Neodymium-doped yttrium aluminum garnet (Nd: YAG) laser treatment in ophthalmology: a review of the most common procedures Capsulotomy and Iridotomy.

Nowadays, lasers are used in various medical fields. Ophthalmology was the first medical specialty to utilize lasers in patient treatment and still remains the leading medical field that uses laser energy for both therapeutic and diagnostic purposes. The neodymium: yttrium-aluminum-garnet (Nd: YAG) laser is one of the most common lasers used in ophthalmology. It is a solid-state laser with a wavelength of 1064 nm that works on the principle of photodisruption. Since its introduction in ophthalmology over 40 years ago, it has found various applications, mainly for procedures where cutting or disruption of ocular tissue is required. Compared to surgical alternatives, the use of Nd: YAG lasers on ocular tissue is minimally invasive. In this review, we focus on the two most common ophthalmic applications of Nd: YAG laser - laser peripheral iridotomy and posterior capsulotomy. The history of the techniques, current trends, potential complications, and the prognosis for future use is discussed.

Angle-closure glaucoma associated with vitreous prolapse after neodymium-doped yttrium-aluminumgarnet laser posterior capsulotomy.

Capsulotomy with neodymium-doped yttriumaluminum-garnet (Nd:YAG) laser is an effective treatment for posterior capsule opacification following cataract surgery. A wide opening of the posterior capsule associated with the ruptured anterior hyaloid can cause anterior chamber vitreous prolapse. Two patients who developed angle-closure glaucoma associated with vitreous prolapse following Nd:YAG laser posterior capsulotomy were successfully treated with antiglaucoma medication and peripheral iridotomies. Patient identification for potential risk factors and a careful postoperative follow-up are essential to avoid these serious complications.

Influence of Nd:YAG laser capsulotomy on toric intraocular lens rotation and change in cylinder power.

PURPOSE: To investigate toric monofocal intraocular lens (TIOL) rotation and associated changes in cylinder power caused by Nd:YAG laser capsulotomy performed due to posterior capsule opacification (PCO). SETTING: Ekol Eye Hospital, Izmir, Turkey. DESIGN: Prospective case series. METHODS: 41 eyes of 20 women and 21 men were included in the study. Before and 1 month after Nd:YAG laser capsulotomy, TIOL tilt and decentration were determined with Scheimpflug camera, and TIOL axial rotation and the change in cylinder power induced by this rotation were measured by ray tracing aberrometry. The time interval between cataract surgery and Nd:YAG laser capsulotomy was noted. RESULTS: Rotational misalignment of the TIOL was measured as 4.65 ± 2.75 degrees (range 0 to 11 degrees) before vs 6.97 ± 2.92 degrees (range 0 to 13 degrees) after capsulotomy, and absolute rotation was 2.75 ± 1.94 degrees (range 0 to 7 degrees, P = .028). Before and after Nd:YAG laser capsulotomy, cylinder power was 0.24 ± 0.70 diopter (D) (range 0.00 to 0.63 D) vs 0.56 ± 0.77 D (range 0.02 to 0.91 D), respectively, with an absolute change in cylinder power of 0.34 ± 0.22 D (range 0.01 to 0.90 D, P = .001). After capsulotomy, there was a significant decrease in IOL tilt in the horizontal and vertical planes and an increase in decentration ( P < .05). Time interval (33.02 ± 12.9 months) and IOL horizontal decentration were independent factors affecting IOL rotation after capsulotomy ( P < .05). CONCLUSIONS: Nd:YAG laser capsulotomy may cause TIOL rotation as well as tilt and decentration, resulting in a change in the TIOL's corrective effect on corneal astigmatism. Although this change was clinically insignificant, it may be beneficial to consider that TIOL rotational misalignment may occur in patients undergoing early capsulotomy.

Nd:YAG laser posterior capsulotomy performed under general anesthesia in the sitting position: a novel approach.

We present a novel approach for performing an Nd:YAG laser posterior capsulotomy under general anesthesia with the patent in a seated position. We illustrate this approach in 2 cases, a young child and an adult patient with developmental delay. This technique may facilitate YAG capsulotomy in patients who cannot sit for the procedure.

The complication rate following Neodymium-doped Yttrium Aluminum Garnet laser posterior capsulotomy for posterior capsular opacification in patients with and without comorbidities.

