Advice needed after YAG laser capsulotomy went wrong.

Posted , 16 users are following.

Hi, this is my first message here.

I'm a 68 year old man who lives in the UK. I have had vitrectomies and cataract ops in both eyes. I have single-vision Tecnis IOLs in both eyes and my visual acuity is excellent (can read bottom line of chart).

I was experiencing glare around lights when outside so opted for a YAG laser capsulotomy. I had it done under our National Health Service. It's been one of the worst decisions of my life. Before the op, everything I read on the Internet suggested it was very simple and safe, and though some sources mentioned lens pitting, they seemed to suggest it hardly ever occurred and seldom caused a problem when it did.

Well, now I get a bright vertical band going vertically through every light sources, plus a diagonal one, and they go right across my field of view. At first I thought it was due to the capsule hole being too small (the usual cause of glare) but then I wondered if it could be due to the laser pitting the lens. I went back to the hospital, and sure enough, they saw lens pitting, but they did not seem to think this was serious.

So, to cut a long story short, I feel as if I've lost my life. I have very obsessive personality traits, and if there is anything wrong with my eyesight, it just occupies my whole experience. Walking around cities in the evening has always been one of my greatest pleasure, but now I dread going out in the evening: I just cannot stand seeing those streaks. The only suggestion the doc at the hospital gave me was anti-glare glasses, but plainly, they wouldn't work, as the source of the glare (if I'm right that it's pitting that's doing this) is in my eye.

I'm going to get myself some Alphagan eyedrops in the hope that they will close my pupil down enough for the edge to cover some of the pits, but I've a feeling the pit that's causing the biggest problem is too near the middle of the pupil. Also, the last time I used Alphagan, for a different glare problem, I developed an allergy, so this can only be a short term remedy.

So now to the main reason I'm posting. If IOL pitting really is the cause here, the only solution is replacing the IOL, and there are two problems: (1) the YAG capsulotomy makes it much more difficult and (2) this IOL has been in place for nearly a decade, so that alone will make it hard to remove. I mentioned lens exchange at the hospital and they were VERY unhappy (as I thought they'd be). The doc treating me said there were lots of things they could try before taking such a step (but the only example she gave was glare-reducing glasses, and I could see straight away that they wouldn't work).

So I'm facing a tough dilemma: try for lens exchange and risk winding up in a far worse position, or just go on putting up with this problem, a problem that's causing me to feel more and more depressed.

My plan at the moment is to go for the lens exchange, but try to find the best surgeon there is for doing post-YAG explantations.

Yesterday I discovered this forum and someone mentione a Dr Steve Safran, of New Jeresy, and claimed Dr Safran had told him he does several post-YAG exchanges every week. If that's true, he might be the safest one to go to, but getting an op in the USA when I live in the UK would be an expensive business.

So I suppose what I'm wanting to know here is:

  1. Should I assume that the problem really is lens pitting - can anyone think of anything else it could be?

  2. If lens pitting is the cause, has anyone heard of a treatment for it other than explantation?

  3. Can anyone recommend anyone nearer to the UK who has a lot of experience in doing post-YAG exchanges?

Any other advice that anyone can offer would be much appreciated. Thank you for reading this.

1 like, 15 replies

15 Replies

  • Posted

    I have no experience with YAG, so can only offer you some suggestions based on what you describe. Is the flare bands you are seeing only at night? Also is this a one eye effect or both? If it is night only, that would suggest, as you have thought, it may be an issue of the pupil opening up and the opening from the YAG coming into the line of vision. I think I might want to get a second opinion on that possibility. Eye drops to constrict the pupil may be another way of testing that theory. I have not heard of lens pitting as an adverse outcome of YAG. Retina detachment is a risk but it is very low.

  • Edited

    Hi arnold. Sending much Blessings your way for recovery. I cant help with the medical part but I familiar with area. Dr Safran is about one hour away from NJ biggest airport Newark Liberty. The closest motel is four minutes away from his Office. Perhaps due to distance Dr Safran could do a video chat or phone chat with you and have your Dr fax him your information and then you might have some kind of plan which does wonders psychologically. Dr Safran might be able to recommend UK or European specialist closer to you. I hope this helps

  • Posted

    Thank you so much, RonAKA and mary27273 for your veru speedy replies, and for trying to help me.

    To answer your questions, RonAKA:

    These bands are most troublesome at night, but I see them at other times. For instance, even if I look at a bright light in a brightly lit room I see them. I even see them coming fro the sun if it's partly obsured by a cloud.

    And it's just in the YAGd eye: before I had that darned YAG, both my eyes were perfect.

    I'm almost certain it's the laser pitiing that's the cause, but I'd love to be proved wrong, as a different cause might be easier to fix.

  • Posted

    after yag safran might be the way to go for lens exchange. he is not too bothered by surgery done a decade ago. i havent had the exchange but i have seen him.

    although do keep in mind that he has kind of move on attitude. this isnt serious so deal with it and move on with your life kind of thing.

    he may also feel that instead of pitting capsule flaps might be still in your visual axis and may recommend making the YAG opening larger.

    good luck.

  • Posted

    Have you had a thorough exam of the eye, including a look at your retina? From what I've read, YAG treatment can cause some retinal issues.

  • Edited

    I have no experience with a YAG but my understanding is that it is done when a cataract patient experiences pco not for glare issues.

    • Edited

      my PCO is causing blinding glare.

