Five-year analysis: Outcomes and complications following neodymium: yttrium–aluminum–garnet laser posterior capsulotomy

Abstract: PURPOSE: To evaluate the incidence of complications after neodymium: yttrium–aluminum–garnet (Nd:YAG) laser capsulotomy and propose follow-up based on individual risk factors. METHODS: We conducted a retrospective review of Nd:YAG posterior capsulotomies performed at an academic center from April 2018 to March 2023. Exclusion criteria included anterior, surgical, and repeat capsulotomies. Parameters considered included intraocular pressure (IOP), corrected distance visual acuity, follow-up interval, and use of steroid or IOP-lowering eye drops. Complications within 1 year were analyzed to determine predisposing risk factors and laser parameters used. RESULTS: Of 594 eyes, an adverse event occurred in 43 (7.2%) eyes, including ocular hypertension in 20 (3.4%), iritis in 7 (1.2%), cystoid macular edema in 6 (1%), corneal decompensation in 4 (0.7%), posterior vitreous detachment in 4 (0.7%), and retinal tear or detachment in 3 (0.5%). Of eyes with complications, 38 (88%) had predisposing risk factors. Eyes experiencing complications were more likely to have a 1-week follow-up ( P < 0.00005), higher number of Nd:YAG laser spots ( P < 0.05), increased power setting ( P < 0.05), and greater total power delivered ( P < 0.005). No correlation was noted related to use of anti-inflammatory eye drops following laser ( P = 0.63). CONCLUSION: Although Nd:YAG laser capsulotomy is generally safe and effective, adverse events disproportionately affected those with risk factors. In low-risk eyes, routine corticosteroid use and early follow-up may be unnecessary.