Purpose: To study the complication rate following Nd: YAG posterior capsulotomy posterior capsular opacification (PCO) in patients with and without comorbid conditions. Methods: This was a prospective, interventional, comparative, and observational study. A total of 80 eyes, consisting of 40 eyes without ocular comorbidities (group A) and 40 eyes with ocular comorbidities (group B) that were being treated with Nd: YAG capsulotomy for PCO, were included. Visual outcome and complications of Nd: YAG capsulotomy were studied. Results: The mean age of group A patients was 61.65 ± 8.85 years and that of group B patients was 63 ± 10.46 years. Of the total, 38 (47.5%) were men and 42 (52.5%) were women. In group B, the ocular comorbidities were moderate nonproliferative diabetic retinopathy (NPDR) (n = 14 eyes; 14/40 = 35%), subluxated intraocular lens (IOL; <2 clock hours of subluxation; n = 6), age-related macular degeneration (ARMD; n = 6), post-uveitic eyes (having old signs of uveitis, no episode of uveitis since the last 1 year; n = 5), and operated cases of traumatic cataract (n = 4). The mean energy required in groups A and B was 46.95 ± 25.92 and 42.62 ± 21.85 mJ, respectively (P = 0.422). The average energy requirement in Grade 2, Grade 3, and Grade 4 PCO was 22.30, 41.62, and 79.52 mJ, respectively. An increase in intraocular pressure (IOP) of >5 mmHg from pre-YAG levels was observed in one patient in each group on day 1 postprocedure, for which medical treatment was given to both patients for 7 days. One patient in each group had IOL pitting. No patient had any other complications attributable to ND:YAG capsulotomy. Conclusion: Nd:YAG laser posterior capsulotomy is a safe procedure for PCO in patients with comorbidities. Visual outcomes were excellent after Nd:YAG posterior capsulotomy. Although a transient increase in IOP was noted, the response to treatment was good and a long-term increase in IOP was not observed.

Analysis of influencing factors associated with the time between cataract surgery and Nd:YAG laser posterior capsulotomy.

PURPOSE: To retrospectively analyze the clinical data of large samples of YAG laser posterior capsulotomy, and to explore the influencing factors of time from cataract surgery to YAG laser capsulotomy (TFCSTLC), so as to provide reference for the occurrence and treatment of real-world posterior capsular opacification (PCO). METHODS: 1093 patients (1093 eyes) with PCO who underwent YAG laser posterior capsulotomy from 2014 to 2019 in the largest eye center of northwest China were analyzed retrospectively. The gender, age, systemic complications, material, and design of intraocular lens (IOL) and TFCSTLC were recorded. The test and Wilcoxon rank sum test were applied to analyze and compare the average TFCSTLC values under different factors, and the relationship between each factor and TFCSTLC was analyzed by multiple linear regression. RESULTS: The average TFCSTLC was 19.2 (range, 7.9 ∼ 31.2) months. There were significant statistical differences in TFCSTLC among the implanted single focus versus multifocal IOLs (P < 0.001), diabetic versus non-diabetic patients (P < 0.001), high myopia versus non-high myopia patients (P = 0.003). Multiple linear regression analysis demonstrated that TFCSTLC was negatively correlated in patients with diabetes mellitus versus with no history of diabetes mellitus (coefficient, -5.36; 95% confidence interval [CI], -8.30 to -2.41; P < 0 .001), and multifocal IOL versus a single focus IOL implanted (coefficient, -5.56 ; 95% CI, -9.01 to -2.11; P = 0.002). CONCLUSIONS: TFCSTLC may be affected by many factors in the real world. The YAG laser posterior capsulotomy time was sooner in patients with a history of diabetes mellitus and multifocal IOL implanted.

Posterior Capsulotomy Size Affects the Formation of Significant Visual Axis Opacification in Congenital and Developmental Cataract.

