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YAG Laser Capsulotomy After Cataract Surgery

 

Why Does Posterior Capsule Opacification Occur After Cataract Surgery?

During cataract surgery, your cloudy natural lens of your eye (cataract) is removed and replaced by an intraocular lens (IOL)  implant.

When the cataract is removed, the capsule of the natural lens is maintained and serves as a support container to hold the artificial IOL. Normally, your vision after cataract surgery should be very clear (glasses or contacts may be required in some cases to obtain the best vision).

However, about 20% of patients with an intact posterior capsule develop (or have at the time of surgery) haziness of the posterior capsule. We call this a posterior capsular opacification or PCO. This causes blurriness, despite the best correction with glasses or contacts.

This occurs because lens epithelial cells that remain after cataract surgery grow on the posterior capsule. In some cases, if the condition progresses significantly, your vision may become worse than it was before cataract surgery.

 

How is Posterior Capsule Opacification Treated?

Fortunately, a YAG laser can be used to treat posterior capsule opacifications safely, effectively, and painlessly. This procedure is performed in our office (which reduces the cost to patients by eliminating the facility fee that is charged if performed in an ambulatory surgery center)and is called YAG laser capsulotomy. The procedure takes only a few minutes and is completely painless (rarely does discomfort occur post-treatment).

YAG laser capsulotomy involves just a few simple steps:

  • A pre-treatment eye pressure is obtained and the eye is pre-treated with a pressure drop
  • The pupil is dilated with dilating drops to obtain full view of the PCO 
  • The surface of the eye is numbed with numbing drops and a small lens is placed on the eye
  • A YAG laser is used to create a round opening in the hazy posterior capsule (painless)
  • The eye is irrigated with saline and a post-treatment pressure drop is applied
  • The patient will wait for a brief period before a final post-treatment pressure is obtained
  • An anti-inflammatory drop will be prescribed for 1 week of use after the procedure (4x’s/day).

You must remain still during the procedure. Very uncooperative patients, such as children and mentally disabled individuals may require referral to a pediatric ophthalmologist or tertiary center.

Following YAG laser capsulotomy, you may resume normal activities immediately. You may experience some floaters, as the debris from the hazy posterior capsule will fall into your vitreous.  As this debris is degraded, the floaters will resolve in a few weeks to months.

Most people can expect their vision to improve within a day. As with any eye procedure, we ask that patients call us immediately for any new or concerning symptoms.

 

What are the Risks of YAG Laser Capsulotomy?

Although a YAG laser capsulotomy poses slight additional risk, overall, the procedure is extremely safe. The most serious risk is that the retina could become detached from the back of the eye. Statistics suggest that the lifetime risk of retinal detachment after cataract surgery is 1%. The risk rises to 2% after YAG Capsulotomy.

Other risks include an increase in the eye pressure (usually temporary), or lack of improvement (due to the presence of other diseases like macular degeneration, diabetic retinopathy, or glaucoma).