Please share PCO/YAG experience

Did all the symptoms vanish and beautiful vision restored after YAG?

This is why I not want the YAG. Will the good vision I enjoy be suddenly gone!

the crystalens has weird plate haptics and it needs to move to accommodate hence the need for caution with it. damage to iol is very disappointing indeed. if i had my way i would like surgical posterior capsulotomy. also after yag does the vitreous gel start hitting the iol and can leak around it to the cornea?

Doctors talk like YAG is no big deal. The procedure itself is "simple", but when you look at the potential complications, I find it very scary.

Yes agree and why I am not so keen on having yag done! And following yag seems like whatever condition you are in is permanent. I thought having cataracts was bad.

Like Lamb to the slaughter house 😃

Do they still do the surgical capsulotomy and if so, what are the advantages?

advantages: no floaters. the capsulotomy is even so reduced glare. not sure if it is offered. most are done at the time of the surgery after iol implantation mostly in pediatric cases.

soks my current thoughts are to not do a lens exchange in my LE. I still plan for floater only vitrectomy and my retinal specialist said he would do the capsulotomy at that time. I won't do it before January but I will let you know how surgical compares to laser.

doing vitrectomy after yag or capsulotomy is a good idea as that will eliminate the floaters from the capsulotomy as well.

deb- can you check if they can do posterior capsulotomy with femtolaser?

I will ask when I see him again in 3 weeks for follow-up on swollen retina. All I know is he said he does the capsulotomy with the vitrectomy to avoid floaters and dinging the iol.

i sent you a link. he may still do yag but with circular method instead of cruciate method to avoid pitting in the line of axis. but circular method creates a large floater which vitrectomy should help get rid of.

I've had it for 2 weeks now and wish I had NEVER gone through with it. Please realize it is permanent.

Hi JHP-00

I assume you had YAG for PCO. What are your pre and post YAG symptoms?

Never mind JHP-00 I just read them above.

PCO is permanent too. What is the alternative?

Could it be that your issues are more multifical IOL related?

What does eye doc say?

I did not get the impression it was done by yag, but I will ask. I did some googling and saw mention of using a vitreous cutter. He did imply that it wouldn't damage the iol.

that would be awesome. while searching for femto and PCO i came across a study that said using femtolaser resulted in early PCO than manual capsular hexis. i have been a a proponent of femtolaser coz i trust machine over man and symmetry of the laser but this is what i get.

but what is the alternative? my theory is wait as long as possible to do any eye procedure. i was rushed into my cataract surgery with the promise of clear vision and now i have PCO.

can you see the pitted IOL then? and what does that look like. the last thing i need is another large floater. i have weiss rings in both eyes from Pvd's

vitreous cutter sounds bad a**.

Let's hope!

i went searching for vitreous cutter and it seems they may a 4mm hole in the posterior capsule with the cutter. and then do the vitrectomy. how come the retina specialist didn't ask you to get the YAG?

w-h, i did some more digging on this. two things i found noteworthy is dislocating is more prone to plate haptics and worrisome for those with toric lemses as it can change their prescription. the other things i found which i really liked was use of abraham contact lens during yag to prevent iol pitting. deb has me really scared about pitting.

for anyone reading, this is just information that i feel is worthy of sharing and not really trying to get into my lens is better than yours debate.

Just seeing this. I'm going by memory, but I think it's to avoid pitting. I'm guessing they can also make a more precise hole with the cutter. I asked my optometrist how many dings I had in my RE and she counted 9. She did think they might be outside my normal pupil (I was dilated at the time). If you have any questions you want me to ask my retinal specialist when I go in 2 weeks, please let me know.

i will message you asking for details. i like the cutter method but does it require a vitrectomy to follow? is it offered only by retina surgeons. precision cut is very good.

