Introduction Cataract is a consequence of the ageing of the lens and is the major priority in the global initiative to eliminate avoidable blindness by the year 2020. At present, the only means of treating cataract is by surgery, which initially restores high-quality vision and this is currently the most performed operation in developed countries. Aim of the Work to evaluate the influence of Nd:YAG laser capsulotomy on visual outcomes and macular thickness in patients with opacified posterior capsule. Patients and Methods This is a prospective comparative study done at the Nour Elein Hospital in Tanta. Thirty one pseudophakic eyes of patients (seven male, twenty four female), were included in the study with PCO following uncomplicated phacoemulsification with posterior chamber intraocular lens implantation. The age ranged from forty six years to sixty seven years old with a mean of (63.32±5.67) years. An informed consent was taken from each patient. All patients were treated by Nd: YAG laser capsulotomy between January 2017 till December 2017. The average time after cataract surgery was 18 months. Results Both groups had increased macular thickness at 1 week after Nd:YAG laser capsulotomy. The degree of macular thickening was similar in group 1 and group 2. Mean macular thickness was decreased to preoperative levels at 4 weeks after Nd:YAG laser capsulotomy in both groups volume. Conclusion Nd: YAG laser capsulotomy is the standard treatment for PCO and gives rise to rapid improvements in visual acuity, relieving the symptoms of blur, photophobia, and glare, and the size of capsulotomy opening does not affect the improvement in visual acuity, but it is better to avoid small sized capsulotomies to avoid post capsulotomy difractions.