A posterior capsulotomy is a type of laser surgery conducted on someone who has had cataract surgery. Cataract surgery involves the removal of the clouded lens. There is a clear cellophane-like wrapping that surrounds the cataract. During cataract surgery, the surgeon removes the front cellophane tissue and follows it with cataract removal.
Meanwhile, the surgeon does not remove the back cellophane-like wrapping (posterior capsule). This is because the intraocular lens (IOL) that the surgeon will implant after removing the cloudy lens is held in place in the posterior capsule. The IOL is a clear, artificial lens.
The posterior capsule can get wrinkled or cloudy weeks, months or even years after cataract surgery. This occurrence is known as posterior capsule opacification (PCO), secondary cataract or scar tissue. PCO results from the abnormal growth of lens epithelial cells (LEC) on the posterior capsule. The LEC left behind from the old, emulsified lens collect at the back of the lens capsule. They change into lens fiber cells and myofibroblasts. The lens fiber cells fill up with proteins called crystallins causing them to scatter light as the light passes through the lens. Myofibroblasts create large amounts of molecules outside the cell causing the lens capsule to wrinkle and obstruct vision.
Diabetic patients have significant PCO than non-diabetic patients. PCO is also high in eyes with uveitis (inflammation of the uvea).
Indications that there may be problems requiring posterior capsulotomy is decrease in vision. There will also be difficulty with glare and sensitivity to bright light. The individual may experience problems while reading or driving. One may experience double vision and the difference in vision between the two eyes may be significant.
Posterior capsulotomy generates an opening in the cloudy capsule. This opening allows light to pass through again for clear vision. The decision to use posterior capsulotomy after cataract surgery depends on how severely impaired the patient’s vision is. It also depends on the presence of associated risk factors like retinal detachment, cystoid macular edema, myopia and if that is the only functioning eye.
Preparation & expectation before Surgery
Before the surgery, the eye care professional does a thorough eye examination to ensure there are no other causes for vision loss.
A posterior capsulotomy is a 5-minute procedure done in a surgeon's office. The following steps comprise the surgical procedure:
- The ophthalmic assistant will numb the eye using eye drops. Specific eye drops will be administered to dilate the pupil. The patient is required to remain still during the procedure.
- The surgeon makes a small opening at the back of the lens capsule and direct a special laser to the affected area. It is a painless procedure.
- The surgeon will then take eye pressure one to two hours after surgery to ensure it is not elevated.
After care, recovery, results
The patient will use eye drops for one week after surgery.
Posterior capsulotomy reduces glare and improves vision. After the surgical procedure, the patient can do all the normal daily activities such as reading and driving. Sight usually improves in about 24 hours. There should be no pain after surgery. There is also no discomfort postoperative.
There is no chance of a recurrence since the procedure permanently removes the central zone of the cloudy posterior capsule behind the IOL.
Risks & complications
Like any other surgery, posterior capsulotomy carries with it certain risks such as:
- Bleeding into the front part of the eye
- A gray curtain moving in someone’s field of vision
- Retinal detachment where tissue pulls away from the back of the eye
- Corneal edema or swelling of the transparent covering of the eye may occur
- The IOL may get damaged or displaced by shifting the posterior capsule opening
- An increase in the number of floaters (spots or specks that move when the eye moves)
- There may be swelling at the center of the retina (macular edema) requiring steroid eye drops
- Intraocular pressure may increase. It may be temporary but it can be a problem if it is prolonged. A patient will need eye drops to lower the pressure