PURPOSE: To assess the relationship between posterior capsulotomy size and significant visual axis opacification (VAO) in congenital and developmental cataract. METHODS: The charts of children aged 7 years and younger who underwent cataract surgery including primary posterior capsulotomy (PPC) and limited anterior vitrectomy between 2012 and 2022 were retrospectively reviewed. Eyes with PPC size smaller than the anterior capsulotomy size were considered as group 1. Eyes with PPC size larger than the anterior capsulotomy size were considered as group 2. Clinical characteristics, the need for Nd:YAG laser treatment or further surgery for significant VAO, and other postoperative complications were compared between the groups. RESULTS: Sixty eyes of 41 children were included in the study. The median age at the time of surgery was 5.5 and 3 years in groups 1 and 2, respectively (P = .076). Primary intraocular lens implantation was performed in 23 (85.2%) eyes in group 1 and 25 (75.8%) eyes in group 2 (P = .364). There was no difference between the groups in terms of postoperative visual acuity (P = .983) and refractive errors (P = .154). Eight (29.6%) pseudophakic eyes received Nd:YAG laser treatment in group 1, but none of the eyes in group 2 (P = .001). Four (14.8%) eyes in group 1 and 1 (3%) eye in group 2 underwent further surgery for VAO (P = .100). The need for further intervention for significant VAO was statistically higher in group 1 (44.4% vs 3%, P < .001). CONCLUSIONS: Larger PPC size in pediatric cataract may reduce the need for further intervention for significant VAO. [J Pediatr Ophthalmol Strabismus. 2023;60(6):441-447.].

Automated precision pulse capsulotomy vs manual capsulorhexis in white cataracts: reduction in procedural time and resource utilization.

PURPOSE: To compare the utility of precision pulse capsulotomy (PPC) with manual capsulorhexis for capsulotomy in white cataracts. SETTING: Hospital-based academic practice. DESIGN: Retrospective analysis of surgical case records and surgical videos from a single surgeon. METHODS: Cases involving intumescent and nonintumescent white cataracts were identified. Capsulotomy outcomes, surgical outcomes, procedural time, and resource utilization, as well as patient demographic and health data, were analyzed and subjected to statistical testing. RESULTS: 15 cases of white cataract (10 intumescent and 5 nonintumescent) performed using continuous curvilinear capsulorhexis (CCC) were compared with 20 cases (9 intumescent and 11 nonintumescent) performed using PPC. The cases covered a period of 14 months before and 30 months after surgeon adoption of PPC. There were no significant differences between the 2 groups in patient age, sex, ethnicity, ocular history, medical history, and medications. PPC resulted in complete capsulotomies without tags or tears and intracapsular intraocular lens implantation with 360-degree capsular overlap in all 20 cases. There was 1 CCC case resulting in the Argentinian flag sign. Compared with CCC, PPC white cataract cases also demonstrated significant advantages in capsulotomy time, reduced use of trypan blue and ophthalmic viscosurgical device, and less overall procedural time. CONCLUSIONS: PPC is a safe and highly effective method to create consistent capsulotomies in both intumescent and nonintumescent white cataracts. The use of PPC provides benefits of significant reductions in capsulotomy time, overall procedural time, and resource utilization, resulting in a streamlined treatment of these complex cataract surgery cases.

Nd:YAG laser capsulotomy rates in the Netherlands: practice variation and association with physician practice styles.

PURPOSE: To determine the practice variation in the rate of Nd:YAG laser capsulotomy within 1 year after cataract surgery and to identify possible associations with physician practice styles. SETTING: All hospitals and private clinics in the Netherlands. DESIGN: Retrospective observational study. METHODS: In the national medical claims database, we identified all laser capsulotomies performed in the Netherlands within a year after cataract surgery in the years 2016 and 2017. Centers with the lowest and highest percentages of Nd:YAG laser capsulotomies were interviewed on their physician practice styles related to the development of posterior capsule opacification. RESULTS: The incidence of Nd:YAG laser capsulotomy varied between 1.2% and 26.0% in 2016 (median 5.0%) and between 0.9% and 22.7% in 2017 (median 5.0%). The rate of capsulotomy was highly consistent over time for each center (Pearson correlation coefficient, 0.89, P < .001). In general, ophthalmology centers with a high rate of Nd:YAG laser capsulotomy more often did not (routinely) polish the posterior lens capsule, performed cortex removal with coaxial irrigation/aspiration (I/A, instead of bimanual), and more often used hydrophilic intraocular lenses (IOLs) (compared with only using hydrophobic IOLs). CONCLUSIONS: We found a significant practice variation in performing Nd:YAG laser capsulotomy within 1 year after cataract surgery in the Netherlands. Routinely polishing the posterior capsule, using bimanual I/A, and the use of hydrophobic IOLs are associated with a lower incidence in Nd:YAG laser capsulotomy. Incorporating these practice styles may lower the practice variation and thus prevent added medical burden for the patient and decrease costs.

