Clinical case of Nd:YAG laser capsulotomy in a patient after Descemet stripping automated endothelial keratoplasty

Relevance. Studies have shown that after laser capsulotomy, the average density of corneal endothelial cells (ADE) decreases. This can lead to corneal edema and a decrease in visual acuity. This is why it is important to take special care when treating secondary cataracts in patients who had Descemet stripping automated endothelial keratoplasty (DSAEK). Purpose. To demonstrate the effect of Nd:YAG laser capsulotomy on the average density of corneal endothelial cells in a patient who had DSAEK. Material and methods. Patient K., 38 years old. Diagnosis: OD Secondary cataract. Artifakiya. The condition after DSAEK. Examination before surgery: the eye is calm, the cornea and the posterior layered transplatat are transparent, the anterior chamber is deep, the posterior chamber IOL is in a capsule bag, in the correct position, fibrosis of the posterior capsule is moderate; Best-corrected visual acuity (BCVA) = 0.45. ADE = 646 cells/mm2. Intraocular pressure (IOP) = 11 mmHg. In February 2024, a Nd:YAG laser capsulotomy was performed on the Ellex Ultra Q Reflex. The minimum effective energy was selected – 1.4 mJ, the number of pulses – 36, the displacement of the focus point of the laser radiation relative to the focus of the navigation beam deep into 200 microns. Results.On the first day after the operation, during examination: the cornea is apparently unchanged, the IOL is in the correct position, the capsulotomic hole is formed, with a diameter of 5 mm. BCVA = 0.6. ADE = 639 cells/mm2, IOP = 16 mmHg. 1 month after surgery – without changes. Conclusion. To prevent a critical decrease in ADE, an individual approach is required with the selection of the minimum effective energy, not exceeding 1.5 mJ, and a shift in the focus of the working beam relative to the focus of the navigation beam deep into 200 microns.