What is Posterior capsule opacification
During your cataract surgery, the surgeon removed the cataract and replaced it with an artificial lens implant. Your surgeon placed the lens implant behind the iris (coloured part of your eye) in the same bag (or capsule) in your eye that held the natural lens in place.
Sometimes some of the lens cells that are left in the capsule grow back and form a layer inside the capsule. This can thicken or wrinkle the capsule, causing blurred vision, glare or double vision.
New glasses may improve your vision to some extent but if the thickening is severe, glasses will not help. In this case, YAG laser capsulotomy is the only option to restore your vision.
A thickened capsule usually gets slowly worse. Leaving the capsule untreated does not threaten your vision straightaway but it can get gradually worse until your vision is very blurred. Your surgeon will assess you and tell you if YAG capsulotomy is suitable for you. However, it is your decision to go ahead with the procedure or not.
This document will give you information about the benefits and risks to help you to make an informed decision. If you have any questions that this document does not answer, ask your surgeon.
What is YAG laser capsulotomy
Your surgeon will use the laser to make a small hole (capsulotomy) in the centre of the thickened capsule so light can pass through the artificial lens to the back of your eye and your vision should improve. This will also allow the surgeon to have a better view of the retina (the inner layer at the back of your eye) to check for other problems that affect the retina.
Surgical capsulotomy is an alternative to YAG laser capsulotomy. However, it is a more invasive procedure and is therefore reserved for cases where YAG laser is unsuccessful.
Day of treatment
The healthcare team will ask you to sign the consent form once you have read this document and they have answered your questions. You will need to keep your head still during the procedure. If you cannot keep your head still, let your surgeon know.
Your surgeon will usually place some dilating drops in your eye to make your pupil larger so they can see the capsule more clearly. They may also put some drops on your eye to reduce the pressure in your eye and to prevent the pressure from increasing after the procedure.
The procedure is performed while you are sitting and in the clinic setting. Your surgeon will instil local anaesthetic drops in to your eye. Than a contact lens will be placed on your eye to focus the laser beam to the area of treatment.
The surgeon will use the laser to make a small hole in the centre of the capsule. You may feel a popping sensation when the hole is made. The procedure may cause a minimal discomfort. YAG capsulotomy usually will be completed within 10 minutes.
You should be able to go home soon after the treatment. The surgeon may ask you to use eye drops for 1 – 2 weeks and will arrange a review appointment. You will need a responsible adult to take you home in a car, taxi or public transport. Most people resume normal activities soon after the procedure. Most people make a good recovery with improved vision within a day.
What are the complications of YAG laser capsulotomy?
YAG laser capsulotomy is a relatively safe procedure but complications can happen. Some of these can adversely affect your vision. The possible complications of YAG capsulotomy are listed below:
• Pain, is usually only mild and easily controlled with simple painkillers such as paracetamol. You may feel pressure or mild discomfort. If you are in severe pain, let your surgeon know as this is unusual.
• Cystoid macular oedema, which is a swelling of the area of the retina responsible for visual sharpness. This causes blurred vision and can happen up to 6 weeks after the procedure. The swelling usually settles but you may need anti-inflammatory eye drops or a steroid injection into your eye. Rarely, blurred vision may be permanent.
• Corneal oedema or injury, caused by the laser. This can cause blurred vision, which usually settles
on its own.
• Iritis, which is inflammation in your eye. This usually settles with anti-inflammatory eye drops.
• Bleeding during or after the procedure. This is usually caused by scar tissue (adhesions) between the iris and the capsule. Usually there is little bleeding and your eye may be slightly red. If it is very red and painful, let your surgeon know as this is unusual.
• Infection (endophthalmitis), if the laser treatment releases organisms trapped inside the capsule during cataract surgery. If your eye becomes red and painful, and your vision becomes blurred, let your surgeon know straightaway. You may need other procedures to control the infection.
• Dislocation of the artificial lens, if the laser treatment causes the lens to move out of place. You will
usually need new glasses. If the lens moves out of the capsule, you will need an operation to replace the lens.
• Pitting in the artificial lens, caused by the laser. This does not usually affect your vision.
• Increase in pressure in your eye. This usually settles within a week. If the pressure does not reduce, you may need treatment with eye drops or glaucoma surgery to drain some of the fluid in your eye.
• Retinal detachment, which is the lifting off of one of the layers at the back of your eye. If you notice that you suddenly get a lot of 'floaters' or flashing lights, or you think you have a shadow in your vision, let your surgeon know or visit your local eye casualty department.