    • Posted

      i am not looking forward to dealing with pco especially if it occurs in RE. i would not be able to read due to Epiretinal membrane in LE

  • Posted

    I've seen other reports regarding YAG-induced lens pitting that you describe, and I think you're on the right track. For example, elsewhere on this forum, one patient described seeing halos in horizontal and vertical crosses after YAG, which turned out to be the exact pattern of his YAG procedure (YAG is also sometimes done in a circle). As you know, YAG blasts laser pulses behind an IOL to obliterate the rear portion of the capsular bag. The slightest mistake in measurement is a laser blast to your IOL.

    It's unfortunate and frustrating that doctors have minimized these negative result and pushed you off into glasses that only mask the problem at best. And you shouldn't have to mess with pupil size to fix it. Your doctors are "very unhappy"? Well, too bad for them!

    (1) Yes, I think it's reasonable to conclude the problem is lens pitting. You've done your homework correctly. Don't grind yourself down chasing illusory and wishful alternatives that are long shots at best.

    (2) I'm unaware of any solution except getting a new IOL.

    (3) My first-hand recommends for doctors are only in the U.S., but perhaps you can contact a top physician here and they can recommend someone who is top-quality and closer to you.

    Don't despair. You'll feel better when you're firmly on a path to fixing the problem.

  • Posted

    I want you to know that I'm having the EXACT problem. Beautiful vision until the YAG. Now I have these absolutely insane light spikes at particular angles.

    Whether or not we have obsessive personalities, anyone in the world would be dismayed by MASSIVE spikes of light blasting across our field of vision like laser rays.

    I was given the runaround by my surgeon after the YAG. They kept blaming dry eye, then glasses (I've had 3 prescriptions which did not help at all), and finally sent me to a cornea specialist. Anything to blame but themselves.

    I've had several eye doctors look at my implants (not cataract surgeons, but other specialists) and none noted any signs of pitting. I thought I'd share this, because my problem sounds very similar to yours, but mine isn't caused by pits. I'm quite certain the YAG opening is too small. The surgeon would not consider this a possibility, even though I brought it up twice.

    My thoughts? Before considering an exchange for the pitted lens, I'd see a new surgeon and ask about the YAG size. Of course, I'd ask them about the pits, as well.

    I'm booked to see two new surgeons as of right now. Don't fall for the doctors brushing you off. I've photoshopped illustrations of my lines to show them - people tend to believe we're exaggerating, especially if we seem nervous or upset while we're trying to explain ourselves. You deserve to have your evenings back (as do I).

    I wouldn't get the second eye done until you have an answer. I had both eyes YAG'd a week apart, and I absolutely wish I hadn't. I would reverse the decision in a heartbeat. I chaulked the lines in the first eye (my more troublesome eye) up to healing. The lines are WORSE in the second eye that was done. By a lot.

  • Edited

    Are the streaks present when your eyes are perfectly still? Or do they only appear when you move your eyes? I have something similar after a YAG and the doctor could not see anything wrong with a slit lamp examination. In my case, it only happens when I move my eyes. It looks like a blurry line moving across my field of vision. When I told the doctor this, he had me move my eyes while under the slit lamp, and he could then see a piece of lens capsule being kicked up into my visual axis. Not sure if this is the cause in your case, but just thought I would mention it in case it helps you troubleshoot your problem.

    One thing that is unfortunate is that a lot of opthalmologists don't care about things like this because they are only interested in eye pathologies. If there is no underlying eye problem, they trivialize any problem the patient may be having because in their view, the eye is perfectly fine. It is frustrating for the patient whose quality of life is being affected because the doctor seems unwilling to put in the effort to figure it out.

    Best of luck Arnold. I hope you find a solution to your problem.

    • Posted

      Hello Karl,

      I am having the same issue after my recent YAG . Did you have the laser again to alleviate the problem and if so how did it go?

      Thanks in advance for your response.

    • Posted

      I had a capsulotomy in one eye and it was done in a circular pattern. The capsule was supposed to drop down out of view but it did not fully drop and when I look at light I see a slowly rotating starburst pattern for several seconds. This is due to the capsule still being partially in my vision. It is worse if I look down and then up. This pulls the capsule into view and then it sinks back down. I was told that it would get better with time as the fluid in my eye loses viscosity. I am 64. I went to another doctor that did some additional laser with the intent of trying to cut some of the strands in the vitreous fluid that it were causing the capsule to not fully drop. This was unsuccessful. I did not have the other eye done due to this issue. Several years later I am now ready to have the other eye done since it is cloudy similar to when I had cataracts and much worse haze than when I had the first eye done. I am looking for an eye doctor that does a cross or pizza slice pattern instead of the circular pattern which leaves a larger piece of capsule that needs to move down. The first eye still does this but it seems better now and I only notice it if I look down then up and only for a few seconds. I was also extremely disturbed by this at first but either it is improving or I am getting used to it, so hopefully those with similar issues can take comfort in that. If the lens is pitted, I think the only solution would be another lens exchange. I would want that positively identified before I would consider a lens exchange. If the capsulotomy was done in a cross or pizza slice pattern, I suppose that any one of the pieces that does not fold back as expected would do a similar thing if it is in your vision. The expectation in that type of capsulotomy is that the triangular capsule pieces should fold back from your line of site.

    • Posted

      There are issues with both the circular "can opener" pattern, as well as the cruciate (pizza slices) method. Silicone lenses are more susceptible to damage from the laser beam and the circular pattern may be the better one if you have a silicone lens. Most current lenses are not, but the LAL lens is silicone. The cruciate pattern puts the lens at higher risk, but I suspect the risk can be minimized by the skill of the surgeon. As I understand it, they should focus the laser initially just behind the targeted capsule and then bring it forward to cut the capsule.

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