Objective  To analyze the clinical characteristics and prognosis of an acute intraocular pressure （IOP） spike posterior to the Nd∶YAG laser capsulotomy in patients with posterior capsular opacification. Methods  Medical charts of 16 patients who underwent Nd∶YAG laser capsulotomy and presented with an IOP spike （≥40 mmHg， 1 mmHg=0.133 kPa） after treatment in Beijing Tongren Eye Center from January 2012 to November 2013 were reviewed retrospectively. Main investigative aspects included age， gender， cataract subtypes， pre- and post-treatment visual acuity and IOP， Nd∶YAG laser parameters used in the treatment， the management of the acute IOP elevation and the clinical outcomes. Results  Sixteen patients （10 males and 6 females） were enrolled in this retrospective study， with an average age of 22.5±11.8 years. Mean IOP level was 17.3±3.5（11-22）mmHg before laser capsulotomy. Two of the patients were receiving anti-glaucoma medication before the laser treatment. IOP increased immensely 3.6±1.3（2-6） hours after posterior laser capsulotomy， with an average of 44.1±4.5（40-57）mmHg. IOP was controlled in 12 patients after intensive anti-glaucoma medication. Nevertheless， the other four patients still had high IOP above 40 mmHg after medical intervention， and paracentisis was performed to reduce ocular hypertension. Except for one patient who still had an IOP of 31 mmHg， IOP was under control （≤21 mmHg） in all other patients by the second day. On follow-up day 3， IOP was 14.7±4.1（11-19）mmHg. IOP remained stable and was 16.3±2.8（12-20）mmHg on the last follow-up visit， which was not statistically different from baseline （t=1.240， P>0.05）. Conclusion  Intensive anti-glaucoma medication and/or paracentisis is safe and effective to reverse the IOP spike in patients with posterior capsular opacification posterior to Nd∶YAG laser capsulotomy. And the prognosis is excellent.