Nd:YAG laser capsulectomy beneficial in some cases of negative dysphotopsia

This study describes six cases in which neodymium:YAG (Nd:YAG) laser anterior capsulectomy achieved limited success in treating negative dysphotopsia following implantation with a posterior chamber (PC) IOL.

The author believes this is the first peer-reviewed report on the use and outcomes of Nd:YAG laser anterior capsulectomy for the treatment of negative dysphotopsia. The treatment in all six patients was intended to eliminate a sector along the nasal aspect of the anterior capsule overlying the PC IOL optic.

In all cases the treatment created a sector void of anterior capsule, disrupting the 360-degree overlap of the capsulorhexis. No significant PC IOL optic damage or pitting occurred in any case.

Five eyes had been implanted with the Akreos AO MI60L PC IOL. Following Nd:YAG capsulectomy, dysphotopsia symptoms resolved completely in three eyes and partially in two eyes, with the results dependent on the extent of the capsulectomy. In the sixth eye, which was implanted with the Acrysof IQ toric PC IOL, the symptoms did not improve following capsulectomy.

The author concludes that success with this procedure supports the role of the anterior capsule as an important optical risk factor for negative dysphotopsia in patients receiving the Akreos AO MI60L PC IOL. Because the symptoms in the patient with the Acrysof IQ toric PC IOL remained unchanged after the nasal anterior capsule was removed using the Nd:YAG laser, the author suggests that other primary optical factors, including the PC IOL optic and edge design, pupil size, distance behind the pupil plane, PC IOL index of refraction and the anterior extent of functional nasal retina, can presumably manifest negative dysphotopsia symptoms independent of light scatter from the anterior capsule.

He concludes that Nd:YAG laser anterior capsulectomy provides a minimally invasive treatment option in patients with persistent intractable negative dysphotopsia and eliminates invasive intraocular manipulation and poorly tolerated pharmaceutical dilation. His results suggest that the anterior capsule is an important risk factor for negative dysphotopsia and therefore responsive to Nd:YAG laser anterior capsulectomy in some patients.