YAG laser capsulotomy for posterior capsule opacification

Posterior capsule opacification is something that occasionally happens to people after they have cataract surgery.

Cataracts is the term for the clouding of the lens in your eye. This affects your vision, but can be corrected using cataract removal surgery. During cataract surgery, your cloudy natural lens is replaced with a clear artificial lens.

In some cases, a hazy membrane can form just behind this artificial lens implant, in the bag (also known as the lens capsule) where it was placed. This affects the light coming through to the back of the eye. This condition is known as posterior capsule opacity, or PCO. It usually occurs a few years after cataract surgery.

The symptoms of posterior capsule opacity are similar to those you will experience with cataracts. These include:

• Blurry vision
• Hazy or cloudy vision
• Bright glares or halos around lights
• Double vision
• Reduced visual focus

PCO is not dangerous, but it does affect your sight. YAG laser capsulotomy is a fast and easy way of improving these symptoms and restoring your sight. There is no other treatment for PCO other than YAG laser capsulotomy, and the condition will not improve by itself.

During YAG laser treatment, eyedrops are used to dilate your pupil, and a local anaesthetic is used to numb the area so you will not feel anything during the treatment.

A special contact lens is put into your eye and you will be asked to sit in a chair, resting your head against a frame. The surgeon then uses a laser beam to make a small hole in the membrane that has formed behind your lens. This will allow light to pass through and enable you to see better.

YAG laser capsulotomy is a quick and easy outpatient treatment that only takes around 20 minutes to complete. You won't usually need to stay overnight, however you will need to wait at the hospital until the doctor has checked your eyes and given you the all-clear to leave.

Usually one treatment is sufficient, but occasionally a second session is needed.

Your vision will be blurry for three to four hours after YAG laser treatment, but it should return to normal quickly. You won't be able to drive for the rest of the day, so make sure you arrange transport to get home after the procedure. A friend or family member might need to help you home and get you set up with everything you need for these first few hours when your vision is affected.

You should be able to continue with most of your everyday activities almost immediately. Some itchiness and mild discomfort are normal, and can be treated at home with painkillers. You might experience floaters in your eye for around a week, along with some sensitivity to bright light.

You might be prescribed anti-inflammatory eye drops to use at home. You probably won't have to use them for longer than a week. You will be able to visit your optician around two weeks later if you need new glasses.

You should avoid rubbing your eyes, wearing eye make-up and swimming for around a fortnight, and should not resume playing contact sports for around four weeks.

It's rare to have any serious complications after a YAG laser capsulotomy. Sometimes there is an increase in eye pressure, which can be treated before you leave the hospital.

There is a very small risk of a build-up of fluid in the macula, part of the retina. This can distort your sight. There is also a very small risk of the retinal detachment. If you experience flashing lights, extreme pain or loss of vision following a YAG laser capsulotomy, you should seek medical assistance immediately.

It's also possible that the opening made by the laser will be too small or incomplete. In these cases, you will probably need a second treatment.

The cost of your procedure will depend on various factors, including which hospital you choose to have treatment at.

If you are paying for your own treatment, we offer fixed-price packages, which include the cost of your aftercare. You can spread the cost over a period of up to five years using our flexible payment options.

If you have private health insurance, YAG laser capsulotomy will often be covered by your policy. Speak to your insurer directly to find out.

How to prevent posterior capsular opacification?

While it's not always possible to prevent posterior capsular opacification (PCO), there are some factors that may help reduce the risk:

• Advanced intraocular lens: At Circle Health Group, our surgeons use the latest lens technologies that may help reduce PCO risk.
• Surgical technique: Our experienced surgeons adopt meticulous surgical techniques during cataract surgery to minimise the risk of PCO.
• Post-operative care: It is important to have follow up care as instructed by your surgeon after cataract surgery.

However, it's crucial to understand that PCO can still occur despite these measures. Regular follow-ups with your ophthalmologist are key to detecting and treating PCO early if it does develop.

Does posterior capsular opacification go away?

Unfortunately, posterior capsular opacification (PCO) doesn't clear up without any treatment. At Circle Health Group, we want our patients to understand that:

• PCO is a progressive condition that typically worsens over time.
• It won't resolve by itself without treatment.
• The good news is that PCO can be effectively treated with a quick, painless procedure called YAG laser capsulotomy.

