Nd:YAG capsulotomy is not a risk factor for retinal detachment after phacoemulsification cataract surgery

Abstract

Purpose To evaluate the cumulative incidence and risk factors of pseudophakic retinal detachment (PRD) following phacoemulsification cataract surgery. Methods Cataract surgeries performed between the years 2007 and 2016 at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland, were included. The cumulative incidence of PRD was estimated through Kaplan–Meier analysis. Patient mortality was incorporated as one of the censoring events. Cox regression analyses were used to evaluate potential risk factors, including age, gender, intraocular lens (IOL) power and previous neodymium‐doped yttrium aluminium garnet (Nd:YAG) laser capsulotomy. Results A total of 17 688 eyes of 12 003 patients were included. The mean patient age at surgery was 75.2 ± 9.1 years with 63.5% females (n = 11 228). During the mean follow‐up time of 4.3 ± 2.7 years, 83 laterality‐matched PRDs were registered (incidence 0.11% per year). Univariate analyses showed that age (HR 0.93; 95% CI 0.92–0.95), male gender (HR 3.99; 95% CI 2.52–6.33) and IOL power (HR 0.86; 95% CI 0.83–0.90) were significantly associated with PRD (p < 0.001 for all) and remained significant in a multivariate analysis. Neither univariate (HR 1.45; 95% CI 0.82–2.54, p = 0.201) nor multivariate (HR 1.03; 95%CI 0.57–1.88, p = 0.919) analyses showed any association between Nd:YAG capsulotomy and PRD. Conclusions Male gender, low IOL power and younger age were confirmed as risk factors for PRD after phacoemulsification surgery. Real‐world evidence suggests that Nd:YAG capsulotomy does not increase the risk for PRD.

Comparing the effects and safety of dorzolamide hydrochloride + timolol maleate versus brimonidine after neodymium-doped yttrium aluminium garnet laser capsulotomy posterior capsule opacification

“…However, there are Nd:YAG laser posterior capsulotomy complications, such as elevation of IOP, 3 intraocular lens damage, 7 iritis and anterior chamber haemorrhage. 8 , 9 Increased IOP develops in more than half of the patients after laser treatment. However, this increase is usually below 30 mmHg.…”

Effect of Nd:YAG laser capsulotomy on the risk for retinal detachment after cataract surgery: systematic review and meta-analysis

“…Of the eligible studies, 4 reported HRs for pseudophakic RD after Nd:YAG capsulotomy using Cox proportional hazards models, representing a total of 175 pseudophakic RD cases in 42 079 eyes undergoing cataract surgery. 13,15,19,21 Among them, 4427 eyes underwent Nd:YAG laser capsulotomy. As the heterogeneity of the study results was marginal (I 2 = 53%, P = .09), a fixed-effects model was applied.…”

“…However, other studies did not suggest a causal relationship between Nd:YAG capsulotomy and the risk for developing RD. 8,9,11,14,17,20,21 Moreover, Elbaz et al recently reported the largest retrospective cohort study based on case records. 21 In 17 688 eyes that underwent phacoemulsification performed between 2007 and 2018, 83 laterality-matched eyes developed subsequent RD (incidence of 0.11% per year).…”

“…8,9,11,14,17,20,21 Moreover, Elbaz et al recently reported the largest retrospective cohort study based on case records. 21 In 17 688 eyes that underwent phacoemulsification performed between 2007 and 2018, 83 laterality-matched eyes developed subsequent RD (incidence of 0.11% per year). The rate of RD among those who underwent Nd:YAG capsulotomy was 0.63% (10 of 1594 patients), compared with 0.45% (73 of 16 094 patients) among those who did not undergo capsulotomy.…”

Refractive Lens Exchange Candidate Selection

“…Posterior capsule opacification 44,45 Capsule opacification If associated with a decrease in visual acuity or there if there is a change in quality of vision, then a YAG capsulotomy should be performed.…”