A rare case of acute bilateral endothelial decompensation after prophylactic nd:Yag laser iridotomy requiring endothelial keratoplasty

Aim: To describe a case of acute bilateral endothelial decompensation following prophylactic Nd:YAG laser iridotomy (LI) for occludable angles. Background: Although regarded safe, LI can occasionally be a source of various ocular complications, including corneal endothelial damage. In the herein case, we describe the first case of acute bilateral endothelial decompensation after Nd:YAG LI. Case description: A 63-year-old man was referred for consultation due to visual acuity deterioration in both eyes 2 weeks after undergoing an uneventful prophylactic LI for occludable angles. On examination, bilateral corneal edema with Descemet’s membrane folds was observed. Direct corneal damage from the laser beam was not seen. Specular microscopy failed to count endothelial density. Anterior-segment optical coherence tomography (OCT), ultrasound biomicroscopy, and ocular biometry were performed. The patient was referred for bilateral endothelial keratoplasty. Conclusion: Subacute endothelial dysfunction should be considered as a possible adverse event following Nd:YAG LI and patients should be advised accordingly. Clinical relevance: Surgeons should be aware of the potentially devastating complication of bilateral corneal decompensation following routine Nd:YAG LI, even in patients without preexisting corneal injury. Patients should be advised accordingly.