Scar tissue operation or YAG

Yes that would be nice. It isn't till afterwards I think of questions. Although the second in command looked at me and said they had never had anyone ask as many questions as me.

Just had letter from eye hospital re diagnosis.

both eyes

anterior capsulophimosis

and. pseudophakic - IOL in bag

visual acuity right 6/6 unaided

left eye PL pinhole CF unaided

IOP 14mm Hg right eye. same left eye

right eye phimosis but not affecting vision

left eye - total capsule phimosis

no hgole in anterior capsule.

page 2. have moved to other device now. adding rest of diagnoses

3. Very thick. Posterior capsule similar but looks less thick. Periphery of retina flat. IOL not wobbly but some zonules under tension present inferiorly.

Not amenable to YAG

Consultant agrees not amenable to YAG. Will need anterior surgical capsultomy then decide on YAG versus posterior capulectomy.

Please can you understand any of it.

Your eye pressure is normal in both eyes. Normal eye pressure ranges from 12-22 mm Hg. You have 14.

I am not fully understanding what they mean by "Not amenable to YAG"- You definitely have opacification of your capsule but apparently they can't use YAG laser on it to blow a hole currently.

They will surgically do something first, then decide if to do YAG...

Looks like your IOL is under some tension in the capsule, maybe due to capsular phimosis.

This shows before on left and after YAG on right

This might be relevant to your case-

Shrinkage and whitening of the anterior capsule opening – capsular contraction syndrome – is a well-known complication after continuous curvilinear capsulorrhexis.

A 72-year-old women underwent continuous curvilinear capsulorrhexis, phacoemulsification, and implantation of posterior chamber intraocular lens with polymethylmethacrylate haptics. Four months postoperatively, the patient reported deterioration in visual acuity that was resulted due to complete occlusion of anterior capsular opening by fibrotic tissue. The fibrous membrane was excised surgically in capsulorrhexis fashion.

I'm sorry but I can't help with this. It's definitely beyond my expertise level. Nothing is mentioned about a vitrectomy though.

Thank you for the explanation I will ask about the "not amenable to YAG means when I get my appointment . Also will ask what's to stop the scar tissue coming back again.

It is very good of you to reply and I hope I will not need a vitrectomy.I don't look forward to putting drops in again. I have Polymyalga and am on a very low dose of prednisolone at the moment.

Hi Beryl,

So this means that the capsules that were cut open in order to remove your cataract lenses and implant the artificial lenses have now scarred up. This is known to happen sometimes.

The left eye has scarring both in front of and behind the lens, with the front part of the capsule totally closed up (they make a hole, and now that hole has closed up like the way a hole in your earlobe can do if you don't wear earrings for a while).

The right eye has the scarring in front of the lens, but it doesn't affect your vision.

Apparently they think the YAG laser is not the best way to proceed: since they are the experts, I would trust that, unless you don't trust them in general. You have an appointment Oct 23 so we'll be anxious to hear what they say.

My guess (but it's just a guess), is that something about your scarring is too complicated or thick for the laser to be safely effective. They want to do the anterior part first, and then see how you go. To me, that sounds like a sound, conservative approach.

The zonules, which are the little tethers on either side of the capsule that hold it in place behind the iris, are being pulled on by the scarring, and that sounds like it's causing some shaking.

They make no mention of vitreous problems, so the impressive story of Deb03 is not relevant to you at this time. Deb, thanks for sharing more detail about your vitrectomy, and so glad it delivered the results you wanted!

Drops are a nuisance, but I use my cell phone calendar to make recurring reminders that alarm so I don't forget. I did that right after surgery and then it was all set up. I did have to remember to carry the drops with me always, but since none of them required refrigeration, and since the bottles are so small, it wasn't an inconvenience. Actually, it made me feel a certain tenderness for my eye...those drops are the part that I have control over...the part where I get to take care of it. 😃

Hi Tamarand Please explain what is the anterior part.

