Yag Capsulotomy- for "after cataract" lens capsule clouding

[hazik619jericho]

i delayed this yag laser treatment due to problems am i at risk of any problems?

[AMahootchi]

What problem are you specifically having before your laser?

[AMahootchi]

(-Continued) Converting yourself to -1.50 would make the intermediate distances clearer (computer, dash board, counter tops) at the expence of near vision (14 inches) without glasses. I would advice doing contact lens trials to mimick the intended fix once you are 3 months out. If you love the difference with the contactllens--then refreactive surgery might be for you. If not, then don't do refractive surgery.

[AMahootchi]

It's too early to even consider. Most advise waiting at least 3 months before considering any refractive surgery. PRK is usually recommended if you have a scleral buckle. If not, then either procedure would be a possibility.Most patients, however would not do surgery for that little difference between eyes. Usually the1 Diopter difference between -1.50 and -2.50 isn't noticable to most people. Also, if you would end up -2.50 your near vision without glasses would be great.

[abrohs1]

(continued) Is PRK better than Lasik in this situation and can PRK be done sooner after surgery than Lasik. Thanks for your Help.

[abrohs1]

(continued) My question is what are your thoughts on laser touch up to improve RD eye to good eye?

[abrohs1]

Thank you so much for your input! I am taking ocuvite, but it only containes 2mg of Lutein. I will be picking up 20mg capsules tomorrow. I am taking Zymaxid, Durezol and Ketorolac drops post op. Two last questions if you will. The RX is pretty far off in the RD eye versus the good eye. Right eye is -2.50 and left is -1.50. That is alot of change and I know eye will improve some I do not believe it will improve to -1.50.

[AMahootchi]

(continued) A common cause of problems in patients with prior surgery is cystoid macular edema, epi-retinal membrane, and changes in the retinal pigment epithelium. It's a good idea to take 20 mg of Lutein by mouth and your doctor probably has already given you non-steroidal eye drops which can help.

[AMahootchi]

Sounds like your doctor was trying to make the prescription in the eye you had done match the prescription in the other eye. Considering your past eye surgery history it may take you longer to get to your best vision than the typical cataract surgery patient.

Posterior capsule clouding can happen early, particulary in young patients but it is not likely the cause of your early blur. Sometimes just the normal healing process can make the vision fluctuate in the first week or two.

[abrohs1]

Thanks, I had RD surgery 4 1/2 months ago and implant 5 days ago. Good eye is -1.50 to - 1.75. They were shooting for -2.0 fir the implant. Did they figure over thinking my eye would get stronger and match my good eye? Distance vision is pretty good but near is not and it is as hazy as before implant. Near vision seems to be getting worse than it was 2 days after implant. That is why I thought I may need Yag. I see my Doctor today but would like to also hear your thoughts. Thanks for your time.

[AMahootchi]

In most cases, it is best to wait at least 3-4 months after the original cataract surgery before performing a Yag Capsulotomy. Usually the lens and capsular bag have settled into position enough by that point. If done sooner, there is an increased risk of lens dislocation. That risk dwindles after 3-4 months for most lens implant types.

[abrohs1]

How soon after cataract surgery can YAG procedure be performed?

[sroh98]

thank you so much for this fantastic educational video. i just had this done today, and fortunately happened to find this video a few days beforehand, and it made the procedure feel even easier and more comfortable.

[AMahootchi]

You are welcome.

[Noler45]

Well. I go in for this procedure on the 25th of this month(July). I was only 25 when I had a cataract removed. I had asthma pretty bad when I was younger and was heavily dosed with steroids. What is the recovery time after the YAG procedure? I'm excited and a bit nervous at the same time.

[AMahootchi]

The majority of patients see a lot better without minutes to hours after the procedure. Some take longer. Usually the wow factor is proportional to how cloudy the capsule is, or how bad the vision is before the procedure.

[ookami93527]

Curious, can this be performed safely on someone who currently has silicone oil in the eye due to a Vitrectomy? A macular hole with a history of retinal detachments is also present. I'm curious of the risks involved while performing a capsulotomy.

[AMahootchi]

Usually the retina surgeon who has placed the oil will give his "clearance" to do the surgery when he/she feels the retina situation is safe enough. Other factors like the status of the cornea, plan for when or if the oil is going to be removed, etc that would all factor into the risk/reward calculations. The certainly is an uncommon scenario.

[ookami93527]

@AMahootchi

Thank you for the quick and informative response. I am sorry I did not reply sooner. I'm still learning a lot about my own condition. If I knew what the future held, I would have become a med student before all of my own retinal traumas and subsequent repairs. It is quite fascinating, albeit frightening from a patient's perspective.

