Ocular complications found in more than 10% of eyes after Nd:YAG capsulotomy
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VIENNA — A nationwide cohort study carried out in France found ocular complications in more than 10% of eyes after Nd:YAG capsulotomy, mainly observed within the first 3 months after the procedure.
Increased risk was found with shorter intervals of 1 year or less between primary surgery and YAG.
The FreYAG2 study included 6,210 patients based on claims data. Complications of interest were ocular hypertension (OHT), macular edema (ME) and retinal detachment (RD).
“We found a 13% cumulative incidence of at least one of these complications within 12 months, specifically 10% for OHT and 6% for macular edema, while retinal detachment remained rare, inferior to 1%, at 18 months,” Corinne Dot, MD, said at the European Society of Cataract and Refractive Surgeons meeting.
Most of the complications occurred within the first 3 months after capsulotomy: 68.4% overall, more than half of OHT cases and three-quarters of ME cases.
One-third (32%) of YAG capsulotomies were performed within 2 years after cataract surgery, classified as “early YAG,” and 8% were performed within 1 year, classified as “very early YAG.”
“Time is one of the most important drivers of complication occurrence,” Dot said.
A short interval, less than 2 years, increased the risk for OHT by 30%, and very early YAG was a major risk factor for ME, with a risk increase of 50%. Patients with diabetes, 18% of the study population, were more at risk for both OHT and ME.
“Since data extraction did not permit to identify the type of IOL used, no correlation was drawn in this study between YAG rates and specific IOL materials and designs,” Dot said. “However, the increased risk in case of early YAG highlights the importance of correcting the known [posterior capsule opacification] factors, such as using hydrophobic IOLs, and caution with quality of surgery like bimanual instead of coaxial aspiration, and posterior capsule polishing,” she said.
Macular OCT should be performed before YAG capsulotomy in patients with diabetes, she recommended.
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Dot C, et al. Incidence of retinal detachment, macular edema and ocular hypertension following Nd:YAG capsulotomy: a population-based nation-wide study – the FreYAG2 study. Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 8-12, 2023; Vienna.
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