YAG laser posterior capsulotomy following cataract surgery

My vision was very good following cataract surgery but has since worsened. Why?

Cataract surgery involves removing the cloudy lens from the eye and replacing it with a clear, artificial lens. The ‘bag’ or ‘capsule’ which encloses the cataract is left behind to support the new artificial lens. In around 20% of people, the capsule bag becomes thickened and opaque, a process known as ‘posterior capsule opacification’ (PCO). This can happen months or even years after cataract surgery and may cause problems with vision, such as misting or glare.

What does the laser treatment do?

The laser treatment allows energy to be targeted very precisely within the eye to create an opening in the middle of the misty lens capsule. This clears a path for light to enter the eye and makes the vision clearer. The treatment is painless and takes only a few minutes to complete.

What does the procedure involve?

No special preparation is required prior to your appointment. On arrival, a nurse will check your vision and put some eye drops in the eye to be treated. The drops will make the pupil larger and allow a clear view for the laser treatment. These drops take around 20 to 30 minutes to work and will leave your vision blurred for approximately four hours.

You will be taken to the laser room where a clinician will give you an opportunity to ask any questions you may have about the procedure before asking you to sign a routine consent form. The clinician will then ensure you are sat comfortably at the laser machine and you will be asked to place your forehead against a headrest that helps to keep your head still.

A special contact lens is usually placed on the surface of the eye to improve the view of your eye for the clinician. This has the added benefit of holding your eyelids open, so that you do not need to worry about blinking. A drop of local anaesthetic will be given first to prevent any discomfort.

The laser treatment itself takes only a few minutes: you may be aware of some clicking noises or lights as the laser is activated, but it is a painless procedure. You are then free to leave shortly after the procedure is complete.

What are the risks of laser treatment?

The YAG laser capsulotomy is considered a relatively minor laser procedure. Some patients experience blurring of vision or floaters afterwards which generally settle within a few days. If you sometimes experience floating black shapes in your vision, these may become more prominent after the laser treatment, as more light can enter the eye.

The laser generates energy inside the eye which may cause inflammation. Sometimes the pressure inside the eye can increase shortly after the procedure. This may require further treatment, usually in the form of eye drops. Occasionally the laser can damage the prosthetic lens inside the eye by making small marks on its surface: this rarely causes any problems with the vision but can in a small minority of cases result in glare.

Other very rare side effects have been reported after this type of laser treatment, including detachment of the retina, swelling of the central part of the retina (called ‘macular oedema’) or dislocation of the new plastic lens in the eye. These complications typically result in marked changes in vision but are all potentially treatable and are all very rare. Should you develop worsening redness, pain or loss of vision after the laser procedure, it is important to contact the eye clinic for advice urgently.

Are there any alternatives?

YAG laser capsulotomy is the only non-invasive way to treat PCO. Mild PCO may not cause symptoms, but it can progress over time and cause the vision to become more blurred. Should this happen, you can be referred to have the treatment performed later.

What happens after the procedure?

Following the procedure, your vision will remain blurred because of the dilating drops and the bright lights used during the procedure. You should not drive or ride a bicycle until the effects of these drops have worn off completely. You can resume all other activities as normal and do not need to take any precautions following treatment. A short course of steroid eye drops may be provided to help to reduce inflammation in the treated eye, but these are not needed in every case.

Unless you have another reason to be seen in the eye clinic, we do not routinely make follow up appointments for patients undergoing this type of laser treatment. In the unlikely event that you develop worsening pain, redness or loss of vision, you should call the Eye Emergency telephone number for urgent advice. Otherwise, it is recommended that you make an appointment to see your local optometrist around a month after treatment to check your vision.

What about my sight?

After this treatment your sight should be restored to the level you had following your original cataract surgery. You will still have to use any glasses as before, but your vision should be clear again with these, unless you have any other eye conditions affecting your sight. Occasionally you may need to update your glasses prescription at your opticians to get the best result.

Contact numbers:

Eye Emergency Clinic (urgent advice): 01223 217778

Appointment Centre: 01223 274580

Specialist Nurses (non-urgent advice): 01223 274889

If there is no answer, please leave a message with your contact details and the nature of the problem, and all calls will be returned.