Thanks again

[RVSimmerman]

Follow up post--as it turns out, I was diagnosed with blepharitis, which in turn led to a dry eye condition. I began treatment yesterday afternoon and already can tell a difference in terms of the eye twitching--now gone--and the vision loss, while not back to where it was before the doctor visit, is nevertheless noticeably better. The doctor recommended a few weeks of treatment before we move ahead with a prescription for refration changes as he indicated blepharitis may be the culprit.

[RVSimmerman]

I am seeing the surgeon who performed the procedure today. The loss of vision was noted at an exam given by a local optometrist, my yearly check to examine the eyes. All that doctor said was "You're eyes have changed" I told him I had the cataract surgery but he had no answer. He did examine further under dilation and said everything looked good, but I'll know more later today. Thank you again.

[AMahootchi]

Thank you. I am glad you liked the video.

The need for repeat Yag capsulotomy is very rare but does occasionally occur. If there is no history of any other eye problem, I would guess that epiretinal membrane, change in refraction, or macular degeneration are some of the more common causes of loss of vision. Hopefully the doctor who checked your vision explained the cause of the decreased vision.

[RVSimmerman]

Whoops--20/25 in left eye, 20/15 in right eye. YAG treatment in right eye.

[RVSimmerman]

Fantastic video! I had cataract surgery in both eyes in the late summer of 2008 with very good results--after IOL implant, 20/25 in right eye, and 20/15 in the left eye. I used readers for up close work and was very pleased. About a year ago, I required YAG to clear up the right eye and it was uneventful and the vision returned to the 20/15.

My right eye recently exhibited at 20/40...is is possible that another YAG treatment is in order? Is it unheard of to have multiple YAG? Thank you!

[AMahootchi]

The laser can treat the cloudy lens capsule either in front or behind the lens. Treatment to the capsule behind the lens ( and in the line of sight) is much more common. There is evidence that making relaxing cuts in the anterior capsule and avoid future tension and movement of the lens.

[a2zaawara]

@AMahootchi Thanks a lot for your quick response.

[a2zaawara]

@AMahootchi Hi doc, i had YAG laser surgery today because I was having problem of multiple images after cataract surgery. After nearly 10 hours, im still feeling multiple images. Do you think the problem is still there or it will take few days to settle down?

Befor YAG laser they checked my eyesight with pinhole device. With that device I was not seeing multiple images but vision was still weak which was 6.5/7

[AMahootchi]

It's best to ask the doctor who did the procedure about any concerns you may have- especially in the immediate post op period.

Blurred vision and floaters are common in the first few hours after the procedure but usually fade away pretty quickly. Post op high pressure or inflammation requiring treatment occurs in about 1% or less.

[a2zaawara]

@AMahootchi Thanks for your reply. I dont have inflammation or pressure. My eye is just normal. But I still have multiple images after YAG laser. I will contact the doctor in next week. Here in UK system is very bad. After my cataract operation it took 10 months to get appointment for laser surgery. Now lets see how long it will take to contact the doctor. Once again I appreciate your help

[jcminnesota]

Hi Doc...your video is very instructive. I live in MN so I will be having a YAG laser treatment in a few weeks. I currently take Flomax for prostate problems. I have heard that if one has cataract surgery while taking Flomax there are special techniques needed. Is that the case with the YAG laser? Or doesn't it matter?

[AMahootchi]

What a great question! It usually isn't thought of as an issue for the Yag. Certainly it can't create issues like Flomax can when the eye is open during cataract surgery. But one way it can create less than an ideal result is if your pupil can't dilate fully. This might have a small chance of problems is the anterior capsule opening is contracting adn can't be seen to laser--this can displace certain types of lenses and can create glare later. It may however help avoid other types of problems.

[jcminnesota]

Thank you! I will mention to my eye doctor. This website is great and you are doing a good service to be willing to answer questions. I will mention you to friends who live in FL!

[1ecedwards]

you probably smelled this coming...the left eye was the intended eye for the yag cap but the right eye was actually done.

[AMahootchi]

That explains it. Inflammation occurs in less than 1% of cases in my experience--it usually is short lived and gone with a steroid drops for a few days. I hope you are all well now.

[1ecedwards]

update...vision still cloudy...appointment last wednesday...exam fears were for vitreous hemorrhage (os)?...sent immediately to a retina specialist for exam and ultrasound...specialist: retina is ok and vitreous is clear...my doctor prescribed prednisolone acetate ophthalmic suspension usp drops friday...for inflammation i am not aware of...no itch, burning, pain,.....sorry to say confidence in my current doctor is waning...if retina and vitreous are ok, hoping for a benign cure to restore sight

[1ecedwards]

to continue...grateful for right eye improvement but my concern is the current state of my left eye...i was told by a tech or ? that one eye is sympathetic to the other, so the slight improvement in the left would affect the right...have read online that yag cap improvement may be immediate or the next day...i am on day 6 with about a 25% improvement over pre yag cap...is there any mending of the eye to delay improvement? hoping from your video that maybe the opening was not made large enough.

