YAG capsulotomy is a safe procedure, but recognised complications exist and should be understood before treatment. Most adverse events are minor and self-limiting; serious complications are uncommon but require clinical monitoring and structured management pathways. ¹
Common, minor complications include transient intraocular pressure (IOP) elevation, which occurs in approximately 15% to 30% of patients within the first few hours following laser treatment. ³ The mechanism involves obstruction of the trabecular meshwork by capsular debris and inflammatory mediators released during photodisruption. Peak IOP elevation typically occurs one to three hours post-procedure and is usually self-limiting, resolving within 24 hours. Topical ocular hypotensive agents are prescribed if clinically indicated.
Vitreous floaters are very common following YAG capsulotomy, experienced by the majority of patients. These result from small fragments of the disrupted posterior capsule dispersing into the vitreous cavity. Floaters typically settle over days to several weeks as debris gravitates inferiorly or is cleared by physiological mechanisms. Persistent, visually disturbing floaters are uncommon but may occasionally warrant vitrectomy if symptoms remain functionally significant beyond six months. ²
Lens pitting, small marks on the intraocular lens surface, occurs in 1% to 8% of cases and is rarely visually significant unless located centrally within the visual axis. ² Rare but serious complications include retinal detachment, reported in 0.1% to 3.6% of cases depending on patient risk factors such as high myopia or lattice degeneration. ¹ Retinal tears may occur due to vitreous traction following capsular disruption. Cystoid macular oedema develops in approximately 1% to 2% of patients, more commonly in those with pre-existing risk factors such as diabetes or uveitis. ² These complications require prompt recognition and management within a structured clinical pathway.
References
- Javitt JC, Tielsch JM, Canner JK, Kolb MM, Sommer A, Steinberg EP. National outcomes of cataract extraction: increased risk of retinal complications associated with Nd:YAG laser capsulotomy. The Nd:YAG Laser Posterior Capsulotomy Study Group. Ophthalmology. 1992;99(10):1487-1497.
- 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.
- Richter CU, Arzeno G, Pappas HR, Steinert RF. Intraocular pressure elevation following Nd:YAG laser posterior capsulotomy. Ophthalmology. 1985;92(5):636-640.
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