The day of posterior capsulotomy

This is Nd:YAG laser opening of the cloudy membrane behind the capsular bag after cataract surgery (posterior capsule opacification, sometimes called a secondary cataract). The implant is still there. The cataract has not “grown back”. Not every later blur needs this laser. The macula, cornea and other causes must be excluded first.

This page is not YAG vitreolysis for floaters. Evidence and indications for that are limited. See Floaters and retinal detachment risk. Do not mix the two.

Posterior capsule opacity years after surgery is not uncommon. The proportion varies with the lens, the operation and how it is counted. Published summaries stay on Phacoemulsification and intraocular lenses (Schaumberg et al., 1998; Royal College of Ophthalmologists National Ophthalmology Database Report 9). Those are study results, not your personal probability. This page does not copy the percentages again.

Outpatient laser, without opening the eye. You sit at a slit lamp. Whether to do it depends on whether the clouding affects reading, driving or daily life, and an ophthalmologist decides.

The order of the day

1. The eye is checked. The pupil is usually dilated. The doctor may put in a pressure-lowering drop first, because pressure can rise briefly after the laser. Which drop, and whether to use one, is the doctor’s decision. This page names no dose.
2. You sit with your chin on the rest. After surface anaesthetic, a contact lens is often used. You feel pressure.
3. You see a very bright light, or hear a slight sound. It is usually not long. If it hurts, say so.
4. The aim is to open a window in the centre of the cloudy posterior capsule so light reaches the retina again. The implant stays in the bag. You do not need to know how large the window is.
5. The doctor usually measures the pressure again. Vision can be blurred from the dilation and from capsule fragments. Floaters can increase for a while.
6. Most people leave the same day. Whether you can drive follows that day’s vision. Review and drops follow the written instruction. This page has no drop timetable.

Diagrams

Risks and complications

• A short rise in eye pressure can happen. That is why the doctor may use a drop beforehand and measure again afterwards.
• A temporary increase in floaters is common, often from capsule fragments.
• A pit can be left on the implant. It can happen. Most do not affect vision. Whether to do anything is the doctor’s judgement.
• Inflammation or macular oedema: uncommon.
• Retinal tear or detachment: uncommon. The doctor explains situations such as high myopia individually. This page does not turn “uncommon” into your probability.
• The window may not be clear enough, or the membrane may grow again. A few people need another look. Not everyone needs a second time.
• Endophthalmitis: there is no incision, so it is extremely uncommon. If pain worsens together with a sharp vision drop, still treat it as an emergency. Do not wait because it was “only a laser”.
• This laser does not treat macular disease, corneal disease, or blur from other causes.

Afterwards: which path

Expected: near blur after dilation, light sensitivity, a few more floaters, mild discomfort.

New flashes or many new floaters, without a curtain, without sudden blindness and without severe pain: prompt ophthalmic assessment (same day if possible).