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Routine follow-up after YAG laser capsulotomy for posterior capsule opacification

Sir,

A national survey found 63% of consultant ophthalmologists review their patients within the first 8 weeks after YAG laser capsulotomy for posterior capsule opacification (RCO Annual Congress Abstract, Goyal and Goel, 2003). Review after YAG laser capsulotomy is not a stipulation of current national guidelines.1 What evidence is there that follow-up is necessary?

A retrospective assessment of patient notes for 121 YAG laser capsulotomies at Queen Mary's Hospital Sidcup from July 2003 to March 2004 revealed that the vision in 81.7% of eyes was 6/9 or better, where as 15.0% did not achieve 6/9 due to a clear comorbidity. Of the remaining 3.3% with vision less than 6/9, one patient had an inadequate capsule gap treated successfully with further laser, where as three patients had moderately reduced vision (6/12–6/18) in the absence of a definitive diagnosis.

No complications were recorded at the time of laser or on review, including the 19% of cases at higher risk of complications (axial myopia, previous retinal detachment, lattice degeneration, atrophic retinal holes, glaucoma, sulcus fixated lens, or uveitis).

Despite the relatively small numbers assessed, the high rate of satisfactory outcomes and the absence of complications concur with findings already published,2, 3 which affirm the efficacy and safety of YAG laser capsulotomy. Given an adequate capsulotomy gap, minimising of lens pitting, and an accurate refraction, visual outcomes for laser should be excellent, in the absence of a comorbid condition.

Even the more common complications, namely retinal detachment and cystoid macular oedema, which have an incidence of approximately 1 : 100, tend to occur after the first few months,4, 5 by which time most patients without a concurrent ophthalmic problem will have been discharged from outpatient follow-up.

More infrequent complications (less than 1 : 600) include macular hole, cracked lens, vitreous prolapse into the anterior chamber, lens subluxation, hyphema, uveitis, pupil block, and exacerbation of local endophthalmitis, many of which, should they occur, are identifiable at the time of the laser treatment.2, 6, 7

The spike in intraocular pressure that may occur following YAG laser, of particular clinical importance in patients with glaucoma, happens in the hours immediately post-procedure. Therefore, patients should have their pressures checked and receive treatment, if required, during the same visit, rather than at a later clinic review.

In view of the available evidence, we feel routine review in the first few weeks after laser is not justifiable, and that clinical resources should be redirected to areas of greater clinical need. We affirm the national guidelines, which emphasise the importance of both warning patients about possible complications and providing an advice sheet.1 In the event of pain, an absence of improvement or indeed a worsening of vision, or symptoms of retinal detachment, patients should be encouraged to report urgently, whether it be days, weeks, months, or even years after laser treatment.

References

  1. Royal College of Ophthalmologists. Management of posterior capsule opacification. In: Seward H (ed). Royal College of Ophthalmologists' Management of Cataract Surgery Guidelines London, 2004 p 34.

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Bunting, H., Laganowski, H. Routine follow-up after YAG laser capsulotomy for posterior capsule opacification. Eye 20, 1449–1450 (2006). https://doi.org/10.1038/sj.eye.6702315

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