Monday, December 8, 2008

after catarct and yag laser treatment

Whenever a patient comes to know that he has got after cataract, he feels like the surgery wasn’t done properly or the surgeon has left some catarct in the eye which is causing trouble to him. To clarify the confusion originated due to similar looking words “cataract” and “after cataract”, today I m discussing the situation which is called as “after cataract or posterior capsular opacification”.

What is cataract?

A cataract is clouding of the lens in the eye that affects the vision. The lens is made up of a bag filled with protein and protein like material and is suspended in the eye with the help of tiny spokes (zonules). When a person gets a cataract the material in the bag gets cloudy and causes blurring of the vision. This can be treated by surgery (phacoemulsification) and once the opaque material(cataract) is removed from the bag, the same bag is used to hold the artificial lens.

What is Intra ocular lens?

An IOL(intraocular lens) is the substitute to the natural lens to maintain the vision without thick glasses. After a cataract surgery IOL implant is a routine step. Most common implants are placed “in the bag” which is considered the safest implant site. There are other sites for the lens implant but they are chosen only if “in the bag” implant is not possible.

What is after cataract?

A posterior capsular opacity is a opacity that can form behind an intra ocular lens implant after cataract surgery. The opacity develops in the posterior capsule ( posterior part of the clear membranous bag) that supports the lens implant after cataract surgery.

After a successful cataract surgery, It may take several weeks to several years to develop a after cataract. It is not essential that all will have after cataract. Other names for this condition include secondary cataract, after-cataract, posterior capsular membrane, or posterior capsular fibrosis.

Why after cataract develops?

The natural lens is made up of the bag and the material filled inside it. The bag is coated with the cells which keep secreting the material inside. When a person develops the cataract this material gets opaque and by surgery it is removed. Even though a meticulous removal of proteinious material is done some calls are always left behind which starts growing and forms the opacity. But this time this opacity develops behind the IOL and above or in the posterior part of the bag.

What are the symptoms of after cataract?

  • Slowly progressive blur in the vision.
  • Colors seem faded.
  • Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
  • Poor night vision.
  • Double vision or multiple images in one eye.

How after cataract is treated?

Most common and most effective method is YAG laser capsulotomy. The final objective is to make the small opening in the post wall of the bag so that a small window can be created from the partially opaque capsule. When capsule is too thick some surgical methods can be employed to cut the central opaque part of the bag.

What is YAG laser?

YAG Laser is a disruptive type of laser which is used to cut or make a hole in the bag. Because of precise nature of lasers this process involves making a controlled small window in the bag. So after the laser we get a window as well as bag is still tough to hold the lens in it without displacing it.

What is the procedure?

This "after cataract" condition is treated by the YAG laser capsulotomy, performed as a minor in-office or outpatient procedure. The pupil is generally dilated prior to the procedure. A laser is then used to cut through the hazy capsule behind the IOL implant. Entirely painless, it takes just a few minutes and results in no postoperative discomfort.

An anti-inflammatory eye drop medication is usually recommended after the procedure. Patients may resume normal activities immediately. Some "floaters" can be expected, which will generally disappear within a few weeks. YAG laser capsulotomy almost always enables vision to be restored or improved.

Is there any risk involved?

After the laser very few may feel the pain, some may develop the inflammation and high Intra ocular pressure. There may be development of floaters which generally disappears with time. In rare instances there may be retinal detachment.however there are very small risks,

Will I get any other opacity after “after cataract”?

No. once after cataract is done there should be no opacity for lifetime. As capsular bag is utilized to hold the Intra ocular lens, some may get the opacity of it (that is after cataract). But when YAG laser is done and a window is made in the bag there is no possibility of getting any kind of opacity in future, related to bag or cataract.