One thing I don't think I brought up is after the 2nd YAG where the hole was enlarged, as soon as the dilation drops wore off, I immediately noticed a change in my vision. They way I'd best describe it is a light ghosting. I have been doing some research and am wondering if my IOL shifted slightly. I don't notice it in the intermediate range, but do at both near and distance. If I put on readers for near vision, it goes away. Any thoughts?

Deb. did they use abraham lenses for your yag? are your lenses toric?

no and no.

I guess you watched Dr Ahad Mahoochi's Youtube video on the subject.

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Also I don't understand how Abraham lens protects the IOL? The laser beam still has to pass through the IOL.

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Does it help in making sure that the laser is focused on the capsule and not the IOL? They are so close/shrink wrapped together so does really help?

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So a toric lens is more prone to refractive changes.

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According to the video plate haptics pre 1995 are more prone to movement. I don't understand why?

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When the time comes I wonder if we should go with Dr Zeiss or look for YAG specialist. Will speak with him on Wednesday.

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People who say cataract is easy piece of cake deserve... & @#!!!!!

i first read about abraham in the comment of shanon wongs video by some russian doctor. ahad's video was recommended after it. i was almost about to post a question about pitting in that video's comments when he talked about abraham right at the end. mebbe it reduces the intensity of the laser. almost like grounding where abraham gets the damage and saves the iol. i have read old plate haptics prone to pco did not know why they would dislocate more. i now understand that pco should be moot for younger patients.

"People who say cataract is easy piece of cake deserve... & @#!!!!!" -- it really isn't.

Александр Переборов is the doctor. he is calling it abraham or goldman's lens.

My guess about dislocating would be, that all the acrylic lenses back then was all hydrophilic as I understand it, and these have very slippery surface, as well have the silicone that also was used in the early days of iols.

At least just a thought....

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I really have a hard time believing that the iol will rotate when the yag is applied, the center of the lens is where it holds the least rotation force, the outer edge will hold the most of the rotational force, so I have a hard time understanding that the toric should be a bigger problem in regard of rotation, I really don´t think any rotation will take place with hydrophobic lenses.

But I do believe that the lens can move backwards, because the backside of the capsular gets weaker, and then I guess both refraction and astigmatism can change slightly.

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About the laser thing - the laser works by shooting several laser beams from different angles at the same time, and only at the exact point of intersection between the laser beams, there will be enough energy to burn tissue or iol.

So it makes no sense to shoot through some type of contact lens to reduce laser or something like that.

The laser can cut a layer that is extremely thin from the cornea during lasik and smile within a fraction of a millimeter. During smile laser it can shape the deeper layer in the cornea with and change refraction and astigmatism, it is extremely precise. It should not be a general problem to only burn the capsular. If the iol is burned, it must be one of these bad luck scenarios, but off course really bad for the unfortunate ones.

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Before yag the pco was treated with manual surgery, where the surgeon used some type of needle, that he guided to the backside of the iol, and made a hole in the capsular bag, by "ripping" the hole. This is still how pco is treated in poor countries, where they can´t afford yag lasers, but the yag is far superior, with much better outcome in general, therefore the yag is being used in high developed countries.

my contribution is...reading about what can go wrong with YAG makes me feel weak.

let's hear about some success stories 😃

Well, I think in a forum like this, you will always get more negative stories than positive.

I have not had the yag done, but I know two people that have, and a third that have been treated for pco with the oldschool method before the yag was introduced, all 3 have had great results, and no problems at all 😃

Yes I know, right? I remind myself that it is important for us to provide support for each other because the vast majority of people have no complications from cataract surgery or YAG or whatever. So I felt totally dismissed with my concerns: "cataracts are easy! What's the big deal?"

My mother, who had hers done when she was 53, now 25 years ago, says it was "nothing." Describes YAG as ,"They just do a little dzz dzz with the laser right there in the office and take care of it."

Most folks here looking for support after the fact are the few unlucky ones, is all. We won't be unlucky forever. 😃

Danish our lens is plate haptic and hydrophillic with hydrophobic coating. I wonder where we slot in!!! lol 😃 Doesn't Zeiss make some of these latest YAG machines...VISULAS YAG III. They better have tested on their own IOLs!!!!

