YAG capsulotomy required six weeks after cataract surgery

Hi Ron,

Thanks for taking the time to reply.

Posterior subcapsule cataracts are the least common type

Yes, I realise they are the least common type, but their description fits what I have experienced. For example, one website says this about them:

"this type of cataract can grow more rapidly than other types of cataracts, and can sometimes cause a significant decrease in vision in a matter of months. As the cataract grows, it causes light entering the eye to scatter, increasing the severity of symptoms. It can make it difficult to see in bright light or while reading, and cause glare and halos around lights at night."

My serious vision problems (other than longstanding myopia) seem to have emerged only over the past 12-18 months and progressed very fast during that period.

The issue with YAG is that because of the hole in the capsule it becomes much more complicated to replace the IOL if that becomes necessary. For that reason I would hold off on the YAG until you can verify that the IOL does not need to be exchanged because the power is wrong, or other issues.

Since my surgery was paid for by the National Health Service, I would be unlikely to have the option of exchanging the IOL even if the power is not perfect. I was not given an option as to when to have the YAG – I was simply told it would need to be in six weeks, and that would be long enough for the surgery to have healed and for my vision to have settled down.

I would say cloudiness of vision after cataract surgery is not normal. They may be due to the pre-existing clouding of the capsule.

That is very worrying to me. Although, if it is the case, I wonder why the cloudiness of vision is currently worse than it was before the surgery. You would think that, if my vision was previously affected by both cataracts (on the lens) and by a cloudy capsule, the fact of the cloudy lens having been replaced with a clear IOL ought to mean that my vision should now be better than it was pre-surgery, albeit not yet optimum because of the clouded capsule.

I'm perplexed and a bit worried.

I have PSC cataracts so your post made do some searching on Google and it led to me learning a bit about posterior capsule plaque. Search for this study: "Preoperative prediction of posterior capsule plaque in eyes with posterior subcapsular cataract"

The authors point out the need for the surgeon to counsel the patient about visual impact from the posterior capsule plaque as under-performance of the eye, postoperatively, is possible. Nd-YAG laser capsulotomy looks to be the recommended treatment.

Very interesting article, thank you. I actually find it somewhat reassuring because of this:

In our previous on incidence of posterior capsular plaque in cataract surgery, no patient with plaque voluntarily reported visual complaints.

The authors go on to clarify that they do not expect posterior capsular plaque to cause serious visual disturbance in the majority of cases where it is present. That might suggest that the cloudiness I'm currently experiencing is not associated with capsule plaque.

If your plan is to wear glasses after surgery, then the accuracy of the IOL lens power becomes less critical, as any error in sphere or cylinder can be corrected with the eyeglass prescription.

Thanks very much for sharing your experience. I think I have no choice but to wait a few days and hope things improve. If the surgeon hadn't said what he did about clouding of the capsule, I'd be less concerned.

Thanks for taking the time to reply. I'll see how my vision is once the initial blurriness has faded and then discuss the way forward with my optomestrist.

robg_uk

Yes a lot of people experience swelling. Some get clear vision after the numbing wears off but others it takes time.

Just because I have family in UK and know a little about NHS - did they prescribe 2 kinds of drops for you or just one? My uncle had issues and I believe I read at the time of my surgeries (James from UK only prescribed one type of drops. They should be giving an antibiotic and an anti inflammation drop. My uncle was prescribed one and developed an infection and was only given antibiotic drops afterward the infection.

I was only prescribed steroidal (anti-inflammation) drops. As a general rule doctors in the UK are reluctant to prescribe antibiotics unless there is a known infection.

that is what happened to my uncle. in canada 2 types of drops prescribed. Antibiotics is preventative vs prescribing only if needed.

At the end of the day, I have little choice but to trust the surgeon and care team. AFAIK, this provider has a very good record with little incidence of post-operative infection.

Yes of course we all trust the surgeons but it is interesting how the approach varies country to country and often in countries that have national health bottom line is to save money where ever possible. if provided anti biotic drops my uncle could have been spared weeks of clearing up an infection. Incidently his vision did clear up once infection was dealt with Not saying this is your situation but could be one possibility of why someone wouldn't experience clearer vision early after cataract surgery. Hoping you do not need a yag this early on.

Interesting reading up on this type of cataract. Was only aware of their rapid growth. Sure wish I had known that all those steriod creams used for eczema could result in cataracts.

I don't think the bottom line for the National Health Service is to save money; to say that is the bottom line suggests it is the most important, overriding consideration. I think the goal of the NHS is to protect health and save lives in the most cost-effective way possible, which seems entirely reasonable to me. If prescribing preventive antibiotics were only actually beneficial in, say, one in a thousand cases, I think it would difficult to argue that it's a cost-effective measure.