Retinal vascular density changes detected by optical coherence tomography angiography following Nd:YAG laser posterior capsulotomy.

Abstract

Clinical relevance: Nd:YAG laser capsulotomy is a standard treatment for posterior capsule opacification. While effective, it may induce subclinical changes in retinal structure or perfusion. Optical coherence tomography angiography enables non-invasive visualisation of retinal microvasculature and is a valuable tool for monitoring potential vascular effects of intraocular laser procedures.

Background: Posterior capsule opacification is the most common delayed complication following cataract surgery. Nd:YAG laser posterior capsulotomy is the standard treatment, but its effects on retinal microcirculation remain under-investigated. Optical coherence tomography angiography offers high-resolution vascular imaging but differentiating true vascular alterations from improved visualisation after media clearing presents a diagnostic challenge.

Methods: This prospective study included 30 pseudophakic patients undergoing Nd:YAG capsulotomy for visually significant posterior capsule opacification. optical coherence tomography angiography imaging was performed at baseline, 1 hour, 1 week, and 1 month after treatment. The untreated pseudophakic fellow eyes of 25 patients served as internal controls. Vessel density measurements were obtained from the superficial capillary plexus (SCP-VD), deep capillary plexus (DCP-VD), and radial peripapillary capillaries. Intra-group changes were analysed with repeated measures ANOVA, and inter-eye comparisons were performed using independent samples t-tests.

Results: SCP-VD showed significant increases in nasal and inferior parafoveal and perifoveal sectors at 1 week and 1 month (p < 0.05). DCP-VD also increased postoperatively, particularly in the foveal and superior perifoveal areas. Deep foveal vascular density at 1 month was significantly higher than in fellow eyes (p = 0.013). Peripapillary capillaries vascular density increased significantly over time (p = 0.035), though inter-eye differences were not significant.

Conclusion: Optical coherence tomography angiography detects localised vascular changes following Nd:YAG capsulotomy. Incorporating fellow-eye controls strengthens interpretive accuracy by minimising the confounding effects of image quality improvement, supporting the clinical use of optical coherence tomography angiography in postoperative retinal assessment of pseudophakic patients.