Anterior hyaloid face opacification after pediatric Nd : YAG laser capsulotomy

Purpose: The purpose of this study was to examine the clarity of the visual axis after Nd:YAG laser capsulotomy following cataract extraction and prim ary intraocular lens implantation in a pediatric population, Methods: A ret rospective review was performed of all cases of cataract extraction and pri mary intraocular lens implantation over a period of 5 years, A group of chi ldren who had been treated by primary surgical posterior capsulotomy and an terior vitrectomy (Group 1) was used as the "gold standard," with whom the children treated with Nd:YAG laser capsulotomy (Group 2) were compared. The groups were studied for the incidence of opacification of the visual axis after the primary procedure. Results: Data on 78 eyes were reviewed, and 56 eyes met inclusion criteria. Of these, 33 eyes were treated with primary p osterior capsulotomy and anterior vitrectomy (Group 1) and 23 eyes were tre ated with Nd:YAG laser capsulotomy (Group 2), One eye (3%) of Group 1 exper ienced postoperative visual axis reopacification. Thirteen (57%) of 23 eyes in Group 2 experienced reopacification, requiring retreatment Four eyes (1 7%) treated with Nd:YAG laser required a third treatment. Conclusions: In o ur series, 57% of patients treated with Nd:YAG laser capsulotomy experience d reopacification across the anterior hyaloid face. With the removal of the anterior vitreous at the time of cataract extraction, the scaffolding for cell migration is removed and reopacification of the visual axis is rarely seen, For patients in whom slit-lamp capsulotomy is not possible, especiall y if there is no Nd:YAG laser available for use in the operating room or wh en loss to follow-up may be an issue, primary posterior capsulotomy and ant erior vitrectomy should be strongly considered.