Posterior capsule opacity and choroidal neovascularization in patients with age-related macular degeneration

To present a series of 3 patients with the dry form of age-related macular degeneration (AMD) in whom choroidal neovascularization (CNV) was observed following neodymium: yttrium-aluminum-garnet (Nd:YAG) capsulotomy.

Three consecutive patients aged 80 to 87 years (average = 83.7 years) with hard drusen or retinal pigment epithelial changes underwent uneventful cataract extraction between 6 months and 20 years before undergoing Nd:YAG capsulotomy for posterior capsule opacity. The patients were examined for retinal changes before laser treatment and at regular intervals after treatment.

All patients developed CNV between 12 days and 1 month after capsulotomy that caused a decrease in the visual acuity from 20/20-20/40 to 20/200--counting fingers at 4 feet. The fellow eye did not show a substantial change in AMD over a year of follow-up. Two of the fellow eyes had disciform scar due to CNV before the cataract surgery, and these patients remained legally blind.

The development of CNV after Nd:YAG capsulotomy suggests a temporal association between the two and calls for further study. Because posterior capsule opacity may mask CNV, patients with dry AMD and posterior capsule opacity who experience decreased visual acuity or glare may undergo indocyanine green angiography before it is decided to perform Nd:YAG capsulotomy.