"Comparing outcomes of advanced nurse practitioners to ophthalmologists performing posterior YAG capsulotomy, a six-year study of 6308 eyes".

PURPOSE: To primarily report the baseline characteristics and visual acuity (VA) outcomes of advanced nurse practitioners (ANP) compared to ophthalmologists following YAG posterior capsulotomy (YAGPC). We secondarily looked to characterise the risk factors that lead to a repeated YAGPC. METHOD: Retrospective consecutive case series of 6,308 eyes attending the Birmingham and Midlands Eye Centre. RESULTS: ANPs performed 33.1% of YAGPC compared to 66.9% ophthalmologists. Compared to ophthalmologists, ANPs performed YAGPC in lower proportion of patients with ocular co-morbidities (p < 0.001) and had lower proportion of patients requiring further YAGPC compared to ophthalmologists (p < 0.001). Median pre, post-operative and LogMAR gain in VA of 0.48 (IQR 0.30-0.78), 0.18 (IQR 0.10-0.40) and 0.30 (0.08-0.48) LogMAR units, respectively. Multivariate regression showed that ANPs had a significantly lower rate of repeat YAGPC compared to ophthalmologists even when adjusting for age, ethnicity, training grade and ocular co-morbidities. No difference in visual outcomes was found between operator grade and ethnicity on multivariate analysis. CONCLUSION: YAGPC leads to excellent visual outcomes. ANPs can deliver safe and effective YAGPC.

Central macular thickness and subfoveal choroidal thickness changes on spectral domain optical coherence tomography after cataract surgery in pediatric population.

Purpose: To evaluate the central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) changes on spectral domain optical coherence tomography (SD-OCT) after cataract surgery with intraocular lens (IOL) implantation in a pediatric population. Methods: This was a longitudinal, prospective, interventional study which included 90 pediatric patients who underwent cataract extraction with IOL implantation. Serial SD-OCT scans were done at postoperative day 1, 1-month, and 3-month follow-up. CMT and SFCT were measured at each visit. Results: A statistically significant increase in CMT was noted at 1 month (from 199.3 µm to 210.04 µm) post surgery, which declined over a 3-month period (202.70 µm, P = 0.0001). In case of SFCT, a constant increase was observed for over 3 months of follow-up (baseline: 296.52 µm; 1 month: 309.04 µm; and 3 months: 319.03 µm, P = 0.0001). The traumatic cataract group showed more pronounced changes in CMT and SFCT than the non-traumatic cataract group. No significant difference was observed regarding these parameters between those who underwent primary posterior capsulotomy (PPC) versus those who did not. None of the patients in the study group developed cystoid macular edema. These posterior segment-related anatomical changes did not affect the final visual outcomes. Conclusion: Cataract surgery induces potential inflammatory changes in the macula and choroid in pediatric patients. Such changes are more pronounced in trauma-related cases; however, they are not significant enough to affect the visual outcomes. Similarly, the additional surgical step of PPC does not induce significant anatomical or functional changes.

Refraction Shift After Nd:YAG Posterior Capsulotomy in Pseudophakic Eyes: A Systematic Review and Meta-analysis.

PURPOSE: To explore ocular refraction shift after Neodymium: yttrium aluminum garnet (Nd:YAG) posterior capsulotomy in pseudophakic eyes. METHODS: A systematic literature search was performed in the PubMed, Embase, and Cochrane Library databases until November 10, 2021. Studies on the evaluation of changes in spherical equivalent (SE), cylindrical error (CE), or anterior chamber depth (ACD) after Nd:YAG laser capsulotomy were included in the meta-analysis. The review was registered in the international platform of registered systematic review and meta-analysis protocols (INPLASY202120059). RESULTS: A total of 805 eyes from 18 studies were included in the final analysis. The pooled mean differences in SE from baseline to postoperative follow-up points were not significant (1 hour: 0.04 diopters [D], 95% CI: -0.13 to 0.21, P = .644; 1 week: 0.04 D, 95% CI: -0.12 to 0.20, P = .640; 1 month: 0.05 D, 95% CI: -0.06 to 0.16, P = .349). There was no significant difference between baseline CE and any subsequent visit (1 week: 0.14 D, 95% CI: -0.06 to 0.33, P = .172; 1 month: 0.17 D, 95% CI: -0.04 to 0.38, P = .108). No statistical difference in ACD from baseline was observed either (1 hour: 0.01 mm, 95% CI: -0.07 to 0.09, P = .846; 1 week: -0.12 mm, 95% CI: -0.24 to 0.01, P = .079; 1 month: -0.06, 95% CI: -0.14 to 0.01, P = .110). CONCLUSIONS: Neither ocular refraction nor ACD changed within 1 month after laser capsulotomy, suggesting laser capsulotomy did not affect ocular refraction in short-term observation. [J Refract Surg. 2022;38(7):465-473.].

