Blurry patch after yag capsulotomy

I'll keep you up to speed steve🖒

Hi steve

How did your yag turn out? I had to have a second yag done as the symptoms I described initially were caused by a large free floating capsule fragment moving in and out of my visual axis. The surgeon had me look down and up and zapped the offending fragment as it appeared. He did this repeatedly until it was broken into smaller pieces. It is certainly improved but is still slightly bothersome. He reckons this will settle within a couple of months. I hope you had a more successful outcome.

I am surprised that the surgeon or his supporting optometrist did not detect the large floating capsule fragment the very first time they checked the eye, specially when you were complaining about the resulting bad vision!

Any way, if you have the option of using a different surgeon for the second eye, I will suggest making a change. This is not that hard a procedure, but obviously needs to be done with care.

They said they were aware of the fragment but expected it to fall into the vitreous over time. Apparently this is almost always what happens but in my case it was just refusing to move away from my visual axis.

Hi Brizy,

I wonder whether you are still available for a brief chat. I have seen your initial question - and that is exactly my present situation - every bit of it, including the fact that I did YAG 2 weeks ago and the blurry patch that is entering my vision each time I move my eye up and down or to the outer side of my head is getting me mad! I am feeling very depressed about this. It has been 10 months since you did your YAG. I really hope your vision is now fine and that the disruptions in your vision have long disappeared. Please can you confirm this? Thankyou.

Hi Mario

I'm sorry to tell you that I am still bothered by the capsule fragment moving in and out of my vision. However, it is nowhere near as bad as it was before the surgeon attempted to break it down with further yag treatment. After the initial yag capsulotomy it was intolerable. I recently went to see a retinal specialist who suggested the only way to fully clear it up was to have a vitrectomy. I am currently waying up the pros and cons of this as it's not a decision to be taken lightly. Apparently because I'm relatively young for rle surgery my vitreous is still quite thick and therefore not allowing the capsule fragment to sink as it would in an older thinner vitreous. In theory as I get older it should eventually sink out of view but this could take years. I wish I could of told you that it had gone completely and everything was fine. I'd be really interested to know how you get on with this problem as apparently it is a very unusual complication of a yag capsulotomy.

Good luck

Hello Brizy

I am very sorry to know that your vision did not get much better in all these months. Regarding vitrectomy I would be very cautious as it is apparently a very delicate procedure which may have very serious lasting consequences on vision. I have been seeing floaters for the past four years or so and I've been told they will eventually settle down. However they just didn't and I have been thinking it could be because I'm 46 and probably the vitreous in my eyes is still thick. Now I'm having this continuous like big bag moving in and out of my vision - especially when I look up/down or to the outer side of my head. Actually I would have preferred to keep my foggy capsule - as it was much better before YAG. I still did not go for follow up at hospital and so I can just imagine what the whole thing may be about. I'm not sure whether it is a big detached fragment or a big fragment still attached to the outer side of my left eye's lens. Next Monday I will be doing the hospital check-up and hopefully I will be enlightened about the problem. I will keep you informed - and hope it eventually turns out positively for both of us!

 

Hello again Brizy!

Well I had a second opinion regarding my YAG capsulotomy. I was told that the laser was done in a circular way and that the removed circular part stayed close to my line of vision. Hence the issues I am perceiving in my lasered eye. This second ophthalmologist told me he usually performs a cross not a circle on the capsule - so that no floater results afterwards. When I remember that it was this ophthalmologist who actually had to do the YAG to me I do actually feel miserable! Anyway. Summary is that I have the same issue as yours - a big 'floater' stuck in my line of vision - that won't move away and that is driving me crazy. The solutions presented to me were exactly as yours - he told me he may try to YAG the big floater (though he said that it was hard to reach on the side of my pupil), to have a vitrectomy (which I am not in favour of doing as I have read that it is really a dangerous procedure) or .... to wait, be patient and hope that the removed piece moves further down the eye - but he did not commit himself as to when this could actually happen (I hope it actually does move some day after all!!!). Well at the moment, and following my ophthalmologist's advice, I will wait (hoping not to go crazy in the meantime ....) Well, I wish you the best of health and good luck with your eye issue!

Hi mario1971

Thank you for the info. Sounds like you were given the same advice as me. However, unfortunately the specialist I saw reckons it could take years for the fragment to sink out of my field of vision as I am effectively waiting for my vitreous to liquify as I age!! She said that it will never break down as it is a part of my eye that belongs there, albeit in an altered position which does make a lot of sense unfortunately. If mine moves out of the way I'll let you know and perhaps you could let me know if yours moves? Like you say, it does drive you a bit crazy at times!

Thanks again for keeping me updated and good luck to you in the future.

You're probably wise to hold off until you are totally happy with the lenses you have. Apparently it's very difficult to replace a lens after a yag capsulotomy as there is not much capsule remaining to hold the lens firmly in place, whereas a lens that has been in place for some time has 'scarred' into place. Good luck with whatever you decide.

If there is any chance of your wanting to get a new lens over the next few months, you should wait for that final decision before having the YAG capsulotomy because otherwise, it will be extremely difficult to replace the lens (it could fall behind the capsule due to the new hole created there).

Having a PRK (or LASIK) enhancement will be a better option to correct your vision because even a new lens will probably not get your cylindrical correction closer to zero.

The order in which you have PRK and the YAG capsulotomy is probably not important. However, it is possible that if you have a good enough vision after doing PRK first, your potential (additional) vision improvement after subsequent YAG capsulotomy may not be enough for you to have that.

Thanks AT and Brizy.  Dr thinks it best to do YAG first then PRK....just in case lens might shift from YAG blast and change outcome of PRK.

 

However still holding out we MIGHT replace lenses.  I have silicon Z9002 lenses and frankly is old technology..(I am going to different DR now!)

Also I don't have much cylinder Rx...was -.25 at 35 degrees.  Likely not causing much vision loss.

However if I do replace lens I could still have PRK to correct cylinder..I think.  Iam sure I'd go with Hydrophobic Acrylic single piece construction.

TBD maybe Oct 12.  

I think you have every right to be concerned about the yag.   If you have any thoughts about exchanging that lens don’t go through with it.   The yag only helps if back of the capsule is cloudy - nothing else.  So if power is off or you have over 1.0 diopter of astigmatism this won’t be helped by a yag.  Yes you could do PRK or lasik to fix that but it would eliminate the possibility of a lens exchange.

Sue.an. Dr suggests yag first as it may change the Rx for future PRK of lasik. Can’t get second or third opinion until end of July when I’m 3 months post exchange surgery, so I’m looking for those that have actually gone thru the next two steps and their reactions to it. Thanks for you thoughts. Greatly appreciate it 

I have read the lens exchange can be done 6 months following and I am pretty certain can be done later than that if capsule is intact.

Yes according to my second opinion prior to exchange surgery dr said he’s had done exchanges years later. But much more difficult if yag has been done. 

Waiting to hear from those that have actually had this done