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My simple man logic says that a plate haptic has more contact surface with the capsule so more binding to the capsule. Logic would say that it would be more stable and less prone to moving.

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Everyone should wait 4 months after cataract surgery if they can so that the capsule latches on to the IOL strongly.

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Deb your YAG was done less than 4 months after cataract surgery, correct?

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Every one says that cataract and YAG is nothing. I feel like slapping them with a dead fish 😃 The mental torture is already enough!

Like waiting for the other shoe to drop.

December 12th, it's YAG for me.

I had LASIK on my eye November 12th to adjust the post-cataract surgery outcome by +0.75D. This was 20 months after the IOL surgery, but the surgeon honored the "guarantee" in the Multifocal IOL cost agreement and the LASIK was free.

The surgeon had been telling me to do YAG every time I saw him, but I wanted to wait until I was 100% sure I could live with the IOL (RESTOR 2.5D) for the rest of my life. A quick summary, distance was fantastic (20ft+) and computer distance was also good (2ft to 3ft) but in between was not very clear (maybe 20/40). The LASIK fixed that for me, so I'm now sure that I won't want the added risk of a lens exchange.

Despite not noticing any visual issues, I finally relented and agreed to the YAG. He says that the PCO is definitely impacting my vision even if I'm not noticing it. He also believes that I feel this way because I'm comparing the vision to my 2nd eye which also has a cataract (which I feel doesn't yet affect my vision). No discussion of the risks of YAG which was a little disappointing.

I guess we'll see in 3-4 weeks and I'll report back on my post-YAG experience.

Derek glad lasik able to fix that intermediate distance to point where no exchange needed. I think I am in same boat as you needing a yag do will be wanting to read your update on it. I am not happy as my initial discussion about pco was told only 1/4 of patients need that. I think that is much higher percentage. Seems all the comments from patients here is they eventually experience pco.

Wishing you well Derek.

Sue, sword of Damocles would be more accurate 😃

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I adapted it for us from a carton 😃

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I hope you enjoy all the perks of your new vision. Above your new vision is the sword of Damocles hanging by a thin PCO strand. I wouldn't worry about it, chances are it might never fall and put an end to your privileged vison lol

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30 days post surgery. I did wonder after the fact if it was too soon. The Maddox Rod effect was very pronounced. Of course in hindsight, I would have lived with it longer if it would be safer to wait.

I'd give anything for my story to be a success story. I am hoping that will be the case with my left eye. Of course even with my problems, there has been a lot of success. My visual acuity is better at all distances compared to pre-surgery.

hahahaha - would be more humorous if it weren't so true!

hi Derek i am same as you. Left eye cataract but still reading 20/20. Right eye had cataract surgery 2/19 and now mild PCO but i cant even tell I have it .Reading 20/20. I'vd rlected to kick the can and do nothing for now. keep

us posted on how it goes:)

So if the YAG pushes the IOL backwards does that move the vision in plano direction or opposite of plano direction? I assume it makes you more farsighted?? Similar to making the eye ball shorter?

Thanks, I'll definitely post after my YAG.

I really don´t know how it affects vision, if iol settles a little bit further back, because the cornea is also a part of the optics, so I have no idea how or what changes.

"Protection against superficial corneal burns also occurs with the use of this lens as the diameter of the laser beam is increased at the cornea, thus decreasing the power density at the cornea by a factor of 2.8x."

source: ocularinc

Sounds to me like advertising of some new stuff in the toothpaste, that you really can not live without, and you are actually lucky that you have survived using regular toothpaste until now 😃

And next year they find something else to put in the toothpaste...

Yag is performed millions of times all over the world each year, and it have been like that for more than 30 years, surgeons are not stupid, I strongly believe they will do what ever necessary 😃

i don't think it is a new method nor is it really advertised as such. i did not even know about pitting until a few days ago but if there are precautions available i would take them.

