Retinal breaks before and after neodymium : YAG posterior capsulotomy

Purpose: To determine th frequency of asymptomatic retinal breaks before an d after neodymium:YAG (Nd:YAG) laser posterior capsulotomy. Setting: Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. Methods: Of 350 consecutive patients referred for their first laser Nd:YAG posterior capsulotomy, 235 eligible eyes were enrolled and 220 eyes complet ed the study. A vitreoretinal surgeon looked for retinal breaks using binoc ular indirect ophthalmoscopy with scleral indentation. The eyes were examin ed 1 week before and 1 hour and 1 month after the posterior capsulotomy. Th e number, type, and location of retinal breaks were recorded. Results: The median age of eligible patients who did not participate in the study was higher than that of enrolled patients (79.6 versus 74.4 years; P = .0005). The mean axial length, median time from cataract surgery, and th e course of cataract surgery were comparable in both groups. Before the pos terior capsulotomy, an untreated retinal break was diagnosed in 4 of the 23 5 eyes (1.7%; 95% confidence interval [CI] 0 to 4) scheduled for surgery an d an undiagnosed retinal detachment was present in 2 additional eyes (0.9%; 95% CI 0 to 3). An asymptomatic retinal break was also present in 4 fellow eyes (1.7%, 95% CI 0 to 4). No new breaks developed during Nd:YAG posterio r capsulotomy using a median total energy of 51 mJ (range 10 to 901 mJ) and a median number of 22 applications (range 4 to 341 applications) and resul ting in an opening with a median largest diameter of 3.4 mm (range 2.0 to 4 .6 mm). In 1 treated eye (0.4%; 95% CI 0 to 2), a new retinal break had dev eloped by 1 month postoperatively. Conclusions: The observed 2.1% frequency of asymptomatic retinal breaks tha t had escaped the attention of the referring ophthalmologist or had develop ed by 1 month after Nd:YAG posterior capsulotomy can be contrasted with the 0.5% to 2.0% frequency of retinal detachment reported in the literature. H owever, it is not known which proportion of such asymptomatic breaks, if an y, will progress to detachment after Nd:YAG laser posterior capsulotomy. J Cataract Refract Surg 2000; 26:1190-1197 (C) 2000 ASCRS and ESCRS.