducted in the ophthalmology department at a tertiary care center in western Maharashtra from September 2022 to June 2024. Approval from the Institutional Scientific and Ethics Committee was obtained before commencing the research. In the study, 72 eyes from 72 patients with PCO following uncomplicated cataract surgery who were undergoing Nd:YAG laser capsulotomy were included, whereas patients with corneal pathology, retinal pathology, complicated cataract surgery, or trauma were excluded. Patients with active uveitis, non-compliant patients, and those unwilling to undergo the procedure were also excluded. Written informed consent was obtained from each patient. Data were managed in Microsoft Excel, and statistical analysis was conducted using the SPSS 26.0 software. As the continuous variables exhibited skewed distribution, the Wilcoxon test was employed to assess categorical variables such as the significance of IOP and endothelial cell differences over time. A significance level of 5% was assumed, with a p-value below 0.05 considered significant. Results The mean age of patients who underwent Nd:YAG capsulotomy was 64 years, with a female predominance of 37 (51.4%). In the study, 37 (51.4%) patients had their left eye treated, while 35 (48.6%) had their right eye treated. Overall, 45 (62.5%) patients had a baseline best-corrected visual acuity (BCVA) of 6/24-6/12. At one hour post-procedure, 46 (63.9%) patients in Group II had a BCVA of 6/24-6/12, and by one week after treatment, 53 (73.6%) patients had a BCVA of >6/12-6/6. ACD was normal in all patients before and after the procedure. Two patients developed macular edema at one hour and one week after the procedure. The mean IOP at baseline, one hour, and one week were 13.5, 13.86, and 13.69 mmHg, respectively. A significant increase in IOP was observed at one hour post-procedure, along with a significant decrease in endothelial cell count compared to baseline, which also persisted at one week. Conclusions Patients undergoing Nd:YAG capsulotomy experienced an initial rise in IOP, followed by a subsequent decline. Improved visual acuity was noted in most patients at one hour and by one week. A significant decline in endothelial cell count was observed following the procedure, and macular edema was noted in two patients. Anterior chamber reaction was observed in nearly all patients, which decreased by one week. With no change in ACD following the procedure up to one week, ocular refraction was not significantly impacted in the short term. Therefore, further large-scale intervention studies are needed to evaluate the effects of Nd:YAG laser capsulotomy size and the energy used on refractive error and post-procedure complications, as well as to explore the long-term effects on IOP.