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you said it didn't make sense. the physics makes absolute sense for those of us from poor countries who have burnt a paper using a magnifying glass and sun's rays.

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the million surgeries have been performed on people who have had reduced vision due to age so any improvement was a huge improvement and may not even have noticed the pitting. the 40% yag rate might even be because people may not live long enough after their surgery.

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i don't know if the surgeons are stupid or or not but many things such as dysphotopsias are unpredictable and they can't tell who will get it. medicine is inexact science. also, they are working on averages of solutions where the population is mostly aged or with pre-exisiting eye conditions. so i refuse to take their word as gospel without researching my options to improve my odds. more so after YAG cause lens replacement then become even more problematic.

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with clear pre-cataract vision the compromises brought by surgery are clearly noticeable and bothersome to me. to each his own. choose your poison or elixir as you see it.

you are lucky in that regard. I was undercorrected and now wear a contact lens in my surgery eye. Not what i hoped for. Very disappointing as I have been nearsughted for 55 years... since grade school and was hoping for crisp vision. Didnt happen and now PCO.

I saw my retinal specialist again today. His opinion is if you are doing a vitrectomy then it is better to do the capsulotomy with the vitreous cutter because it is precise, avoids IOL pitting, and potential floaters. But he stressed that it's better to do a YAG than to risk vitrectomy surgery. In my case I will be having a vitrectomy so it's the better option. Unfortunately, it will be a while before I can post back with results because my RE still has a swollen retina and I am on drops for 6 more weeks. It is improving but dr wants to make sure my RE is in good shape before he goes in to do anything to my LE. All of my floaters from the YAG are gone. Dr said they were absorbed by my body. I'm not sure why some people have YAG and floaters don't go away, but dr said that does happen.

thanks for the update. glad that the floaters are gone. speedy recovery for the RE. did u get circular yag or cruciate yag? do you have any symptoms from pitting or are they outside the visual axis?

Circular. Retinal specialist has only seen me dilated so I didn't ask him if he thought the pits are outside my normal pupil. We didn't discuss it today, but on my last visit, he didn't seem to think they would be causing me problems. Not sure if he would tell me though otherwise. He knows I am a worrier. My optometrist also discussed them with me when I was dilated but she thought they might be outside my normal pupil. I don't know if I have symptoms. All I can say is something changed after my second YAG. I see more ghosting. Waiting for retina swelling to subside to get refraction done again. I saw you have floaters from PVD. If they bother you, then you could consider the surgical capsulotomy and vitrectomy. Mine definitely impact my vision.

what's the risk with vitrectomy?

From uncle Google, the risks are usual! Atleast you can cross out cataract form the list 😃

Complications of surgery are rare, but include infection, bleeding, high or low eye pressure, cataract, retinal detachment, and loss of vision. Surgical Goals: Vitrectomy or vitreous surgery can treat a number of conditions. ... The potential benefits outweigh the potential risks of surgery.

I had my YAG procedure yesterday, so I can finally answer all these questions:

How long after the surgery did you get diagnosed with PCO and when did you get the YAG? Doctor said I'd be back to have YAG within a year. He noted a PCO on my follow up visits.

What were your symptoms of PCO? None. Despite being told that the PCO was affecting my vision, it seemed very clear to me.

Did YAG clear the PCO symptoms or did nothing to improve vision? I do not notice any improvement, but, then again, I was happy with my vision before YAG.

Was any special method for YAG used such as the cruciate method? Cruciate

Did you have non YAG posterior capsulotomy instead?

For those with multifocal lenses did near vision not improve after YAG? Near vision seems similar. Maybe just a very small amount clearer.

What are the post YAG complications you faced? (floater, glare etc.) Severe Starbursts (more details below)

Did you address these complications? (vitrectomy, etc). Too early to tell.

