Adverse clinical consequences of neodymium:YAG laser treatment of posterior capsule opacification

Abstract

Purpose: 

To evaluate the clinical consequences of complications from neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO) over the lives of cataract patients.

Setting: 

CHU de Caen, Caen, France.

Methods: 

A model was constructed to estimate the lifetime clinical consequences of postoperative PCO treated by Nd:YAG laser capsulotomy. The probability of death was modeled from French mortality tables as a polynomial function of sex and age. The probability of becoming blind was modeled as a function of age from data in the literature. The incidence of Nd:YAG complications came from the literature. The rate of Nd:YAG capsulotomy over time was modeled as a survival curve using data from a cohort of 3335 patients.

Results: 

Over 9 years in a 70-year-old population, switching from an IOL with a 20% Nd:YAG capsulotomy rate at 3 years to an IOL with a 5% rate would avoid 1 chronic intraocular pressure increase requiring medical follow-up in every 54 surgeries, 1 case of glaucoma in every 237 surgeries, 1 case of cystoid macular edema in every 265 surgeries, and 1 retinal detachment in every 265 surgeries. A 3-year clinical study would only capture one-third to one-half of long-term adverse events of Nd:YAG capsulotomy.

Conclusion: 

Reducing PCO and the associated use Nd:YAG laser capsulotomy may contribute to preserving visual acuity in patients over their lifetimes.

In Brief

Based on an analysis of the literature and a cohort of 3335 pseudophakic patients, a Markov statistical model was used to estimate the long-term incidence of sight-threatening complications after Nd:YAG capsulotomy. Reducing PCO, and therefore the use of the Nd:YAG laser, preserves visual acuity over a patient's lifetime.