PCO Timeline After Cataract Removal Surgery

[MrPresley]

Is it possible to require a YAG procedure three and a half years after having successful cataract removal surgery? This involves my LE which had a vitrectomy/ERM peel in 2015 followed by subsequent cataract (as expected) removal in March 2017.

[NightHawkGuy]

I had a full dilated eye exam today with my ophthalmologist after experiencing significant increased cloudiness over the past few months in my right eye reducing visual acuity in that eye to worse than 20/60. My right eye had cataract surgery with a Tecnis toric IOL 3.5 years ago, so I suspected PCO was the possible cause and my eye doctor confirmed that today using slit lamp and also viewing the eye with a handheld lens - he noted the membrane was very cloudy now.

So I'm scheduled for the YAG procedure for May 10 now and a followup exam 2 weeks after that.  My eye doctor told me the hole made by the YAG in the capsule is typically about 3mm. He warned of a couple risks after the YAG operation, possible retinal detachment also possible IOL dislocation.  Both he said were under a 1/1000 chance however.

I hope this will be as successful for me as it was for you, Mr.Presley!

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

You should be a happy camper again.  Yag cap is not no risk but it is very low risk.  Dislocation of IOL is highly unlikely unless the IOL is already unstable or the eye has pseudoexfoliation syndrome. Both of these are easily diagnosed prior to surgery.  Also the risk of RD does not increase much at all except in eyes already prone to RD>;  high myopia before cataract surgery, history severe trauma, family history of RD or RD in fellow eye.  It also does not change the glasses RX so your old glasses will likely do fine.

[MrPresley]

I’m confident you’ll do just fine, and be sure to return here with your results.

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

Nice to hear from you Mr. P.

[NightHawkGuy]

I got thru the YAG procedure on my right eye yesterday.  The doctor told me he used the cross method and 11 spots with the laser.
Took over 8 hours for the dilation to wear off and then my vision in my right eye was clear again and back to 20/25 uncorrected and 20/20 or better with glasses.  I had one floater appear for a few hours but then it disappeared and all day today no noticeable floaters!
Have appointment in two weeks for followup check.

FYI, the clinic with my doctor and ophthalmologist was part of the one that got hit by a ransomware/cyberattack a little over a week ago and all their computer systems are still down, the doctor and staff had to write everything down by hand without the computer network...

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

Thanks for the posting NightHawk.  These ransomware criminals are the lowest of the low.  

[JohnHaganMD]

Mr. P good hearing from you again.  A person can need Yap capsulotomy at anytime the rest of their life after cataract surgery. In fact some of the patients I operated on the posterior capsule was cloudy at the time of surgery and I told the patient and family immediately after surgery then would need a Yag cap in 2-3 weeks.  Overall about 1 out of 5 people need yag capsulotomy in their lifetimes after cataract surgery.

[MrPresley]

Thanks Dr. Hagan, glad to find you're still the MD here in the Eye Care forum. Fortunately that's my only issue of concern vision-wise, it's very much like the original cataract in how I'm perceiving it.

[JohnHaganMD]

And the reason people say "I think my cataract is coming back"  Most of my surgical career 90% of people needed Yag laser for PCO.  Then about 2000 the manufacturers started making ridges and sharp edges which cut down clouding of posterior capsule and we added an additional step using 'scrubbers" or "Capsule polishers" to try and scrape all the cells off the back capsule. Since 2000 when these changes occurred the % needing yag cap is about 15-20%.  It's a 2 minute, painless procedure with usually no drops afterwards and no post op visits after the laser.

[MrPresley]

Had this done on 11/05/2020 and immediately noticed improvement. No side effects other than a very few minor floaters that resolved within a few days. Followup on 12/28/2020 found 20/20 vision restored as before.

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

Thank you Mr P.  Good to hear from you. Happy New Year and a better 2021 for the world.

[xltjim]

Hello Dr. and Mr. Presley Happy New Year.

Can I ask Mr. P how you knew you were having issues?  Was it like your cataract was coming back?  Vision blurred, starbursts around lights, etc?

Curious also Dr. Hagan - are symptoms of a PCO similar to ERM?

