The authors report a case of macular hole post YAG peripheral iridotomy (PI) of a patient with pre-existing vitreomacular adhesion. Although a relatively safe procedure, some anterior segment complications are well documented such as corneal endothelium damage, rise in IOP, iris bleed and lens damage. The authors report the case of a 64-year-old female who had an adherent leucoma in the right eye with occludable angles confirmed on indentation gonioscopy. Optical coherence tomography (OCT) was normal in the right eye and showed epiretinal membrane with vitreomacular adhesion in the left eye. The patient received prophylactic YAG PIs to both eyes and three days later complained of dimness of vision in the left eye with reduced vision to 6/36. Examination revealed a stage four full thickness hole requiring vitreoretinal surgery and the vision improved to 6/9. The authors describe the small number of previously reported posterior segment complications with only two being macular holes. The authors postulate that macular hole formation is due to the shock waves generated by Nd:YAG laser and that careful planning and counselling should be performed in such cases along with post PI posterior segment checks.