[AMahootchi]

It's hard to say. Usually when the opening isn't large enough the complaint is glare from the patient. If the central or reading vision isn't much improved then there are a lot of other possibilities--macular problems are the most common.

[1ecedwards]

yes...i had noticed a slight difference in my right eye before the appointment that scheduled the yag cap for the left eye...at that appointment i was told i would need a yag cap later for the right eye...a few weeks earlier i had purchased new glasses for computer use...after the yag cap on my left eye i noticed immediately an improvement of the right eye, i immediately questioned which eye was in fact done...i was emphatically told the left eye was done...now back to using my old pc glasses

[1ecedwards]

Cataract surgery on both eyes august 2006. Nothing special IOL's. Noticed a change, then clouding about 6 weeks ago. Had yag cap last Wednesday a.m. Instant improvement but in my RIGHT eye. Confirmed LEFT eye was done, pressure was checked that afternoon to be ok with only slight relief of the clouding. Dr. said everything looked fine. Today is Monday noon and 25 to 35% improvement at best. I was expecting more, quicker. Would appreciate your comments. Scared to say the least. 62 yrs old. thanks

[AMahootchi]

To be clear, are you saying your left eye was the one that had the laser but that the right eye ( the untreated one) was the one with the improvement?

[AMahootchi]

Most will need a Yag capsulotomy- so I don't let that influence the choice of lens--just choose what's best for the patient -since Yag capsulotomy has sucha low complication rate. If you are young--you'll need a yag most likely whatever lens is chosen. But you may have had some special considerations that I don't know about.

[tb518]

I just had one today

[AMahootchi]

As for "premium" lenses I think the optical system as to be just about perfect and the patients expectations are higher-- ..so any opacity leads to a degradation in quality that leads to a patient seeking help earlier. Most experience surgeons with these type of lenses acknowledge this in their own practices.

I like Crystalens better than multifocals but in general I don't pick a lens based on whether I think the patient will need a Yag cap or not.

[AMahootchi]

Another good question. I don't thing we know "why" younger patients tend to get earlier opacification of the capsule--it just seems to be that way. In babies, the central capsule is removed at the time of the original surgery because it gets cloudy in weeks and it's difficult to do a Yag on an infant who can't sit up.

[rjt808]

Thanks. If I may, why is there a greater risk of clouding the lens capsule with a younger patient or by using a fancy (I assume multifocal) lens? I think I was given a standard lens because of the risk of clouding, and now I've got the clouding anyway requiring Yag capsulotomy, and I wonder what I lost from a vision standpoint by not getting a multifocal.

[rjt808]

question: how do you reduce the risk that the patient is blinking at the moment the laser is active? I didn't see the "clockwork orange" eye clamps being used.

[AMahootchi]

Great Question. A lens is placed over the eye to magnify the area I'm treating. It's called an Abraham capsulotomy lens. The lens has a a side that contacts the numb eye but the external side has a flange that keeps the lids back. The lid can blink--but just not over the center part that I'm viewing the capsule through.

[rjt808]

I had cataract surgery two days ago and the doctor mentioned probably needing to do follow up laser treatment in a few weeks after my eye stabilizes. Your video was very helpful in answering my questions about how, what and why. Thank you!

[JISTVN]

i HAD THE CAPSUL0T0MY D0n3 AnD i CAnT SEE AT ALL 0UT 0F Mi LEFT EYE. i WENT FROM A -11.50 TO A +13.75 in Mi LEFT EYE in AbOUT 5 MOnTHS.

i GO in SOOn TAH HAVE A FAKE LENSE PUT in CUZ i CAnT WHERE GLASSES (i WEnT FROM A -12.5 TO A -7.5 AFTER Mi TREbECOLECTOMY in Mi RiGHT EYE)

[AMahootchi]

Without knowing the specifics of your case it would be difficult to comment in specific for you. However, several things you mention strike me as unusual. Yag capsulotomy is for those who have had " fake" or made made lens implants already. So to mention that you are going for a "fake" implant just now--after the laser-is very unusual. Also, after cataract surgery it would be very unusual to be -11. So the specifics you mention would be something seen very, very rarely.

[JISTVN]

before the surgery i had -11 and now i have +13 and i can barely see so thay have to put in a fake lense to even it out becouse in mi right eye i have -7.5

Ive had PI's done in both of mi eyes...it didnt work in mi right eye so i went into emergency Trebecolectomy becouse mi pressure had reached 75 and i could not stop puking. but taking the lense out was schedueled becouse im only 17 i was diegnosed with it when i was 16 & notheing has worked.

[videorookie]

I just had this proceedure done in both of my eyes today. Painless and quick. I'm glad this video was here to show me what was going to be happening. Thank you.