Regional Corneal Densitometry Changes and Endothelial Stability After Cruciate-Pattern Nd:YAG Laser Posterior Capsulotomy: A Retrospective Self-Controlled Study

Background/Objectives: Nd:YAG laser posterior capsulotomy may be followed by subtle corneal optical changes. We evaluated regional corneal densitometry (CD) and endothelial parameters after standardized cruciate-pattern capsulotomy. Methods: In this retrospective, self-controlled study, 51 eyes of 51 pseudophakic patients with clinically significant posterior capsule opacification underwent capsulotomy by a single surgeon. Scheimpflug CD was assessed in the anterior, central, posterior, and full-thickness cornea across 0–2, 2–6, 6–10, and 10–12 mm zones. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), pachymetry, keratometry, aberrometry, and specular microscopy were evaluated before treatment and at postoperative week 1 and month 1. Results: CD increased in the 0–2, 2–6, and 6–10 mm zones of the anterior and central layers, while the 10–12 mm zone showed no statistically significant time-related difference. The largest reported effect was in central-layer CD at 0–2 mm (d = 0.52). BCVA improved (decimal values, 0.32 ± 0.18 to 0.81 ± 0.13; p < 0.001). Endothelial cell density (ECD) and hexagonality showed no statistically significant time effects (p = 0.720 and p = 0.290); coefficient of variation decreased (p = 0.003), an isolated finding of uncertain clinical significance. IOP differed between week 1 and month 1 (15.0 ± 3.14 vs. 16.4 ± 2.73 mmHg) but both means were within the conventional physiological range and measurements were affected by the postoperative medication schedule. Corneal thickness, keratometric indices, and aberrations showed no significant time effects. Conclusions: Central and paracentral backscatter increases were detectable over one month without a statistically demonstrable deterioration in the measured endothelial or corneal structural indices. These findings do not establish endothelial equivalence or the clinical superiority of a capsulotomy pattern; controlled studies with longer follow-up are required.