Delayed capsulotomy much preferable over early procedure to prevent AEs

Ocular hypertension (OHT) and macular edema (ME) are the most common and relevant adverse events (AEs) following neodymium:yttrium-aluminum-garnet posterior capsulotomy (Nd:YAG-caps), reports a study. These AEs normally occur within 3 months after the procedure, which stresses the need for a close follow-up during this period or a delayed capsulotomy.

Adults who underwent Nd:YAG-caps between 2014 and 2017, with no ocular disease history in the year prior, were included in this observational cohort study. The authors identified patients using data from the French national representative sample and followed them for 12 months postprocedure. They used the Kaplan‒Meier method to assess time to AE and Cox models to determine factors associated with AE.

A total of 6,210 patients (mean age 75.0 years) received Nd:YAG-caps, with 7,958 procedures in total, during the study period.

Overall AE rates (≥1 AE of interest) at 3 and 12 months were 8.6 percent and 13.3 percent, respectively. Some 68.4 percent of AEs among patients with ≥1 AE of interest occurred within 3 months after the procedure. OHT and ME had 3-month rates of about 5 percent. During follow-up, retinal detachment rate was at ≤0.5 percent.

On Cox models, patients with Nd:YAG-caps carried out within 1 year after cataract surgery showed a greater risk of AEs than those who undertook the procedure much later (hazard ratio [HR], 1.314, 95 percent confidence interval [CI], 1.034‒1.669; p=0.0256), particularly ME (HR, 1.500, 95 percent CI, 1.087‒2.070; p=0.0137).

Patients with diabetes were at higher risk of OHT (HR, 1.233, 95 percent CI, 1.005‒1.513; p=0.0448) and ME (HR, 1.810, 95 percent CI, 1.446‒2.266; p<0.0001) than those without. In addition, patients who underwent Nd:YAG-caps between 1 and 2 years after cataract surgery were at greater risk of OHT than those with later procedures (HR, 1.429, 95 percent CI, 1.185‒1.723; p=0.0002).

“Diabetes and an early Nd:YAG-caps after cataract surgery were among the main drivers for AE occurrence,” the authors said.