I am trying to reduce my prednisolone which I am down to 1mg. I don't know if you understand autoimmune diseases and am worried that the steroids in the drops may be causing the scar tissue and what's to stop it coming back again? as you can see I am in a dilemma.

If you are referring to the prednisolone eye drops, then go with what the ophthalmologist recommends, as long as you feel s/he is a good doctor. I can't offer an opinion on medication dosing. Since steroids decrease inflammation, I wouldn't think it would cause MORE scarring...rather the opposite. But truly, I don't know so you should ask your eye doctor.

If you are not confident in your current ophthalmologist, schedule an appointment with another for a second opinion.

The anterior part is in front of the lens, in other words, between the lens and the outside world. So the anterior part of the capsule is what faces out...it is the part of the capsule between the lens and the iris.

The posterior part of the capsule is the part facing backwards, or in towards the body. So it faces the retina.

There are lots of diagrams of the anatomy of the eye online, and they may help clarify that for you.

Thank you that explains it well. I am just hoping they get it done in one visit as it will have been been 5 months + whenever the date of the operation is. Didn't expect it to go wrong.

Hi W-H I AM replying on this thread as it includes your help with my diagnosis and also Tamarinda's very helpful of you both. 're the Dexafree eye drops I was first given them in February when I had my right eye done and was on them for one thing or another for 8 months when I had left eye done. I was so pleased to see socks post as I am trying to find out what caused the terrible scar tissue I have got. My appointment for the operation is 22nd November I truly don't want to take any more just in case the Dexamethasone or the Dexafree drops had anything to do with it. As I also am on steroids for my PMR (POLYMYALGA RHUMATICA) I am worried

Hi Beryl,

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Ok got it. I guess you already read my reply on my thread? Correct?

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So I am not exactly sure what is wrong with your eyes but from memory I think you might have had a rare thing happen.

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When the front Capsulorhexis is done. Capsulorhexis = A full 360 degree circular cut is made on your capsule on the front side (Capsule is hidden behind the cornea etc). This circular piece of the capsule is then sucked out, then our natural lens which is inside this capsule is destroyed and also sucked out.

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You are left with an empty capsule/bag with front circular piece removed forever. Inside this capsule then goes the IOL (artificial lens)

Here you see the start of the Capsulorhexis process.

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Here you see side cross section view of the capsule with IOL/artificial lens sitting inside it. The dark thick outline is the capsule and as you see there is no front dark thick outline as it was cut in a circle like I mentioned above and that circular piece sucked out.

Think of capsule bag as something extremely thin like cling film used in kitchen for wrapping food.

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So the capsule has exposed/open front area. After the operation the rear part of the capsule which has no cut also can start getting opaque. This stops the light going in and is called "second cataract" by some.

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With YAG laser they make a kind of circular cut on the rear part of the capsule too. Pieces from the circular cut fall into the the back of the eye ball and kind of cause floaters initially and eventually disappear and get absorbed by the eyeball fluid.

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FROM THIS POINT ON READ WITH A BIG PINCH OF SALT AS I AM NOT A DOC NOR 100% SURE IF WHAT I AM SAYING IS REALLY WHAT HAPPENED TO YOU

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Now in your case you have rear opacification and it needs YAG BUT it seems that the front circular hole that was created on the capsule, the edges of this circular hole are forming fibers and trying to close the front hole.

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I assume the surgeon will go back in and do another Capsulorhexis, widen the circular cut again. Then if all goes ok they will think about YAG for the rear part of the capsule.

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Is all this related to you taking steroid drops for 8 months? I have no idea nor am i qualified to give that answer 😦

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Anterior segment photograph of a patient with anterior and posterior capsular opacity showing a dense fibrotic change around the contractured capsulorrhexis margin.

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Also Beryl when you put the drops I am not sure they come in any direct contact with the capsule as the cornea is in the way. Unless they go in through osmosis. So MAYBE the steroid drops have nothing to do with it.

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You need to ask your surgeon all this.

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I know how complicated it must be to get hold of the surgeon directly via NHS!

