In this case, the patient was treated with Nd:YAG laser capsulotomy and vireolysis therapy for PCO and VF in one procedure. Powell et al. [
5] reported that the incidence of RD following Nd:YAG laser capsulotomy was 0.82%,with a mean time of 13.5 months between capsulotomy and RD. A study by Wesolosky et al. [
6] reported the cumulative risk of RD at 3, 6, 9, and 12 months after Nd:YAG laser capsulotomy was 0.6,0.96,1.19 and 1.39%,and the rates of RD varied significantly between age categories. In a study by Ranta P et al. [
7] reported that by 5 years, the overall cumulative of proportion of RD in the 341 patients was 2.0%, and the axial lenth had strongest association with RD after Nd:YAG laser capsulotomy. The axial lenth of our case was 26.81 mm, but RD occurred as soon as 7 days after Nd:YAG laser capsulotomy has been rarely reported. A recent review [
8] reported that Nd:YAG capsulotomy is not associated with RD, thus, it is more likely that RD developed following Nd:YAG vitreolysis rather than posterior capsulotomy. Moreover, the total energy delivered after capsulotomy was 34 mJ, while 130 mJ for vitreolysis. There was no abnormality during Nd:YAG capsulotomy. However, during Nd:YAG vitreolysis, the fiber cables in the posterior segment of the vitreous were found to shake violently, this may be related to higher energy. After vitreolysis the patient immediately complained of a flash sensation. One possible explanation is that due to the 3 DD separation of floater from optic disc, the laser induced rapid completion of PVD and hence the horseshoe tear and the further RD forms. The photodisruption effect of the Nd:YAG laser seems also affects the vitreous fibers around the VF, which could cause traction to the peripheral retina then the retinal tear forms and the higher energy of vitreolysis maybe the another reason of acute RD. There have been few studies reporting the complications following treatment with Nd:YAG vitreolysis. Cowan et al. [
3] reported two cases of open angle glaucoma 7 days and 8 months after YAG laser vitreolysis with >40 mmHg of interocular pressure. In addition, some studies reported cataracts [
4,
9]; posterior capsule defects requiring cataract surgery; retinal tear; retinal detachment [
10]; retinal hemorrhages; scotomas; increased number of floaters [
11]. Acute RD as severe as this case has not been reported. The laser energy should be as low as possible and it must be focused on the PCO and vitreous floaters as precisely as possible to reduce interference with retina. It is suggested that Nd:YAG capsulotomy maybe performed first on PCO and then Nd:YAG vitreolysis maybe performed after a safe interval and a thorough retinal examination. It should be alert to the possibility of RD when patients complain of prominent darking and flashing sensation flash sensation after Nd: YAG vitreolysis or capsulotomy. After this case, we did not have any RD complications with Nd: YAG laser therapy in similar patients.