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Post-Nd:YAG laser complications in cataract patients treated for posterior capsular opacification: a systematic literature review

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First Author: D.O'Boyle IRELAND

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Posterior capsular opacification (PCO) is the most common complication after cataract surgery and its development is associated with several factors, including lens material and design of implanted intraocular lens (IOL). Nd:YAG laser capsulotomy is the only effective treatment for PCO, however, the procedure can place a financial burden on health care systems and has been shown to be associated with a number of complications. A systematic literature review (SLR) was conducted to compile evidence on the complications associated with Nd:YAG capsulotomy for PCO after cataract surgery.


A systematic literature search was conducted on Embase®, MEDLINE®, MEDLINE®-In Process, and Cochrane databases to include studies from January 1996 through January 2019


A systematic literature review was performed and post-Nd:YAG capsulotomy complications were identified in patients with age-related cataract, treated for PCO after IOL implantation. Randomized controlled trials (RCTs), and non-RCTs were included after independent screening by two reviewers, with conflicts resolved by a third reviewer.


Overall, 70 studies (nine RCTs and 61 non-RCTs) were included. Retinal detachment (28 studies), IOP elevation (23 studies), cystoid macular edema (14 studies), and IOL pitting (14 studies) were most frequently reported post-Nd:YAG capsulotomy, with incidence rates ranging between 0.1% and 6.3%, 0.8% and 70%, 0.2% and 9.6%, and 0.5% and 19.2%, respectively. Other complications included uveitis, iritis vitreous prolapse, floaters, corneal injury, hyaloid phase rupture, hyphema, and posterior vitreous detachment. A limited number of studies reported other ocular changes, including effect of Nd:YAG capsulotomy on foveal and macular thickness and compared pre- and post-surgical values without any conclusive correlation.


The evidence suggests that a number of complications occur after Nd:YAG capsulotomy, potentially leading to adverse clinical consequences for patients and may place financial burden on healthcare systems. The observed rates of complications vary hugely among the published studies, potentially due to multiple risk-inducing factors, such as comorbidities, age, and eye structure. The optimal choice of IOL with PCO-inhibiting design may play a role in improving health outcomes in cataract patients and decreasing the economic burden on national healthcare systems by reducing the requirement for Nd:YAG capsulotomy.

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