Huge glare increase after YAG capsulotomy

[HerrEye]

I've got really mild PCO but because I've got also EBMD on some parts of my cornea and I wanted to undergo PTK I was advised to have YAG first. I didn't though it was necessary and and thought it was unsafe because I'm single eyed person but I was assured it is safe, OK, for my IOL etc.

Now I've got huge glare which was significantly lover before YAG. It was present only when I was looking on very bright lights now light spills from every bright object in my field of view. Whit t-shirt on dark sofa? Light spills. Sky outside the windows? Light spills. Light areas on the photo - light spills on the darker parts.

I've set an appointment with my doctor next week but I'm desperate nad scared. Can it really be IOL pitting? I hoped I've chosen the operator wisely.... I didn't asked about the technique used, I know the energy supposed to be low and the whole is not big too.

I can't find any doctor in my city to check the IOL (no free terms) :( What are the symptoms of pitting? General glare, light spill and light for? Or very distinc starburst? I think I've got some starburst too but it was present after the cataract surgery... Of course starburst is visible only around the bright light spots, any other light surgaces cause huge light spill.... :(

[HerrEye]

Is there any chance that it's something not so serious as IOL damage? Inflammation, macular edema, severe epithelium injury from the contact lens used during the YAG? Even too smal hole could be better however I'm afraid that making it bigger is too risky (ED possibility, for single eye person it would be complete disaster)... I really don't understand now why I decided to do that YAG... :(

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

I said it need not be serous and not permanent. Only an exam will give you answers, this is as far as I can take it Good luck

[HerrEye]

I understand that the examination is needed but can be such light spill and glare a symptom of damaged IOL?. I found a topic that confirms that but I've also seen an image on the internet suggesting that minor damages give rather bright spots not such light "fog". I know, you will  probably say that it depends on the damage size.... But what different explanations can be there? I found almost no similar cases described on the internet - of course there are some suggestions in a few articles that "size matters" but if cloudy capsule caused less light glare, how partially open can give worse results? My glare does not have any significant shape as some described on the internet where crucial hole was too small (light stripes etc)
I've found a doctor working tomorrow and I'm planning to visit him. I hope that even less experienced ophthalmologist can spot damaged IOL in slit lamp. That's what I'm most terrified of because another problems as swelling, inflammation etc can be cured. Replanting lens in one eyed young persons after capsulitomy would be insane so I'd have to live with that terrible effect... Did you have similar cases in your practice (huge glare after YAG) that were not connected with damaged optic?

[JohnHaganMD]

I hope the exam goes well. Consider coming back and posting what the problem was. I cannot add any more useful information. I don't like to speculate or guess.

[HerrEye]

If don't want to speculate even about less serious explanations that doesn't sound well for their possible existence :(

[HerrEye]

So  fortunately it seems that IOL is OK, perhaps it has one tiny mark close to the capsular opening edge but the doctor said it can be also some capsule residues. He said it can be too small capsular hole indeed (however it's only a bit smaller than my undilated pupil... is there any way to confirm that theory? cosmetic contact lenses with smaller pupil? Eye drops to narrow the pupil temporarily? (can it be more constricted than in bright light conditions? because even in bright environment I see that light spill on the border between darker and lighter objects)

[JohnHaganMD]

If the surgeon that examined you cannot give an exact diagnosis no way I can.  Yag marking of IOLs is common and rarely causes problems even when numerous and near visual axis.  If it is the posterior capsule edge you should see better in daylight when pupil smaller than in the dark when pupil bigger.  Also would need to see how it responds to a new glasses test (refraction)