Posterior capsular vacuuming to avoid PCO formation.

AIM: To retrospectively evaluate the effectiveness of the capsular vacuuming technique in reducing posterior capsule opacification (PCO). METHODS: Group 1 of the study consisted of 2752 eyes of 2752 patients with a cataract who had undergone phacoemulsification and IOL implantation surgery with anterior, equatorial, and posterior capsular polishing between January 2010 and December 2014. Group 2 consisted of 2761 eyes of 2761 patients with a cataract who had undergone phacoemulsification and IOL implantation surgery with anterior, equatorial, and posterior capsular polishing as well as posterior capsular vacuuming between January 2010 and December 2014. RESULTS: The mean patient age was 63.45 ± 12.23 years (range, 43-89) in Group 1 and 64.02 ± 13.36 years (range, 40-91) in Group 2. The two groups did not significantly differ with respect to age, sex, preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) measurements (p > 0.05). At the 5-year follow-up, 253 eyes (9.19%) in Group 1 developed PCO requiring Nd:YAG laser capsulotomy, whereas 24 eyes (0.86%) in Group 2 developed PCO requiring Nd:YAG laser capsulotomy (p < 0.001). During capsular vacuuming, posterior capsule rupture was observed in the shape of a hole in only 2 eyes in Group 2. But the IOLs were implanted in the capsular bag in all eyes in both groups. CONCLUSION: PCO is the most common complication of cataract surgery; therefore, surgical technique is important in preventing PCO formation. We recommend posterior capsular vacuuming together with anterior, equatorial, and posterior capsular polishing, as this method significantly reduced the PCO rate.

Predictors of Price Transparency for Cataract Surgery and Laser Posterior Capsulotomy at Academic Hospitals in the United States.

PURPOSE: To describe the characteristics of United States (US) academic hospitals that predict transparency of cash and commercial payer-negotiated prices for cataract surgery (CS) and laser posterior capsulotomy (LPC). METHODS: A systematic review of websites for hospitals affiliated with ophthalmology residency programs was conducted to determine price transparency. Hospital characteristics were extracted from the American Hospital Association Annual Survey and Turquoise Health. Descriptive statistics, t-tests, χ2 tests, and logistic regression analyses were used to compare hospitals based on price transparency for CS and LPC. RESULTS: There were no differences in price transparency for CS and LPC based on net income, urban-rural classification, region, hospital beds, or surgical operations. Having more full-time personnel was associated with cash price transparency. No differences were identified between hospitals based on payer-negotiated price transparency. CONCLUSIONS: Academic hospitals for ophthalmology with more full-time personnel had greater cash price transparency for CS and LPC. However, price transparency did not vary for other characteristics.

Efficacy and safety of primary posterior capsulotomy during phaco-vitrectomy for epiretinal membrane.

PURPOSE: To evaluate the necessity and safety of primary posterior capsulotomy during phaco-vitrectomy for idiopathic epiretinal membrane (ERM). SETTING: Seoul National University Bundang Hospital, Seongnam, Korea. DESIGN: Retrospective consecutive cohort analysis. METHODS: This study enrolled 219 patients (228 eyes) who underwent combined 25-gauge phaco-vitrectomy for idiopathic ERM and cataract, divided into capsulotomy (-) group (152 eyes, 144 patients) and capsulotomy (+) group (76 eyes, 75 patients). The main outcomes were rate of posterior capsular opacity (PCO) occurrence and postoperative complications. Ophthalmic examinations were performed at baseline, 1, 3, 6, and 12 months postoperatively. RESULTS: PCO only occurred in capsulotomy (-) group (20 eyes, 13.2%), with mean onset of 10.59 months. Visually-significant PCO that needed Nd:YAG posterior capsulotomy was present in 9 eyes (45.0% of PCO eyes). The rate of cystoid macular edema (CME) was higher in capsulotomy (+) group (6.6% vs. 15.8%, p = 0.026) with longer duration (1.50 vs. 3.36 months, p = 0.019). Female sex and posterior capsulotomy were significant risk factors for CME occurrence (p < 0.05). CONCLUSION: Primary posterior capsulotomy during phaco-vitrectomy for idiopathic ERM obviated the need for Nd:YAG posterior capsulotomy, but visually-significant PCO that needed Nd:YAG laser was not common. Considering the low rate of visually-significant PCO and high rate of postoperative CME, routine posterior capsulotomy during phaco-vitrectomy may not be necessary for preventing PCO in ERM.

