YAG Laser Capsulotomy Increases the Risk of Proliferative Diabetic Retinopathy

Management of posterior capsule opacification after cataract surgery is fairly routine, but diabetic patients could be at risk for other complications after treatment, according to a new study. Recently, researchers from Texas published findings in Journal of Cataract & Refractive Surgery highlighting the need for close monitoring of diabetic patients receiving further surgical care after cataract removal. Diabetic patients post-YAG laser capsulotomy have an increased risk of developing PDR, vitreous hemorrhage, tractional retinal detachment and neovascular glaucoma. These patients are more likely to eventually require PRP compared to those who do not undergo YAG; however, the risk for other required subsequent treatments, such as pars plana vitrectomy, is found to be insignificant between both patients treated with or without YAG. Photo: Nathan Lighthizer, OD. Click image to enlarge. In a large multicenter study, researchers examined electronic health record data from type 1 and 2 diabetes patients with nonproliferative diabetic retinopathy (NPDR) with or without a history of YAG laser capsulotomy following cataract surgery. From 69 United States healthcare institutions, a total of 10,750 patients were identified: 5,375 treated with YAG and 5,375 who were not treated. Researchers compared one-year follow-up results between the two groups to determine the risk of proliferative diabetic retinopathy (PDR), vitreous hemorrhage, tractional retinal detachment and neovascular glaucoma, along with the need for panretinal photocoagulation (PRP) or vitrectomy.“No previous studies have directly assessed the impact of YAG laser capsulotomy on DR progression in patients with NPDR,” said the authors in their published paper. “Given the anticipated increase in cataract surgeries, understanding the impact of YAG laser capsulotomy on DR progression enables a comprehensive risk assessment of these vulnerable patients.”After calculating hazard ratios, the researchers found that tractional retinal detachment treated with YAG had an increased risk of PDR (HR: 1.9), vitreous hemorrhage (HR: 1.4), tractional retinal detachment (HR: 2) and neovascular glaucoma (HR: 1.5), as well as the need for PRP (HR: 1.5). However, no significant difference was discovered between the two groups in relation to the risk of requiring vitrectomy.An assessment of the risk of ophthalmic complications and interventions between the two groups was also reported. A hazard ratio of 1.3 was determined. Additionally, in a secondary analysis, researchers found that patients with nonproliferative DR for five years or more showed similar risks to those during one-year follow-up.  “These findings highlight the need for closer monitoring post-YAG in this population,” conclude the authors. “Future studies should explore how NPDR stage, laser settings, and age influence these outcomes.”Click here for the journal source. Alshaikhsalama AM, Mansoor BS, Zaidi Z, et al. Risk of diabetic retinopathy progression following YAG laser capsulotomy. Journal of Cataract & Refractive Surgery. October 29, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.