Utility of post-operative review following Nd:YAG laser capsulotomy

ABSTRACT

Purpose: NdYAG laser capsulotomy (YAG) is a common procedure with infrequent adverse events. We reviewed intraocular pressure (IOP) measurements 30 minutes after YAG in glaucomatous and non-glaucomatous eyes and a one-week post-op dilated fundus exam (DFE) to detect retinal tear (RT) and detachment (RD). We are interested in the utility of these same day and one-week visits, especially in glaucoma patients and in this COVID19 era. Methods: We analyzed 1,406 eyes from 1,138 patients who received YAG from 2011 to 2020 at the University of Florida. Exclusion criteria included YAG performed for reasons other than posterior capsular opacification, IOP not recorded and glaucoma status not analyzed. IOP (pre-op, 30 minutes post-op and at follow-up), follow-up DFE and glaucoma history were recorded. Primary outcome measures were change in IOP at same day and one-week post-op visits and incidence of RT and RD. Statistical analyses were conducted in IBM SPSS Statistics. Pre-op and same day post-op IOP in all patients (N=578) and in glaucoma patients (N=93) were compared with paired ttest. Univariate regression analysis was performed to assess if glaucoma history predicted which patients would have a rise in IOP of 5mmHg or more. ANOVA was used for comparison of intergroup difference between pre-op, same day post-op, and follow-up. Results: There was no significant change in mean pre-op and post-op IOP in all patients (p = 0.557), nor in the glaucoma patients (p = 0.194). Many patients (68.9%, N=404) were given a drop of brimonidine prior to YAG procedure. 69 patients had a rise in IOP of 5 mmHg or more at 30 minutes following YAG, including 13/93 (14%) of glaucoma eyes and 56/485 (12%) of non-glaucoma eyes. An IOP spike of 10mmHg occurred in 9 of these eyes of which 1 eye had glaucoma (1%) and 8 did not (89%). Using binary logistic regression, we found that glaucoma was not predictive for rise in IOP of 5mmHg or more following YAG (OR 1.23;95% CI=0.64-2.34). No patients had RT or RD detected during one-week follow-up visit. Conclusions: There is no significant change in IOP in all patients and in glaucoma patients. Glaucoma was not considered a risk factor for rise in IOP. YAG does not seem to increase the risk of RT or RD. In this COVID-19 era, when all practitioners aim to decrease in-person visits, small changes on a large scale can make an impact. If validated, our results bring into question the necessity of post-op visits after YAG.