If do you not have PCO and not had YAG and are still reading this and have had surgery more than 3 years ago then how long has it been since the surgery

I underwent YAG on 12/12/2019. I posted a separate reply with answers to the original questions in this thread.

Unfortunately, I have EXACTLY the same issue as Komiko and I would have worded it identically. I had no starbursts at all due to the cataract surgery, just small halos due to the multifocal IOL design (Restor 2.5D). Post YAG, I now have very large and noticeable starbursts (or rays of light emanating from a point source). With a light source and mostly dark background, I see a large "cross" with the "rays" at 2 o'clock and 8 o'clock and the second one at 4 o'clock and 10 o'clock. I see additional, but shorter, rays of light in between. With most light sources I am seeing a total of (4) lines crossing, the two main ones and two more but with brighter lights I see a few more.

One interesting thing I noticed is that while looking at a white light source I can see that the light is being refracted like a prism and I can distinguish a full color spectrum along the ray of light from violet to red. I think that, right now, I could probably drive on the highway but I'm not sure about driving in the city. The interaction with multiple light sources might be too great and the rays of light are quite long.

I also noticed this issue last night while watching TV. Light sources on the screen extended out past the edge of the set. I think that I may need to change to watching TV with a light on and having an illuminated background hides this effect. I had no issues like this prior to the YAG.

I saw my surgeon today. He said that this effect should decrease over time, but since it's so noticeable and perfectly geometric, I think that this is probably not going to happen. If it was due to swelling or something that would be cured by healing, I would expect some asymmetry or at least some variation on the length of the main light rays. He said that the opening was already as large as he could make it, so he would not do a 2nd YAG procedure. Still, I am interested to know if this is caused by the light striking the edges of the IOL (which is now no longer filtered by the PCO) OR is it caused by light hitting the of the boundary where the YAG stopped (at each axis). In the latter case I would think that there would be the possibility of rounding or re-shaping the edge of the opening in the capsule to reduce this affect.

Komiko, can you let me know if you noticed any decrease in this effect over time or was day 1 the same as day 30?

Thanks.

Hey derek40125. I saw my specialist yesterday. He explained to me that my IOL is not damaged, no pitting and he feels what I am seeing (yes the X is still there) is reflection from the edges of the capsule. You are correct on rounding or re-shaping the edge of the opening. He doesn't want to do this procedure for another 6 months or so as he is very cautious in using YAG. He said having it done too soon increases chances of bad effects (retinal detachment/tears etc.) He wants to wait until then, re-evaluate and then do YAG on the edges rounding out the corners in the capsule.

On another note, the cataract in my right eye is getting worse and now he says he sees some "frosting" on the posterior of the lens (posterior subcapsular cataract?) I have been experiencing an increase in starbursts in that eye. After everything I've gone through with this Symfony lens I'm scared off doing any surgery on my right eye. He would do monofocal for distance in that eye. We didn't discuss lenses yet. I'm going to hold out as long as I can.

Thanks very much, Komiko. Please update if you see your specialist again.

I think that advice he gave you makes sense. I planned to wait and see how it goes over the next few months. I am encouraged that at least there seems some possible option to try in case I fund this unbearable. I just keep telling myself that it could be much worse. Good luck with your right eye too.

thanks for the update Derek.

i wonder if the circular method would be better for the glare but then it would add a large floater to the vitreous. choose your poison. thanks for updating.

Thanks Derek. This whole yag thing scares me very much.

that's just fantastic!

As a result of PVD, I ended up with significant floaters. LE and RE slightly different. More severe in RE, but more in the center of my vision in LE. My cataracts were only moderate but the floaters drove me nuts. Little did I know what lay ahead with complications, but I can't turn the clock back now. When I did my RE lens exchange and vitrectomy, dr could have done the surgical capsulotomy at that time. My retinal specialist is surprised that he didn't. Seems to me if there is a more precise circle, then there might be less light reflections. We will see when I get my LE done.

doing vitrectomy before YAG was suprising as the YAG floaters would have remained.