Resident-performed neodymium:YAG laser posterior capsulotomy

Objective: To investigate the outcomes of resident-performed Nd:YAG laser posterior capsulotomy.

Design: Combined retrospective and prospective study.

Participants: Patients (N = 301) who underwent Nd:YAG capsulotomy by ophthalmology residents at Rassoul Akram Hospital, Tehran, Iran.

Methods: Assessment of visual outcomes and complications and the results of second- and third-year residents.

Results: In the retrospective arm, 131 eyes of 129 patients were enrolled. Mean best-corrected visual acuity (BCVA) improved significantly from 1.15 ± 0.26 to 0.54 ± 0.39 logMAR (p < 0.001). Mean intraocular pressure (IOP) before capsulotomy and at the final visit was 13.1 ± 2.34 mm Hg and 13.6 ± 2.17 mm Hg, respectively (P = 0.30). Retinal detachment occurred in 2 eyes (1.5%). No case of intraocular lens decentration or endophthalmitis was detected. In the prospective arm on 173 eyes of 172 patients, mean pre-YAG BCVA was 1.14 ± 0.25 logMAR and increased to 0.51 ± 0.37 logMAR after surgery (p < 0.001). There was no significant difference between pre-laser IOP measurements compared with the 1-month IOP measurements (P = 0.32). The postoperative changes in mean BCVA and IOP between the second- and third-year residents were not significant; however, the applied laser power, the number of laser spots, rate of incomplete capsulotomies, and the amount of total and central laser-induced IOL pits were significantly higher among the second-year residents.

Conclusions: Resident-performed capsulotomy appears to be effective with a low complication profile. Despite the lower levels of surgical skills, second-year residents could achieve good visual outcomes. The laser parameters and IOL-related complications improved with increasing surgical experience.