Question about floaters in a vitrectomied eye

[PSwires]

I recently posted a question because I am suffering severe glare issues after a YAG laser capsulotomy. I was unsure about their cause, but then I discovered they were caused by the edges of the capsulotomy opening. A surgeon used YAG to enlarge the opening, but although the glare phenomena changed, they did not improve very much, so I have agreed to have more YAG work done to remove a lot more of the capsule.

This will inevitably cause floaters, and I am very worried about this. A few years ago, the floaters in that eye were distressing me so much that I underwent a pars plana vitrectomy to remove them, and this was 100 percent successful: I have not had one floater in that eye since then. Experiencing being totally floater-free for years has been wonderful, so now I am very worried (in fact, frightened) at the thought of going back to having them.

My surgeon told me that these floaters will sink to the bottom of my eye, out of my line of vision, and I imagine this is possible, especially since my vitreous chamber is now full of water rather than jelly, making it much easier for the floaters to move. However, I find it hard to imagine them just settling on the bottom and staying there, in view of the fact that the eyeball moves about so much.

I am facing a nasty dilemma, because I cannot face having this glare problem but don't want to swap it for another.

Can anyone give any advice on how these floaters are likely to behave?

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

I can't be of  help to you. Although I have done several thousand Yag capsulotomies, I have not had patients complain of glare afterwords.  Also I tell patients they may see floaters for several days the ones from Yag surgery 'settle quickly" again no one has complained of persistent floaters post yag capsulotomy. So I really cannot offer an opinion.

[jbecker666]

Although your history is dissimilar from mine, our concerns are aligned. i underwent multifocal IOL/cataract removal in my rt eye in 2019. I developed posterior capsule opacification shortly thereafter, unfortunately. This followed initial elevated pressure and eye pain for a brief period. A YAG was recommended. Potential complications were discussed and were described as rare. I underwent the YAG and had perfect vision the following day. Roughly three weeks post YAG, I developed blurry vision and had additional diagnostics performed. Retinal tear and residual PCO were ruled out. There was no bleeding. I was told the surgeon needed to review the diagnostic test results. On a subsequent recheck, I was told that I had "floaters" which were not initially diagnosed. I postponed the left eye cataract removal/IOL procedure.
Upset with the information I was given, I obtained a 2nd opinion. I have a large translucent floater which moves across my left eye field of vision. I was given a referral to a vitreous retinal surgeon who confirmed the diagnosis. This was 3 months ago. Based on my research, I am leaning towards living with it rather than risking more complications. I don't believe there are any sure results following either another YAG or FOV to remove floaters.  Please keep us informed with your status and plan

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

In large population studies by age 50 half of people have floaters and by age 70 it is 75%    Rarely is it worth the risks of vitrectomy to get rid of a floater.  Most vitrectomies for floaters are in diabetics who have had an eye full of blood.  jbecker 666  I don't see a problem with your care and no reason why you should not proceed with Cat/IOL surgery in your other eye when indicated.  People have bothersome floaters with/without cat/IOL surgery  and with/without Yag capsulotomies.