YAG Laser Capsulotomy

One of the commonest complications which can occur after cataract surgery with an artificial IOL (intraocular lens) implantation is Posterior Capsule Opacity (PCO). This can happen typically 2-3 years following the surgery, in up to 50% of patients who undergo otherwise routine cataract surgery & IOL implantation. The PCO is an opaque or clouded thickened membrane which replaces the previously transparent capsule behind the IOL, causing the previously clear vision to deteriorate and become blurry or cloudy, and causing glare from lights at night-time or from bright lights. If your eye surgeon has recommended YAG Laser Capsulotomy, it is because this laser procedure will create a clear opening through the clouded posterior capsule so that your vision will be restored to its previous clarity.

YAG Laser Capsulotomy is a simple, commonly performed and very safe laser treatment, which is used to improve your vision, if a posterior capsule opacity forms after you have had cataract surgery with an artificial intraocular lens implant. In a YAG Laser Capsulotomy, the ophthalmologist uses a special lens to apply a laser beam to the centre of the opaque, clouded capsule. This creates a small hole in the centre of the thickened capsule so that there is a clear pathway for light to get through. Currently, YAG Laser Capsulotomy is the only non-invasive way to treat this condition.

It is very uncommon to have complications after YAG Laser Capsulotomy. Nevertheless, the following complications are possible following the procedure and careful monitoring is a routine part of the post-treatment care:

Increase in floaters: These appear like dots or wavy lines in the vision and they are the commonest side effect of this treatment, but they are not serious, and people learn to ignore them after a little while.

Increased pressure in the eye: This can occasionally occur immediately after the laser treatment. Before you are discharged to go home, additional treatment with eye drops or tablets will be provided, and you may be asked to remain in the clinic until the eye pressure has dropped to a satisfactory level. Typically this may take a few hours at most.

The laser capsulotomy opening is not large enough or is incomplete: The treatment will need to be repeated at a later date.

Extremely rarely, macular oedema (swelling) and retinal detachment have been reported as possible complications. Retinal detachment can produce a shadow in the vision or flashing lights accompanied by large floaters. Such symptoms, or any new blurring or distortion of vision should be reported urgently to your doctor for further investigation.

Mild eye inflammation, lens dislocation and lens damage (pitting) which reduces the clarity of the new artificial lens have also been reported as rare complications.

Continue using your usual drops and medications, including blood thinning medications like Aspirin, Warfarin and Clopidogrel, until the day of surgery.

At your pre-treatment assessment, check that any underlying medical conditions you may have such as diabetes, hypertension or cardiac disease have been disclosed and discussed. Special preparations such as fasting or wearing operating theatre clothes will not be required as the treatment will be done as a day case outpatient procedure, lasting for about half a day.

You will be asked to sign a consent form which will set out the risks and benefits of the treatment, after they have been discussed with you. Measurement of your vision and eye pressure will be done. You will have some drops put into your eye to widen the pupil, and an anaesthetic eye drop to numb the surface of the eye. As a result of these drops, your vision may be blurred for about 4 hours. You may have drops of apraclonidine (“Iopidine”) before the treatment to help prevent rises in eye pressure, but this may be omitted if you have a history of ischaemic heart disease (heart attack or angina). If you have heart problems, especially severe angina that has required surgery or vascular stenting, it is important to ensure that your doctor is aware of this.

YAG Laser Capsulotomy takes about 10 – 20 minutes. You will be seated at a “slit-lamp” – a machine likely to be similar to the one used to examine your eyes when you visit the eye clinic for your routine eye checks – this one will have a special laser attached. A special lens will be placed on your eye by your ophthalmologist, before applying the laser beam. This lens enables the ophthalmologist to see the membrane clearly before applying the laser and creating a small hole in it to clear the vision. You will be instructed to look at a target in front, and to keep still while the treatment is performed. This is important because movement during the procedure can cause problems such as lens pitting. You will see a bright, white light as it is shone into the eye by the ophthalmologist, to see the spot where the treatment is being applied. This may cause your vision to be dimmed for up to 30 minutes afterwards. The YAG laser machine makes a clicking noise and gives a very short “flicking” sensation when activated. The ophthalmologist will need to adjust the laser power depending on the thickness of the capsule. After the procedure, you will return to the waiting room to await a further check on your eye pressure about an hour later. The treated eye is also re-examined to assess the outcome of the laser procedure.

After YAG laser capsulotomy, most patients find that their vision is blurry for about four hours as a result of the drops and some are bothered by the glare from bright lights. It will therefore be helpful for someone to accompany you home, but this is not essential. Avoid driving or riding a motorcycle or bicycle for the rest of the day. Typically, no special treatment is required following the procedure, and you can go back to your normal daily activities straight away. Sometimes, if the eye pressure remains high following the procedure, you will be given tablets and/or drops to use for a few days. You will sometimes be advised to use anti-inflammatory eye drops for 1 week to prevent inflammation in the eye. If you routinely wear contact lenses, you will need to use preservative free drops, or stop wearing contact lenses for the week. Those with glaucoma should continue to use their normal glaucoma medication for both eyes unless specifically told not to.

You should urgently report the following symptoms: Excessive pain, increasing redness of the eye, loss of vision, a shadow in the vision, flashing lights, sudden appearance of large floaters.

You may take your usual pain relieving tablets following the instructions on the pack, if you have some discomfort when you are at home. It is normal to have itchy, gritty or sticky eyes and mild discomfort for the remainder of the day after the treatment. You will be given a follow-up appointment a week or so after your laser treatment to ensure that the eye has settled down normally and to assess the success of the treatment.

YAG Laser capsulotomy helps restore clear vision in people who develop hazy vision as a result of developing a posterior capsule opacity following cataract surgery with an intraocular lens implant.

This outpatient laser procedure is simple, commonly performed and very safe. Complications resulting from YAG laser capsulotomy can sometimes occur but they are very uncommon.