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

PCO symptoms not usually those of ERM which are mainly distortion.  PCO is more like original cataract symptoms hence people saying "my cataract came back"

[NightHawkGuy]

I am now 3 years + 3 months after my right eye cataract surgery with a Tecnis toric IOL. My left eye has the natural lens still with no need for cataract surgery yet since it still corrects perfectly with eyeglasses to better than 20/20.
However recently my right eye vision has been noticeably getting less sharp vision, a little cloudy less contrast, especially later in the day and evening.
Does this sound like early symptom of PCO or something else?
Would my eye doctor need to dilate my eyes to look at the capsule for PCO in my right eye?

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

The problem could be anything from a change in glasses to PCO to a new problem like retina/macula. Only an exam by an ophthalmologist can tell.  Yes you would need your eyes dilated.  I think you are in your 60's.  The younger the person the  higher the rate of PCO because the cells on the posterior capsule are younger, stronger and more of them. When infants and kids have surgery the surgeon cuts a hole in posterior capsule because it always turns cloudy.  

[xltjim]

Saw my opthalmologist today due to the diminished vision, starbursts around lights, etc.  Went in for right eye, she found that one was pretty dense.  Left eye is just starting to cloud and should be ok for awhile yet.  Right is scheduled for YAG on 2/12.  Have some ointment to take between now and then to address blepharitis, if that clears up by my 2/12 appointment we go forward.  Thank goodness for modern medicine and the great MD's.  I would be blind without.

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

yes, before the Yag Laser was invented to open the cloudy membrane (Yag laser capsulotomy), we had to go back into operating room and stick a knife/needle into the eye and but the membrane manually.  Much safer and less expensive with laser.  The Yag laser was developed simultaneously in France and Switzerland in early 80's.

[MrPresley]

@xltjim I noticed somewhat cloudy vision, no distortion, and could not get corrected better than 20/40 in my left eye. The same cataract surgeon I went to in 2017 also performed the YAG. The return to clarity was instantaneous, there were a few minor floaters that completely resolved within a day or two. Corrected vision is now back to 20/20 in both eyes.

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

Noted an interesting typo in my last reply  not "but the membrane"  instead "cut the membrane"

[MrPresley]

@NightHawkGuy that’s about how long my PCO took to become noticeable enough to do something about it. Like you I only had cataract surgery on one eye and the other needs nothing done at this point.

[MrPresley]

That happens Dr. Hagan, like you I look for 2021 to be a better year for all of us than 2020.

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

Smiles

[NightHawkGuy]

Thanks for the info MrPresley.
Over the past couple months, I've been getting gradual more cloudy vision and more noticeable halos around street lights at night in my right eye.
My last visual field test a few months ago gave strange results too, probably effected by the worse overall vision?
My eye doctor wanted to repeat the visual field test after a few months, but I am now planning on trying to get a full dilated vision exam from him first to look for PCO or other issues first.

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

In the presence of significant PCO, visual fields are not accurate.

[xltjim]

Just to update to anyone contemplating this, I had the YAG done on my right eye on 2/12/21 3:00 pm.  Vision was blurry afterwards, eye was scratchy but used copious amounts of genteal tears which helped a lot.  By 9:00 pm things were getting clearer and by the next day everything was good.  I can't believe how bad it must have been.  A few floaters but I had a few to begin with.  Admittedly, I was shaking in my boots with my history of RD/Vitrectomy in that eye (the other as well).  The Dr. gave me assurances that all will be monitored and I basically had no choice but to proceed onward if I wanted to see clearly again.  So far so good.  I go in for a one week follow up and retina exam but am optimistic that all is ok.  The left eye has slight PCO but going to monitor to see if/how it progresses.  Now that the right is done, I can tell very slight blurriness on the left.  If the time comes for YAG on that eye I won't hesitate to go forward with the treatment.  Regards,  Jim

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

Hello Jim, thanks for posting. Do report immediately many new floaters, new flashes or loss of peripheral vision. Usually we have the retina surgeon check the retina 4-6 weeks post yag (which is not part of the regular routine for non-high risk eyes).