[Posterior YAG capsulotomy: selection of the application pattern]. / Hintere YAG-Kapsulotomie: Wahl des Applikationsmusters.

BACKGROUND: The posterior neodymium-yttrium-aluminum-garnet laser capsulotomy is an established and simple method with a low complication rate for the treatment of secondary cataracts; however, the risk of intraocular pressure elevation, pit marks of the intraocular lens (IOL), anterior hyaloid damage, cystoid macular edema and retinal detachment may increase with high pulse number, pulse energy, and total energy. PURPOSE: The optimization potential of the method through a rational choice of the laser pattern and the strategy, taking into account the mechanical properties of the posterior capsule and the anatomical features of the retrolental region, is shown. MATERIAL AND METHODS: The article provides a literature review with own clinical observations and a geometric representation. RESULTS: The efficiency of a laser pattern is examined with a constant capsulotomy length: The largest opening can be reached with the U­pattern, which is followed by the +, T, H, V, O and spiral patterns in decreasing order. When estimating the size of the opening, its incircle is of particular functional importance. If the ability of the posterior capsule to tear spontaneously, which is predetermined by its anatomical and mechanical properties, is taken into account when choosing the application pattern and the laser strategy, the efficiency of the method increases. CONCLUSION: An efficient technique is not only determined by an adapted defocusing and a minimum possible individual pulse energy setting but also characterized by the lowest possible total energy consumption if the necessary opening size is achieved by the smallest number of pulses. Taking into account the individual retrolental anatomical conditions and the mechanical properties of the NS membrane can contribute to the gentle implementation of a YAG capsulotomy.

The prophylactic effect of betaxolol 0.5% versus brimonidine 0.2% on IOP elevation after Nd:YAG laser posterior capsulotomy.

CLINICAL RELEVANCE: Posterior capsule opacification is a common late complication of cataract surgery. Posterior capsule opening with Nd:YAG laser, which is the standard treatment, may cause transient elevation of intraocular pressure (IOP). BACKGROUND: To evaluate the efficacy of betaxolol 0.|5% compared to brimonidine 0.2%, in prevention of intraocular pressure increase after Nd:YAG Laser posterior capsulotomy. METHODS: In a double masked randomised clinical trial, 38 eyes from 38 pseudophakic patients over 21 years of age who had significant posterior capsule opacification after phacoemulsification were randomly assigned to receive either betaxolol 0.|5% (18 eyes) or brimonidine 0.|2% (20 eyes) one hour before Nd:YAG Laser posterior capsulotomy.| Exclusion criteria were: glaucoma or history of glaucoma surgery, active uveitis, active ocular infection, pregnancy, unstable cardiovascular condition and severe asthma and lung diseases. Intraocular pressure was measured by Goldmann applanation tonometry, 1 hour before applying the laser and 4 hours after the laser application. RESULTS: There was no statistically significant difference between the two groups regarding the baseline mean IOP and the 4-hour post-laser mean IOP. There was a statistically significant decrease in the 4-hour post-laser mean IOP as compared to the baseline mean IOP in each group. The mean IOP change in the betaxolol group, was -2.39 ± 1.79 mm Hg and in the brimonidine group was -4.25 ± 2.20 mm Hg. The difference was statistically significant (P = 0.007). None of the patients experienced clinically significant IOP increase (≥5 mm Hg) in either group. CONCLUSION: Use of a single topical dose of betaxolol 0.5% and brimonidine 0.2%, 1 hour before laser treatment, can prevent significant acute IOP increase after Nd:YAG laser posterior capsulotomy, and betaxolol may provide a new alternative for prophylactic use.