Topical steroid drops are not universally mandated following YAG capsulotomy, but they are routinely prescribed in thorough clinical pathways to reduce post-operative inflammation and minimise the risk of complications such as cystoid macular oedema and intraocular pressure elevation. ¹ A typical post-operative regimen involves prednisolone acetate 1% or dexamethasone 0.1% eye drops instilled four times daily for five to seven days.
The rationale for post-operative steroid therapy is based on the inflammatory response triggered by YAG capsulotomy. The laser’s photodisruptive action releases inflammatory mediators, disrupts the blood-aqueous barrier, and generates capsular debris that can provoke anterior chamber inflammation and increase prostaglandin synthesis. ³ These inflammatory processes can contribute to cystoid macular oedema, elevated intraocular pressure, and prolonged visual recovery.
Evidence regarding the necessity of routine steroid prophylaxis is mixed. Some studies suggest that post-operative steroids reduce the incidence of inflammation-related complications, while others indicate that uncomplicated YAG capsulotomy in low-risk eyes may not require routine steroid coverage. ² However, clinical practice in the United Kingdom typically favours short-term topical steroid use as a precautionary measure, particularly in patients with risk factors for inflammatory complications such as diabetes, previous uveitis, or history of post-operative cystoid macular oedema.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ketorolac or diclofenac eye drops, are an alternative or adjunct to steroids. Some evidence suggests NSAIDs may be more effective than steroids in preventing cystoid macular oedema post-YAG due to their direct inhibition of prostaglandin synthesis. ² In high-risk patients, combination therapy with both steroids and NSAIDs may be prescribed.
References
- Khalaff AG, Alfaraidy MR, Bukhari AA, Alhassoon FH. A case report on acute cystoid macular edema days after YAG laser posterior capsulotomy: Importance of post-operative optical coherence tomography. American Journal of Ophthalmology Case Reports. 2025;37:102349.
- Henderson BA, Kim JY, Ament CS, Ferrufino-Ponce ZK, Grabowska A, Cremers SL. Clinical pseudophakic cystoid macular edema. Risk factors for development and duration after treatment. Journal of Cataract and Refractive Surgery. 2007;33(9):1550-1558.
- Steinert RF, Puliafito CA, Kumar SR, Dudak SD, Patel S. Cystoid macular edema, retinal detachment, and glaucoma after Nd:YAG laser posterior capsulotomy. American Journal of Ophthalmology. 1991;112(4):373-380.
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