French Study Sheds Light on YAG Complications

Timing of YAG laser treatment implicated in complications. Dermot McGrath reports

Although Nd:YAG laser capsulotomy remains the gold standard posterior capsule opacification (PCO) treatment after cataract surgery, more data and largescale studies are needed to better understand the risk of complications associated with its use, according to Corinne Dot MD, PhD, Lyon, France.

“While the complications of Nd:YAG laser treatment have been known for years, there is still much to learn about the incidence and onset time of such complications—all the more so when one considers YAG capsulotomy is the most common ocular procedure practiced in France after cataract surgery,” Prof Dot said at the online annual meeting of the French Implant and Refractive Surgery Association (SAFIR).

Nd:YAG laser capsulotomy complications that cause decreased vision are uncommon but include ocular hypertension (OHT), cystoid macular oedema (CME), retinal detachment, IOL damage, endophthalmitis, iritis, and vitritis.

To shed light on the issue, Prof Dot carried out a noninterventional longitudinal cohort study using secondary data from a General Sample of Beneficiaries (EGB) database of patients who underwent Nd:YAG laser capsulotomy between 2014 and 2017 in France. The EGB is a permanent sample representative of 1/97th of the French population. Excluded were patients under 18, those with a history of OHT/glaucoma, retinal surgery, and medical retina treatment within 12 months of Nd:YAG laser treatment.

The study focused on three complications: OHT/glaucoma, retinal detachment, and macular oedema. All three complications were identified in 13.3% of the 6,210 patients included at the oneyear follow-up point after Nd:YAG. The complications occurred within three months for 68% of patients and within six months for 81%. Specifically, the 12-month incidence of OHT/glaucoma, macular oedema, and retinal detachment was estimated to be 9.6%, 6.4%, and 0.4%, respectively, Prof Dot said.

“The interval between surgery and Nd:YAG laser treatment showed that complications were more frequent in cases of early treatment—notably, maculopathy if the laser followed within one year of surgery, and OHT/glaucoma if the Nd:YAG laser treatment occurred within two years of surgery,” she said.

Summing up, Prof Dot said the data from the French study needed to be evaluated against the natural history of the pathologies in question to understand more about the risk of complications after Nd:YAG laser treatment.

“It also highlights the importance of developing and using fibrosis-free IOLs in our cataract surgeries,” she concluded.

Corinne Dot: corinnedot.pro@hotmail.fr

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