Corneal Perforation After Neodymium-Doped Yttrium Aluminium Garnet Laser Posterior Capsulotomy

To describe a case of corneal perforation (CP) as a rare complication following Neodymium-doped Yttrium-Aluminium-Garnet laser posterior capsulotomy (Nd:YAG LPC) to treat a posterior capsule opacity (PCO) developed after cataract surgery.

Ophthalmology Department, Hospital El Bierzo, Ponferrada (León), Spain.

We present an 89-year-old woman with no relevant medical history besides prior cataract surgery. She developed CP in her left eye and was scheduled for Nd:YAG LPC. The procedure was performed using an Alcon 3000 laser device and an Abraham capsulotomy contact lens. After completion, topical nonsteroidal anti-inflammatory drugs (NSAIDs) were prescribed. Eight days after the procedure she returned to the hospital complaining of redness, pain and decreased vision. Visual acuity of the left eye was light perception. The ophthalmic examination revealed a full-thickness CP, measuring 1 × 1 mm in the inferior nasal periphery/mid-periphery (at seven hours), corneal melting, positive Seidel test and a shallow anterior chamber. The patient underwent surgery to repair the defect with amniotic membrane transplantation. The procedure was successful, accomplishing the sealing of the eye and the recovery of the anterior chamber depth. Six months later, a penetrating keratoplasty was performed due to extreme corneal thinning in the area surrounding the perforation (230 μm).

PCO is a frequent complication after cataract surgery. Its treatment with Nd:YAG LPC is a safe procedure, but not free of complications. Only a few cases of CP related to Nd:YAG have been reported. A possible mechanism is the accidental release of laser energy into de cornea, which has been described in a rabbit model as a cause of CP. The use of topical NSAIDs after the procedure may also play a role altering the epithelium's regenerative capacity, with the development of an ulcer and posterior perforation. Therefore, it is essential to ensure the proper focus of the laser pulses and also take into consideration the possible adverse effects of the drugs prescribed on the follow-up.