Complication after inadvertent Nd:YAG laser capsulotomy in a phakic eye.

Purpose: To report a case of complication after inadvertent Nd:YAG laser in a phakic eye. Observations: A 65-year-old man presented with a sudden vision loss on his right eye after undergoing Nd:YAG laser for posterior capsulotomy. Best-corrected visual acuity (BCVA) was hand motion and slit-lamp examination revealed a dense posterior cataract with 3 circular holes on posterior capsule and on anterior segment OCT confirmed a posterior capsule rupture (PCR). Due to scattered fine echoes on eye ultrasound, suggesting remnants of cataract, the patient underwent phacoemulsification with posterior vitrectomy and IOL implantation in the ciliary sulcus. One day later BCVA was 20/100 and one month later improved to 20/50. Although rare, inadvertent Nd:YAG laser on phakic eye is a complication that can result in traumatic cataract, PCR and vitreous loss. These complications can be minimized through careful preoperative assessment and adherence to a strict time-out immediately before the procedure. Conclusion and importance: We describe a case of complication after inadvertent Nd:YAG laser in a phakic eye. The slit-lamp examination and anterior OCT revealed a traumatic cataract and a PCR. These complications were successfully managed with combined phacoemulsification and pars plana vitrectomy, resulting in improved BCVA postoperatively. The case highlights the importance of preoperative time-out to prevent a rare complication after Nd:YAG laser.