Retinal breaks and detachment after neodymium: YAG laser posterior capsulotomy: five-year incidence in a prospective cohort.

ABSTRACT

PURPOSE: To determine the 5-year incidence of retinal breaks and retinal detachment (RD) after neodymiumYAG (NdYAG) laser posterior capsulotomy and the prophylactic treatment of perioperative retinal breaks. SETTING: Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. METHODS: This study design was stage 2 of a prospective nonrandomized interventional case series. Of 341 patients (350 eyes) referred for a first NdYAG laser posterior capsulotomy between October 1994 and February 1996, 211 (220 eyes) were examined for retinal breaks before and after capsulotomy (stage 1 of study). Asymptomatic breaks were prophylactically photocoagulated. Of the 211 patients, 106 (113 eyes) were examined at stage 2 a median of 4.9 years after NdYAG capsulotomy. The charts of all 341 patients were reviewed for development of RD and retinal breaks. The proportion of patients developing RD was estimated by Kaplan-Meier survival analysis, and the risk for RD was modeled by Cox proportional hazard regression. RESULTS: By 5 years, the overall cumulative proportion of RD in the 341 patients was 2.0% (95% confidence interval [CI], 1.0-4.0). Of the 211 eyes enrolled in stage 1, 2 (1.2%) developed an RD (95% CI, 0.3-4.7). Of 51 fellow eyes that had a capsulotomy and 120 eyes that had a capsulotomy but were not enrolled in stage 1 and were not prophylactically treated, RD occurred in 6 eyes (5.8%; 95% CI, 2.6-13). By univariate Cox regression, the axial length, whether modeled as a continuous variable (hazard ratio [HR] 1.51 for each millimeter increase) or categorized using 25.0 mm as a cutoff (HR 11.1), had the strongest association with RD after NdYAG posterior capsulotomy (P =.0002 and P =.0016, respectively). CONCLUSIONS: In addition to the capsulotomy, other known risk factors predicted RD after NdYAG laser posterior capsulotomy. Close follow-up and prophylactic photocoagulation of preexisting retinal breaks are worth considering, especially in high-risk eyes.