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LATE POSTERIOR SEGMENTAL COMPLICATIONS AFTER ND YAG
CAPSULOTOMY AND WAYS TO MINIMIZE THEM
Nigmatjonova Nozima
Doctor of ophthalmology in the private clinic "Nazar"
https://doi.org/10.5281/zenodo.15575178
Relevance.
Despite the widespread use of Nd:YAG capsulotomy and its recognized
efficacy, late posterior segmental complications - damage to the optical zone of
the intraocular lens and vitreoretinal changes - remain an underestimated
problem. IOL pitting compromises image quality even with preserved visual
acuity, and vitreomacular traction and posterior hyaloid membrane tears can
serve as a trigger for late retinal detachment. Clear threshold values of
permissible total laser energy and retinal monitoring algorithms for patients
with different axial eye length have not been formulated yet, which leads to
variability of tactics and heterogeneity of outcomes. Considering the increasing
number of highly myopic patients and increasing average life expectancy after
IOL implantation, systematic study of risk factors and development of
personalized recommendations for laser energy reduction and dispensary
monitoring are of great clinical importance to prevent late visual loss.
Purpose of the study
.
To determine the incidence and key risk factors for intraocular lens
damage and vitreoretinal complications after Nd:YAG capsulotomy.
Materials and methods of the study.
A prospective study of late posterior-segmental complications of Nd:YAG
capsulotomy, focusing on intraocular lens damage (IOL pitting) and the
occurrence of vitreoretinal events, was conducted at the Nazar Clinic between
2022 and 2024. Fifty-one eyes of 49 patients (mean age 69± 7 years, axial
length 23.9± 1.2 mm) were included in the study. A low-energy mode was used
in all, but the total energy ranged from 40 to 220 μJ. Examination was
performed after 1 day, 1 week, 1 month, and 6 months using slit lamp, wide-
angle OCT, and ultra-widefield retinography.
Results of the study.
Among 51 eyes analyzed, damage to the optical surface of the intraocular
lens (IOL-pitting) was detected in one eye (2%). The case was registered at a
total Nd: YAG energy of 160 μJ and laser focus distance < 0.3 mm from the
posterior surface of the lens. Logistic analysis showed that exceeding the 150 μJ
threshold increased the risk of IOL pitting almost fourfold (p= 0.04).
Vitreoretinal changes were noted in two eyes (3.9%): subclinical posterior
CURRENT APPROACHES AND NEW RESEARCH IN
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hyaloid membrane tears without vision loss. Both cases were observed in
patients with axial eye length ≥ 24.5 mm and total energy> 140 μJ; no macular
changes or retinal tears were found. The changes regressed independently
within three months without intervention.
Thus, when the total laser energy is limited to 150 μJ and the focusing
distance ≥ 0.5 mm is maintained, the incidence of IOL-pitting and vitreoretinal
complications is reduced to single cases. The main risk factor remains axial
myopia, which requires extended retinal monitoring.
Conclusions.
Even with low-energy Nd:YAG capsulotomy, posterior segmental
complications remain clinically significant. The key risk factors are total laser
energy and axial eye length. Limiting the energy to 150 μJ and focusing the
pulse ≥0.5 mm from the posterior surface of the IOL reduces the incidence of
IOL- pitting, whereas patients with axial myopia require extended retinal
monitoring for up to 6 months. Personalized energy dosing and screening of
highly myopic patients can significantly reduce the incidence of late vitreoretinal
complications of Nd:YAG capsulotomy.
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Bhargava R, Kumar P, Sharma SK, et al. A Randomized Controlled Trial of
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