Yangpu district shidong hospital, Shanghai, China.
BMC Ophthalmol. 2020 Apr 19;20(1):157. doi: 10.1186/s12886-020-01428-7.
Modern laser surgery uses Nd:YAG laser capsulotomy for posterior capsule opacification (PCO) and Nd:YAG laser vitreolysis for symptomatic vitreous floaters (VF). We report a case of acute retinal detachment seven days after Nd:YAG laser capsulotomy combined with Nd:YAG laser vitreolysis and analyze the cause of this complication.
A 58-year-old myopic woman complained of decreased visual acuity and symptomatic floaters with her left eye for 3 months. We found she had significant PCO and VF in the posterior vitreous. She underwent neodymium-doped yttrium aluminum (Nd:YAG) laser vitreolysis immediately after Nd:YAG capsulotomy. After 7 days, she complained of rapid vision decline and dark shadows in her treated eye. We found she had a acute severe rhegmentogenous retinal detachment (RD) involving the macula. Then she underwent vitrectomy, retinal reattchment and silicone oil tamponade surgery immediately. Six months later, silicone oil was removed and the best corrected visual acuity (BCVA) of her left eye gradually improved to 10/20 and maintained during a 1-year follow-up period.
As myopic patients are at risk of developing retinal detachment, Nd:YAG vitreolysis and capsulotomy should be performed with caution. The laser energy should be as low as possible and careful focus is necessary to reduce interference to the retina.
现代激光手术使用 Nd:YAG 激光后囊切开术治疗后囊混浊（PCO）和 Nd:YAG 激光玻璃体切割术治疗有症状的玻璃体浮游物（VF）。我们报告了一例 Nd:YAG 激光后囊切开术联合 Nd:YAG 激光玻璃体切割术后 7 天发生急性视网膜脱离的病例，并分析了这种并发症的原因。
一名 58 岁近视女性左眼视力下降和有症状的漂浮物 3 个月。我们发现她的后玻璃体有明显的 PCO 和 VF。她在 Nd:YAG 后囊切开术后立即接受了钕掺杂铝（Nd:YAG）激光玻璃体切割术。7 天后，她主诉治疗眼视力迅速下降并出现黑影。我们发现她患有急性严重的裂孔源性视网膜脱离（RD），累及黄斑。随后她立即接受了玻璃体切除术、视网膜复位和硅油填塞手术。6 个月后，硅油被取出，左眼最佳矫正视力（BCVA）逐渐提高至 10/20，并在 1 年的随访期间保持稳定。
由于近视患者有发生视网膜脱离的风险，Nd:YAG 玻璃体切割术和后囊切开术应谨慎进行。激光能量应尽可能低，并需要仔细聚焦，以减少对视网膜的干扰。
