What is an After Cataract?

A common complication of cataract surgery is posterior capsule opacification (PCO). The complication occurs in about 20-50% of cataract surgery patients.  The incidence of PCO also varies with the type of material used for the intraocular lens. A posterior capsulotomy corrects that after-surgery complication.

Although some people call a posterior capsule opacification a secondary cataract, that is not truly correct. When a clouded lens is removed, the cataract is removed, and a cataract cannot form on the artificial plastic lens that is inserted to replace the natural lens that had a cataract.

What is a Posterior Capsule Opacification (PCO)?

During cataract surgery, your eye’s natural lens is removed because it was cloudy and obstructing your vision, and it is replaced with a plastic intraocular lens (IOL). Part of the tissue that covered your lens—the capsule, is left so it can hold the IOL in place. 

Capsule opacification occurs when a layer of cells forms and thickens behind the artificial lens. This layer of thickened tissue can become opaque (cloudy) and that can cause blurry and hazy vision and may also cause glare from bright lights.

This thickened tissue on the capsule can form in weeks, months, or even years after cataract surgery. Why the cells in the capsule  grow and thicken behind the IOL is not completely understood.

How is PCO Treated?

A quick, painless, and highly effective treatment that takes only a few minutes using a low-energy laser called Nd:YAG laser is used to delicately make an opening in the cloudy capsule to allow light to pass through, and this clears your vision. 

After a posterior capsulotomy you may need eye-drop medication for a week or so, and blurred vision caused by the capsule opacification should clear within 24 hours after surgery.

Only one laser treatment is required to permanently correct the problem. The YAG laser procedure removes the central zone of the cloudy posterior capsule behind your intraocular lens, which means the condition cannot return.

Risks of Posterior Capsulotomy

The YAG laser procedure for posterior capsulotomy is extremely safe, but as with any surgical procedure there are risks. The following is a list of possible risks:

• A detached retina. This occurs when the retina becomes separated from its underlying supportive tissue. This is a very rare complication, but if it does occur the retina must be reattached soon after it detaches or there will be permanent vision loss. If you see a lot of floaters or a gray curtain moving across your field of vision call your ophthalmologist immediately so the retina can be reattached.
• The pressure in your eye might increase. This spike in intraocular pressure usually happens in the hours immediately after the procedure and your surgeon will detect this pressure in your follow-up examination and the pressure increase can be treated.
• You might have swelling in your eye and need steroid eye drops.
• The IOL might move through the posterior capsule opening.

If you have pain, don’t experience improved vision, have worsening vision, or signs of a retinal detachment call your ophthalmologist immediately.