Cataract formation after YAG laser vitreolysis: importance of femtosecond laser anterior capsulotomies in perforated posterior capsules.

PURPOSE: To report a patient who developed a white cataract after Nd:YAG laser vitreolysis with a posterior capsule defect.

METHODS: Femtosecond laser-assisted capsulotomy was performed for optic capture fixation in a patient with a cataract due to a posterior capsule defect after Nd:YAG laser-vitreolysis.

RESULTS: A 55-year-old, highly myopic woman presented with visual impairment 4 days after Nd:YAG laser vitreolysis due to preexisting floaters. The slit-lamp examination showed a mature white cataract; therefore, the intactness of the posterior capsule could not be judged. The patient underwent cataract surgery with femtosecond laser-assisted capsulotomy. Intraoperatively, a highly disrupted posterior capsule was observed. Intraocular lens (IOL) was implanted into the ciliary sulcus and the anterior circular and centered capsulotomy was used for posterior optic capture fixation. Then vitrectomy was performed. No intraoperative or postoperative complications occurred.

CONCLUSIONS: YAG laser vitreolysis presents a new and promising therapeutic approach for floaters. However, the complications are unknown. We describe the induction of cataract as a major complication. Furthermore, the femtosecond laser can ensure a circular and complete anterior capsulotomy, which is essential for optic capture fixation in these cases.