Diameter of Capsulotomy

[MrAstro]

I'm 44 and recently had clear lens exchange performed using toric acrysof IQ IOLs. I had hyperopia and mild astigmatism and this has been reduced to virtually a neutral script with increased astigmatism.

The IOL's were 6mm in diameter I think from memory.

I enjoy astronomy and maximum scotopic vision is important to me.

My question is if I end up needing a capsulotomy are they able to give me a full 6mm of unobstructed lens or will the opacity effectively vignette my dark adapted pupil size effectively meaning I can't see faint objects on the bounds of vision as effectively - ie. ending my hobby as a visual astronomer?

Also if the complication rate was cited as 1-2 percent in my pre-surgery consultations how is it that this complication rate is 40% to 60% (i've heard possibly even higher if you are young) and conveniently not mentioned in my consultation? Yet I disclosed astronomy is important to me.

Also I'm worried about the damage done to the implants by the laser - I've seen some nasty pictures of cracks and fissures in the lenses from the pulses. I wouldn't be happy if someone did that to my eyepieces - let alone my eyes.

Anyway I realise the above might sound a bit emotive - so I apologise for that if it comes across that way.

[John C Hagan III, MD, FACS, FAAO]

Make this the year not to worry about everything that might happen and stay in the moment and in the stars and galaxies.
JCH

[MrAstro]

Thank you very much Dr Hagan - that last response made me feel a lot better and it's extremely nice of you to make me feel better too.

I think they might even have a femtosecond laser at the place where I had mine done - I know the surgeon talked about it - although not in the context of the capsulotomy. I think they used it (but I could be mistaken) to make a cruciform incision before they did the RLE.

I will make sure I get a few opinions. I would even travel to the U.S. from Sydney to see you if I had to and assuming I ever need to. My eyes are worth it to me.

[John C Hagan III, MD, FACS, FAAO]

Make that "is now in use"

[MrAstro]

My optometrist noticed some 'fibres' in my right eye when I was getting my reading glasses and I said you mean the fibres that might need a yag capsulotomy later she said yes. I also have monocular vision and amblyopia from when I was a child.

My left eye is dominant but I assume if it's starting on the right it will eventually happen on the left.

Can I assume the 6mm large size you mention above would only be possible if if you had a lens larger than 6mm? Or do the haptics/wings on the IOL's hold them in anyway. I was reading about problems nothing stopping the vitrious fluid from leaking around if the whole capsule is removed.

Or basically should I just accept my eyes are going to be eventually such that I can give up on astronomy (I hope not night driving as well?).

I am very sad about the whole thing. I'm sure there are people with worse problems but I can't help being depressed about it. Most of my friends are from astronomy - I wouldn't be able to participate any more. Not to mention all the equipment I've built over the years that will just sit and gather dust.

[John C Hagan III, MD, FACS, FAAO]

The size cannot be exactly created with a regular yag, it's more like small medium and large. 6 mm would be large.

JCH MD

[MrAstro]

But what is the diameter of the final capsulotomy? Can it be the same size as the dark adapted pupil?

[John C Hagan III, MD, FACS, FAAO]

Opacification of the posterior capsule is not a complication of surgery. It occurs because the growth cells that produce the lens fibers are under the posterior capsule. When surgery is done an effort is made to scrape these cells to reduce their number. At present it is not possible to remove 100%. Steady progress has been made in reducing the frequency of the posterior capsule clouding over. In the early 80's it was 90% plus and before the development of the Yag laser required a trip back into the operating room.  Right now an overall cloudiness within say 5-7 years is more like 30-40%. However in younger people the % is much higher because the celss are more numerous and hardier. In children it is 100% and an opening is almost always made in the posterior capsule.

It doesn't sound to me like you were mislead. The incidence of serious complications with cataract surgery is 2-5%.  Again I state that the posterior capsule turining cloudy is not a complication.   If you lens are clear I would not fret unless it developed.   The biggest risk of opening the posterior capsule is increased risk of retinal detachment

JCH MD