Risk of diabetic retinopathy progression after YAG laser capsulotomy.

PURPOSE: To evaluate the risk of diabetic retinopathy (DR) progression and associated ophthalmic complications after YAG laser capsulotomy in patients with nonproliferative DR (NPDR) after cataract surgery.

SETTING

Multicenter study using deidentified electronic health records from 69 U.S. healthcare organizations across outpatient and academic ophthalmology settings.

DESIGN

Retrospective cohort study using propensity score matching to balance baseline characteristics.

METHODS

Patients aged 18 years or older with type 1 or 2 diabetes and NPDR who underwent cataract surgery with or without subsequent YAG laser capsulotomy were identified. Patients were followed for 1-year postcataract surgery. Exclusion criteria included less than 6 months of follow-up. Primary outcomes included development of proliferative DR (PDR), vitreous hemorrhage (VH), tractional retinal detachment (TRD), neovascular glaucoma, and need for panretinal photocoagulation (PRP) or pars plana vitrectomy.

RESULTS

10 750 patients (10 750 eyes) were included after matching: 5375 YAG-treated and 5375 control eyes. At 1 year, YAG-treated patients had higher risk of PDR (hazard ratio [HR], 1.91; 95% CI, 1.67-2.18), VH (HR, 1.40; 95% CI, 1.15-1.72), TRD (HR, 2.04; 95% CI, 1.32-3.13), and PRP (HR, 1.48; 95% CI, 1.14-1.91). A secondary analysis of patients with ≥5 years of NPDR showed similar elevated risks.

CONCLUSIONS

YAG laser capsulotomy in patients with NPDR is associated with increased risk of DR progression and vision-threatening complications. Ophthalmic screening and close follow-up are recommended in this population after YAG treatment.