Neodymium:YAG laser posterior capsulotomies performed by residents at a Veterans Administration hospital

Purpose: To assess the initial efficacy of neodymium:YAG (Nd:YAG) laser posterior capsulotomies performed by residents at a teaching institution and to evaluate the associated complications over an extended follow-up. Setting: Department of Ophthalmology, Edward Hines, Jr. Veterans Administration Hospital, Hines, Illinois, USA. Methods: This retrospective noncomparative case review comprised 212 pseudophakic eyes having Nd:YAG laser posterior capsulotomies from April 1992 through March 1995. Evaluated were postoperative changes in best corrected visual acuity (BCVA), intraocular pressure (IOP) elevations, and complications related to the procedure. Results: In all 212 eyes, Snellen visual acuity was obtained at least 1 week after the capsulotomy. The BCVA in 96 eyes (45.3%) improved by 3 or more lines, in 43 (20.3%) by 2 lines, and in 51 (24.1%) by 1 line. Nineteen eyes (9.0%) did not improve by 1 or more lines, and 3 eyes (1.4%) had decreased Snellen acuity. All but 4 eyes with less than 1 line of improvement had underlying ocular pathology or a previous incomplete capsulotomy. For evaluation of postoperative complications, long-term follow-up was available for 133 of 212 eyes (62.7%). The mean follow-up for this group was 3.18 years. Postoperative complications were found in 14 of these eyes (10.5%). Nine (6.8%) had a rise in lOP greater than 10 mm Hg after the capsulotomy. One eye (0.8%) developed a persistent iritis, 2 (1.5%) had vitreous prolapse into the anterior chamber, and 2 (1.5%) developed rhegmatogenous retinal detachments. Conclusion: Postoperative Snellen acuity results and complication rates compare favorably with those in previous studies. The results indicate that Nd:YAG laser posterior capsulotomies performed by residents with attending supervision are safe, effective, and carry a low associated complication rate over a long follow-up.