Abstract

Posterior capsular opacification (PCO) is the most common long-term complication following cataract surgery, significantly impacting visual quality and necessitating Nd:YAG laser capsulotomy for treatment. This prospective study evaluated comprehensive ocular parameter changes following Nd:YAG laser capsulotomy in 150 patients with PCO. All participants underwent detailed assessment including intraocular pressure (IOP) measurement, refraction, anterior chamber depth (ACD), macular thickness analysis using optical coherence tomography (OCT), and specular microscopy at baseline and at 1 day, 1 week, 1 month, and 3 months post-procedure. Mean patient age was 68.4±8.2 years with PCO developing 18.6±12.4 months post-cataract surgery. Pre-procedure IOP was 14.2±2.8 mmHg, increasing significantly to 16.8±4.1 mmHg at 1 day (p<0.001), with gradual normalization by 1 month (14.6±3.2 mmHg, p=0.34 vs baseline). Spherical equivalent refraction showed a myopic shift from -0.12±0.68 D to -0.31±0.72 D at 1 week (p=0.02), returning to baseline by 1 month. Anterior chamber depth increased significantly from 4.18±0.42 mm to 4.24±0.44 mm at 1 week (p=0.01), remaining stable thereafter. Central macular thickness demonstrated transient increase from 243.6±18.4 μm to 251.2±22.1 μm at 1 week (p=0.006), normalizing by 1 month. Specular microscopy revealed significant endothelial cell loss with cell density decreasing from 2486±284 cells/mm² to 2398±301 cells/mm² at 3 months (3.5% reduction, p<0.001). Coefficient of variation increased from 32.4±4.8% to 35.1±5.6% (p<0.001), indicating increased pleomorphism. Hexagonality decreased from 61.2±8.4% to 58.7±9.1% (p=0.02). Visual acuity improved significantly from 0.48±0.22 logMAR pre-procedure to 0.08±0.12 logMAR at 3 months (p<0.001). Complications included transient IOP elevation >21 mmHg in 18 patients (12%), resolving with topical therapy. No cases of retinal detachment, significant inflammation, or IOL damage occurred. Laser energy positively correlated with endothelial cell loss (r=0.34, p<0.001) and IOP elevation (r=0.28, p=0.001). The study demonstrates that Nd:YAG laser capsulotomy effectively treats PCO with generally transient effects on ocular parameters, though permanent endothelial cell loss occurs. Careful patient selection, optimal laser technique, and appropriate monitoring are essential for minimizing complications while achieving excellent visual outcomes.