The aim of the review was to systematize the current data on the medical management of patients after Nd:YAG laser capsulotomy for secondary cataract and to identify optimal strategies for the prevention of complications

Аннотация

The aim of the review was to systematize the current data on the medical management of patients after Nd:YAG laser capsulotomy for secondary cataract and to identify optimal strategies for the prevention of complications. A literature search was conducted in PubMed, Scopus, and CyberLeninka databases for 2014-2024 using the keywords "Nd:YAG capsulotomy," "secondary cataract," "intraocular pressure spike," "cystoid macular edema," and "anti-inflammatory therapy." Thirty- four studies meeting the selection criteria were included in the analysis. The results indicate that the combined use of hypotensive agents (β-blockers, carboanhydrase inhibitors, rock inhibitors) and prolonged anti-inflammatory therapy (topical GCS ± NSAIDs) reduces the incidence of intraocular pressure spike by more than 70% and reduces the risk of cystoid macular edema development to 1-2%. Low-energy laser mode (≤35 μJ, ≤25 pulses) additionally reduces the probability of damage to IOL and vitreomacular structures. Individualization of treatment taking into account biometric parameters of the eye, total laser energy and risk factors (myopia, pseudoexfoliation, early macular changes) provides the best functional outcomes and forms the prerequisites for standardization of clinical recommendations. Keywords: secondary cataract, Nd:YAG capsulotomy, intraocular pressure, anti-inflammatory therapy, cystic macular edema, rock inhibitors. Relevance. The relevance of the study is determined by the increasing prevalence of secondary cataract, which forms in a significant proportion of patients within the first five years after cataract surgery. Nd:YAG-laser capsulotomy has long been recognized as the optimal method for the elimination of posterior capsular opacification, but even with perfect equipment, the procedure is associated with the risk of a whole range of 140 ACADEMIC RESEARCH IN MODERN SCIENCE International scientific-online conference complications: short-term or persistent increase in intraocular pressure, development of iridocyclitis, cystic macular edema, rupture of the posterior hyaloid membrane, intraocular lens movement and, rarely, retinal detachment. In the conditions of increasing requirements to the quality of visual rehabilitation and to the safety of outpatient procedures, optimization of medication support after Nd:YAG capsulotomy, which allows minimizing inflammatory and ophthalmotonal fluctuations, preventing late retinal complications and ensuring maximum visual acuity in the shortest possible time, is of particular importance. At the same time, clinical practice still lacks unified schemes of patient management, and the prescription of topical glucocorticosteroids, nonsteroidal anti- inflammatory drugs and hypotensive drugs is often empirical, which determines the variability of outcomes. In addition, the heterogeneity of the results of randomized and observational studies creates the need for a systematic rethinking of the available data on the prevention of the discussed complications in order to develop evidence-based clinical recommendations. Together, these factors determine the scientific and practical significance of the study aimed at improving the postoperative management of patients undergoing laser capsulotomy. The aim of the study is to summarize and analyze the current scientific data on the methods of medical management of patients after Nd:YAG-laser capsulotomy in order to increase the effectiveness of inflammatory processes prevention and improve the functional results of secondary cataract treatment. Materials and methods of the study. To prepare the review article, we conducted a targeted search of scientific literature in PubMed, Scopus, CyberLeninka and other authoritative sources for the period 2014-2024. Original studies, clinical reviews, and guidelines on the management of patients after Nd:YAG capsulotomy were examined. The selection was based on keywords in Russian and English, with a focus on inflammatory and ophthalmotonal complications, as well as methods of their prevention. The selected publications were analyzed, systematized, and critically reviewed to identify effective treatment regimens and modern approaches to postprocedural therapy.Keywords and their combinations in English and Russian included "Nd:YAG capsulotomy", "secondary cataract", "intraocular pressure spike", "cystoid macular edema", "anti-inflammatory therapy", "post- 141 ACADEMIC RESEARCH IN MODERN SCIENCE International scientific-online conference laser management", "laser capsulotomy", "secondary cataract", "inflammation", "hypotensive prophylaxis". Results of the study. The results of the review analysis of scientific literature showed that the most frequent complications after Nd:YAG-laser capsulotomy are short-term increase in intraocular pressure (IOP), inflammatory reaction in the anterior segment of the eye and, in some cases, development of cystic macular edema. According to Ji-Ping Cai et al. data, prophylactic inj