WOW that sounds about right. Did I tell you I had a surgeon who was being instructed (without asking my permission) which I would have refused, he said at one point "I will take over and when she was doing it " lift that flap (3 times and - perfect) then he asked her if she wanted him to finish off, to which she replied "no I can do it. What do you think of that? is it usual with NHS.

hi beryl,

think of the above process as an MnM. The capsule is the MnM shell and the lens is the chocolate inside. They make a small circle in the front of the MnM shell and then suck the chocolate out. The remaining front side of the shell is called anterior capsule. phimosis sometimes is a result of small capsularhexis. capsularhexis is the opening on the front side of the MnM. I think the steroid is a good thing. They increase the steroid dose if they see some reaction to the surgery like this. Some people have side effects to the steroids so it is a balancing act as with everything about the cataract surgery. I did not want to get anyone worried.

Sounds like they were training an intern. A lot of teaching hospitals do that. Some ask your permission while others don't. The experienced surgeon would / should have been there to oversee the procedure.

Hi soks you didn't worry me you have all helped me to understand what's going on. I was under the impression it was going to be a breeze.Couldn't do the eye drops very well, hated them and every time I was seen they kept giving me more. I was worried about the consequence. I am 85 and am dreading the next op but I have no alternative as I can't see through my left eye.

Must be a young resident doctor next to the main surgeon. Yeah happens in lot of places.

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In NHS type of setting probably happens more as you don't even get to pick your surgeon.

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It is like the assistant surgeon who wanted to take over and operate on my wife even though we were sent to their clinic to be operated by the main surgeon.

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On confronting her she said we are part of his team. Like hell i would have let that arrogant doc anywhere near my wife's eyes!!!! Good that we did not operate there.

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Our current surgeon does ALL operations himself.

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Beryl I am so sorry that you have to deal with all this!

Yes, it sounds like your attending ophthalmologist was training a resident or fellow. This would not have been an intern, as they are only one year out of medical school and would not be doing an ophthalmology residency yet. Ophthalmology training usually requires one separate internship year before beginning the ophthalmology residency (most choose to do internal medicine for that year because many eye patients have a lot of medical problems).

I would not think that work by a resident on your eye would impact whether you have scarring or not. These things often just happen. I would recommend that you make it clear you would not like any residents working on you in the future, and just leave it at that: no need to stress more about it.

I agree that pretty much anyone who is on this forum is not a good patient to have a resident working on them. We are all over-analyzers and probably more sensitive than many people, so best to keep it to the experts when working on folks like us. That's not necessarily true for folks who are more easy-going. 😃

Yes at my pre-op I asked to have the consultant and it was ok'd and in my appointment letter. We'l see !!!

Thank you, it is good to have your support.

Thank you, it is good to have your support.

If I was near you and if you had wished, I would have accompanied you for the consultations 😃

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The least I can do is give you moral support from far away. Most probably all will be good in the end, you just have to go through some hardship unfortunately. Stay positive.

Ohh- that is so nice of you last night I was so upset and I am afraid of upsetting my poorly husband but I had to unburden myself. Unfortunately he is not up to coming with but my 2 daughter's and their husband's take me. The worst thing happened after my pre-op on the 23rd my consultant's secretary rang me on the next day to offer me an appointment at 7.30am, would have been yesterday, Tuesday, then half an hour afterwards, after I had let my daughter know and her husband, Steve who comes in with me and tells me all things I miss, she rang me up and cancelled it and replaced it with one on the 22nd November. I argued the toss with her but no good. She said the other lady had to have it because hers had been cancelled. Can you believe it? My cosultantant hasn't spoken to me since my last visit.when I asked his secretary if he could ring me she said Mr. xxx doesn't telephone people.

Hi Sue This is the discussion telling you of my symptoms. Tamarinda's reply explained it.Beryl. see above Scar tissue operation or YAG

This is the thread explaining my symptoms.

Scar tissue operation or YAG.Beryl