How Safe is Nd: YAG Laser Capsulotomy in Patients with Uveitis? Outcomes of a Long-Term Study

Purpose: To study the outcomes and complications of Nd: YAG laser capsulotomy in patients with uveitis.

Methods: This study retrospectively evaluated outcomes of Nd: YAG laser capsulotomy in 260 eyes of 260 patients with uveitis. The main indications for performing capsulotomy were a visually significant posterior capsule opacification (PCO) and inability to visualize the posterior segment. The presence of 5 or <5 cells per high-power field in the anterior chamber for a minimum period of 3 months was a prerequisite for capsulotomy.

Results: The mean age of patients was 52.8 ± 11.3 (range, 38-75 years). The incidence of PCO in the study was 22.4%. The mean follow-up was 21.5 ± 11.3 months postcapsulotomy. The mean best-corrected visual acuity (BCVA) improved in 161 (62%) eyes after capsulotomy. The BCVA remained stable in 50 (19.3%) eyes due to preexisting ocular pathology involving the macular area. There was worsening of BCVA in 49 (18.8%) eyes. The main causes of worsening of BCVA were sustained intraocular pressure (IOP) elevation (n = 13%), cystoid macular edema (CME) (n = 8.5%), and retinal detachment (RD) (n = 2.7%), respectively. Ninety-one percent (n = 20) of patients with CME had exaggerated postlaser inflammation and recurrent uveitis. The presence of posterior vitreous detachment (PVD) and higher laser energy levels were significant risk factors for RD.

Conclusions: Nd: YAG laser capsulotomy in patients with uveitis may be associated with complications. Inflammation and IOP should be well controlled before initiating laser capsulotomy. Capsulotomy should be performed with caution in patients with preexisting PVD.