Georgalas et al Posterior capsular opaciﬁcation (PCO) is the most common complication of cataract extraction, occurring in up to 33% of patients after ﬁve years.5,6 PCO, apart from visual impair- ment, can obscure fundus view and potentially compromise follow-up ability of patients with posterior segment pathology such as diabetic retinopathy and macular edema. Neodymium: YAG (Nd:YAG) laser capsulotomy, the treatment of choice, is not without complications, some of which might be sight- threatening such as macular edema and retinal detachment.7 Prognosis and complication rate of Nd:YAG laser capsu- lotomy in patients having undergone combined vitreoretinal surgery and phacoemulsiﬁcation has been inadequately described in the literature.8–10 We reviewed a series of 34 eyes that developed PCO and required Nd:YAG laser capsulotomy after combined cataract and vitreoretinal surgery. Patients and methods We retrospectively reviewed the medical records of 34 patients (34 eyes) with PCO who had previously undergone combined pars plana vitrectomy with phacoemulsiﬁcation and intra- ocular lens (IOL) implantation. All patients had surgery at the Department of Ophthalmology, Athens General Hospital ‘G. Genimatas’ by a single surgeon. All patients presented with decreased visual acuity which was attributed to PCO during their follow up in our clinic. Nd:YAG laser capsulotomy was performed if it was clini- cally indicated by a decrease in visual acuity of two lines at least since previous examination or in the presence of a clinically opaque capsule. Nd:YAG laser capsulotomy was eventually performed in all 34 eyes. The procedure was performed under topical anesthesia (tetracaine drops), and pupil dilatation was achieved with the use of tropicamide 1% and phenylephrine 10%. The procedure was interrupted if more than ﬁve IOL pits were observed. Postoperative use of dexamethasone 0.1% and iopidine drops were prescribed for one week. Follow up examinations included visual acuity measurement, evaluation of IOL centration, intraocular pressure (IOP) measurement using Goldman applanation tonometry, and dilated fundus examination. The mean follow-up period (after Nd:YAG capsulotomy was performed) was 11 months. Results The demographic and clinical features of the patients are listed in Table 1. The mean age of the patients was 65.08 years (range 45–87) and the mean follow up period was 11.05 months (range 4–23). 134 All eyes had clinically signiﬁcant lens opaciﬁcation at the time of vitreoretinal surgery. The indications for vitreoretinal surgery included: vitreomacular traction syndrome (VMT) (four eyes), MH (12 eyes) and the presence of an ERM (18 eyes). In all eyes after uncomplicated phacoemulsiﬁcation, the IOL (foldable three-piece hydrophobic acrylic PC IOL Acrysof MA60BM; Alcon Laboratories, Fort Worth, TX) with 5.5 mm optic diameter was implanted in the capsular bag through a 4.5 to 5 mm capsulorhexis. Subsequently in eyes with MH (12 eyes) and with VMT (4 eyes) a 20-gauge-vitrectomy was performed with induction of PVD using the vitreous cutter to engage and pull on the peripapil- lary vitreous. A volume of 0.3 ml of Trypan blue was injected in the vitreous cavity over the posterior pole and removed two minutes later; Internal limiting membrane (ILM) was peeled off from the macular area. Perﬂuoropropane C3F8 gas 14% was used in the cases with MHs and the patient was instructed to adopt prone positioning for seven days. In eyes with ERMs, a 20-gauge-vitrectomy was performed, ERM peeling and subsequently the ILM was peeled of the macula with the aid of Trypan blue. No tamponade was used in any case with ERM or VMT. Posterior capsule opacification was observed in all 34 eyes and required an Nd:YAG capsulotomy because of deterioration in postoperative best-corrected visual acuity. None of the eyes had persistent endotamponade when they underwent Nd:YAG capsulotomy. Postcapsulotomy, four eyes developed moderate anterior chamber reaction that resolved with topical cor- ticosteroids. In seven eyes IOP increased temporarily for a few days post-op, but it was well controlled with topi- cal antiglaucoma agents. None of our patients developed retinal detachment or recurrence of MH. IOL decentration or dislocation did not occur in any of the studied eyes. Cystoid macular edema was observed in two eyes that had undergone combined vitrectomy and phacoemulsiﬁcation for ERM removal, however, the edema was also evident before the YAG-capsulotomy and did not augment after the procedure. The visual acuity pre- and post-YAG capsulotomy, as well as the time elapsed until the appearance of PCO are listed in Table 1 and vary according to the nature of the disease. It seems that PCO appears earlier (Table 2; P = 0.001, t-test for equality of means) in the eyes suffering an ERM (mean 10.00 months) compared to patients with MH disease (mean 15.33 months). No difference between the two groups was observed in age (P = 0.491, t-test for equality of means) or Therapeutics and Clinical Risk Management 2009:5