Neodymium:YAG laser posterior capsulotomy in eye with an intrastromal inlay

We report intraoperative issues, patient outcomes, and lessons learned from inadvertently contacting a Kamra corneal inlay with a neodymium:YAG (Nd:YAG) laser during a routine capsulotomy procedure for posterior capsule opacification. We also present scanning electron microscopic and histopathologic images from a series of 4 inlays implanted in postmortem porcine eyes that were purposely contacted with an Nd:YAG laser. Our capsulotomy patient developed a clinically insignificant and transient corneal opacity accompanied by mild blanching on the inlay. Modeling this scenario in porcine corneas demonstrated the potential for carbon particle liberation into the overlying stroma, damage to the inlay body, and fusion of inlay nutrition holes.