A 64-year-old female presented with a sudden onset of painful, defective vision in the left eye (LE) who had undergone Nd:YAG laser capsulotomy 6 months back. Her vision at the time of presentation was 6/12. Anterior segment examination revealed circumcorneal congestion, corneal edema, a large capsulotomy opening Fig 1b, and liquefied vitreous in the anterior chamber Fig 1a. The intraocular pressure (IOP) was 40 mmHg. Fundus examination showed glaucomatous cupping with inferior neuroretinal rim thinning in LE (cup–disc ratio 0.75) compared to a healthy rim in the right eye (cup–disc ratio 0.5). The patient was started on topical brimonidine 0.2% + timolol 0.5% combination therapy and subsequently underwent anterior vitrectomy in LE Fig 1c. At follow-up, both anterior and posterior segment findings were normal except for persistent glaucomatous cupping. She was advised to continue antiglaucoma medications.Figure 1: (a) Slit-lamp photograph of the left eye showing liquefied vitreous in the anterior chamber indicated by an arrow; (b) Slit-lamp photograph with retroillumination demonstrating a large Nd:YAG capsulotomy opening extending beyond the optic edge indicated by the dotted blue line; (c) Slit-lamp photograph of the left eye following anterior vitrectomyDiscussion Posterior capsular opacification (PCO) is the most frequent late complication of cataract surgery, developing in 20–50% of patients within 2–5 years.1 Nd:YAG capsulotomy is the standard treatment but may cause complications including IOL pitting, transient IOP elevation, iritis, hyphema, cystoid macular edema, retinal detachment, and vitreous prolapse. Vitreous prolapse occurs when the anterior hyaloid face is disrupted, especially if the capsulotomy is oversized or excessive laser energy is applied. An optimal capsulotomy size is 3.9–5.0 mm, avoiding extension beyond the IOL optic edge to minimize this risk.2 Most reported cases of post-capsulotomy glaucoma involve angle closure from pupillary block by vitreous prolapse.3,4 This case represents the rare occurrence of open-angle glaucoma caused by trabecular meshwork obstruction from liquefied vitreous. This case highlights the importance of meticulous laser technique, energy moderation, and vigilant postprocedure IOP monitoring to prevent vision-threatening complications following Nd:YAG capsulotomy. Authors contributions Suganya Babu: Concepts, Design, Definition of intellectual content, Literature search, Clinical studies, Experimental studies, Data acquisition, Data analysis, Manuscript preparation, Manuscript editing, Manuscript review, Guarantor; Kamatchi Nagu: Literature search, Clinical studies, Data acquisition, Data analysis, Manuscript preparation, Guarantor; Madhu Shekhar: Concepts, Design, Definition of intellectual content, Literature search, Clinical studies, Experimental studies, Data acquisition, Data analysis, Manuscript preparation, Manuscript editing, Manuscript review, Guarantor. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the parent has given his consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.
Babu et al. (Thu,) studied this question.