A capsulotomy is a relatively non-invasive laser surgery used to treat posterior capsular opacification (PCO). Posterior capsular opacification is a common long-term complication that arises from cataract surgery. During cataract surgery, the natural cataract is removed and replaced with a transparent, artificial intraocular lens (IOL). In most cases, this artificial IOL can give the patient clear vision.
However, in rare cases (about 10%), this artificial IOL becomes cloudy or wrinkly after some time, following the surgery. This is what is known as posterior capsular opacification.
The cloudiness is caused by the proliferation of lens epithelial cells and the wrinkling of the posterior capsule. This is sometimes called an aftercataract or a 'secondary cataract'. However, it isn't a cataract because the lens isn't opaque. Patients suffering from PCO experience glare and decreased vision.
The procedure uses a laser to apply several focal ablations in the posterior capsule to make a small round opening. Because of this, light passes through the cloudy lens helping the patient gain clear vision once again. Dr. Aron-Rosa and Fankhauser developed YAG capsulotomy in the early 1980s.
A successful capsulotomy helps to improve vision and reduce glare. It is not necessary until the clouding of the lens causes vision loss and affects the patient's lifestyle. Indications include:
- Decreased vision
- Difference in vision between the two eyes
- Double vision
- Another vision-threatening eye disorder
- Issues with conducting day-to-day activities
- Glare caused by bright lights
- Problem locating the fundus
The contraindications include:
- Macular edema
- History of retinal tears/detachments
- Presence of glass IOL during the cataract surgery
- Glaucoma patients with IOP spike resulting from postoperative inflammation or steroid response
- Corneal scarring which affects clear view during the procedure
Also Known As
- AG laser posterior capsulotomy
- Neodymium-doped yttrium aluminum garnet (Nd: YAG) laser capsulotomy
- Yttrium aluminum garnet (YAG) laser capsulotomy
There are two techniques that the eye specialist can use during the capsulotomy.
- Circular pattern
- Cruciate pattern
Before the Procedure
The patient is asked to eat, drink, and use their medication as usual before the procedure. Before the surgery commences, the eye specialist will need to check intraocular pressure levels. Due to the dilating eye drops used during the surgery, patients are required to have someone take them home after the procedure.
To begin the surgery, the specialist will administer anesthetic eye drops. S/he will also use dilating eye drops to open up the pupil. S/he then places a unique contact lens onto the eye. The contact lens helps keep the laser beam steady on the areas to be treated and keeps the eyelid open during the procedure.
The patient will be asked to sit and place their chin on the chin rest of the laser machine. The machine also has handles that the patient can hold on to. The patient will be asked to remain very still for the entirety of the procedure. There will be a bright light, helping the specialist see inside the eye.
The eye specialist will then activate the laser beam, which shows as a bright light. The laser beam makes small holes in the capsule, creating an opening that lets illumination go through the membrane, to the retina. The eye specialist removes the contact lens at the end of the procedure. This process lasts about 10-20 minutes.
Risks & Complications
The patient may be unable to see properly or experience blurred vision for about 40 minutes after the procedure is done due to the bright light flashes and dilating eye drops. For a day or two after the procedure, the patient may experience inflammation, mild discomfort, and gritty and itchy eyes. For a few weeks after the capsulotomy, it is normal for the patient to experience spider-like floaters or cobwebs in the eye. These side effects should slowly disappear within a few days or weeks.
Although rare, there are potential risks and complications associated with the surgery. They include:
- A transient rise in IOP – This is the most common complication associated with the capsulotomy, but it is easily managed using eye drops.
- Sudden flashes of light – The patient should immediately seek medical attention if s/he experiences this.
- Retinal tear and detachment – This is rare as it occurs in less than 1% of patients. Further treatment is required to solve this.
- IOL dislocation or damage
- IOL pitting
- Macular edema
- Corneal edema
Aftercare & Recovery
After the procedure, the eye specialist will prescribe some eye drops to lower any rise in IOP and topical steroids to help control inflammation. These will be used for a few days to a week. In case the patient experiences some discomfort, s/he may use an over the counter pain reliever.
The patient is encouraged to rest for at least a week before their vision resumes to normal. The patient should avoid rubbing their eyes, wearing any eye make-up, swimming, or participating in contact sports for at least a week.
Patients are required to go back one week postoperatively to assess IOP levels and check for inflammation. A dilated fundus exam may be conducted, but it is not necessary.
Retreatment isn't required unless the capsulotomy did not ablate the posterior capsule completely.