If you have symptoms of PCO after cataract surgery, we advise booking an appointment with one of our ophthalmologists for a full assessment and discussion of treatment options that will best suit you.

How long after cataract surgery can posterior capsular opacification occur?

Posterior capsular opacification (PCO) can develop at different times after cataract surgery. At Circle Health Group, we often see that:

• PCO usually develops within 2 to 5 years after cataract surgery.
• However, it may sometimes occur as early as a few months post-surgery or as late as 10 years or more.
• The risk of PCO increases over time after the first cataract surgery.

This underlines why we encourage all our patients to attend regular follow-up appointments and report any changes in vision as soon as possible, even years after their cataract surgery, to allow for early detection and treatment of PCO if it occurs.

What causes posterior capsular opacification?

Posterior capsular opacification (PCO) is a common occurrence following cataract surgery. We explain to our patients that PCO is caused by:

• Residual lens epithelial cells: Cells that remain on the lens capsule after cataract surgery has been performed.
• Cell proliferation: Remaining cells that can grow and multiply on the underside of the lens capsule.
• Fibrosis: The cells can also transform and cause the capsule to become wrinkled and cloudy.

Although our surgeons take the greatest of care to remove as many of these cells as possible during cataract surgery, it's not always possible to remove all of them, which is why PCO can still develop.

Can posterior capsular opacification cause headaches?

While posterior capsular opacification mainly affects vision, some patients at report associated symptoms like headaches. Here's what you should know:

• PCO can cause visual disturbances such as glare and blurred vision.
• These visual changes can sometimes lead to eye strain and headaches, especially when trying to focus.
• However, headaches are not a direct symptom of PCO itself.

If you're experiencing headaches or any vision changes after cataract surgery, we recommend scheduling an appointment with one of our specialists for a comprehensive eye examination.

How common is posterior capsular opacification?

Posterior capsular opacification (PCO) is a fairly common occurrence after cataract surgery. At Circle Health Group, we inform our patients that:

• PCO is the most common complication of cataract surgery.
• It occurs in about 20% to 40% of patients within the first 5 years of surgery.
• The risk can vary depending on factors such as age, type of intraocular lens used, and surgical method.

While these numbers might seem high, it's important to emphasise that PCO is easily treatable with YAG laser capsulotomy, a quick and effective procedure that we offer at Circle Health Group.

How to test for posterior capsular opacification?

At Circle Health Group, our ophthalmologists diagnose posterior capsular opacification via several methods:

• Visual acuity test: Measures how well you can see at various distances.
• Slit-lamp examination: Enables our consultant to examine your eye in detail, including the lens capsule.
• Dilated eye exam: Allows for a thorough investigation, and a clearer view of the back of your eye.
• Contrast sensitivity testing: Can detect subtle vision changes in vision that may not appear on standard vision tests.

If you're experiencing changes in your vision after cataract surgery, we advise scheduling an appointment for a comprehensive eye examination to check for PCO.

What happens if posterior capsular opacification is left untreated?

We advise our patients that untreated posterior capsular opacification (PCO) can lead to:

• Progressively worsening vision
• Increased difficulty with daily activities like reading or driving
• Potential safety risks due to impaired vision
• Reduced quality of life

However, it's important to remember that PCO does not cause permanent damage to your eye. Even if left untreated, it can still be corrected effectively with YAG laser capsulotomy. Nevertheless, we recommend addressing PCO promptly to maintain the best vision and quality of life. The sooner PCO is treated, the lower the risk of other complications.

What does vision look like with PCO?

Patients often describe their vision with posterior capsular opacification as:

• Cloudy or hazy, as though looking through frosted glass
• Blurry, especially for distant objects
• Seeing glare or halos around lights, especially when driving at night
• Having difficulty reading or seeing small details
• Noticing a gradual decrease in vision clarity over time

It's important to note that these symptoms can be similar to those of cataracts themselves. If you're experiencing these vision changes after cataract surgery, we strongly advise booking an appointment with one of our specialists for a full diagnosis. 

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to suit your routine
• The freedom to choose which hospital and consultant fits your needs
• Personalised, consultant-led treatment plans tailored to your specific requirements
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private cosy ensuite rooms as standard and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about treatments for cataracts or, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in February 2023. Next review due February 2026.

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3. YAG laser capsulotomy following cataract surgery, NHS
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7. Posterior capsule opacification, EyeWiki