An 86-year-old Asian man with asteroid hyalosis presented with decreased vision in the left eye. He underwent phacoemulsification and implantation of silicone intraocular lens (IOL) in the left eye 18 years ago, and also received neodymium:yttrium-aluminum-garnet (Nd:YAG) laser 3 years ago. At presentation, his corrected visual acuity (CVA) was 20/1000 in the left eye. Slit-lamp examination showed white-gray membranous deposits on the posterior IOL surface. The deposits were removed using Nd:YAG laser treatment. One week later, his CVA improved to 20/30, and opacity of the posterior IOL surface was removed. Six months later, his CVA was 20/30, and visual axis was clear. This case suggests that Nd:YAG laser treatment can be a viable option in some patients with posterior surface opacification of silicone IOL associated with asteroid hyalosis, especially in those who are a poor candidate for IOL exchange due to old age or compromised general condition.