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Cataract surgery involves removing the eye's natural lense or the opacified "crystalline lens" without damaging the "capsular bag" in which it is found.
This capsular bag must be polished and left transparent before finalising the surgical operation, given that this is when the artificial intraocular lens is implanted to substitute the eye's natural crystalline lens.
Months or years after cataract surgery, the patient may notice reduced vision. This is due to an opacification of a part of the capsular bag called the "posterior capsule". A posterior capsule opacity, known in the past as a "secondary cataract", is treated quickly and simply via a procedure called a Nd:YAG laser posterior capsulotomy.
Treatment involves restoring transparency to the posterior capsule by making an opening in it with a Nd:YAG laser without the need for incisions.
To perform a capsulotomy, the pupil is dilated using eyedrops around 30 minutes before the procedure. Then some anaesthetic drops are applied and the laser is applied. This is painless and usually lasts a few minutes.
Very rarely, in cases where patients do not cooperate adequately, a lens is put on top of the eye. Once the procedure is finished, anti-inflammatory and anti-hyperintensive eyedrops are applied and the patient is discharged after checking that everything is in order.
It is an outpatients treatment and does not require any prior preparation by the client. It is advisable that you are accompanied by someone as you may experience passing glare due to the light of the microscope used to carry out the procedure. You can usually resume your daily activities the day after the operation.
After a few days during which anti-inflammatory eyedrops should be used, an eye check-up is performed to monitor the patient's progress and the final results.
An obvious improvement is usually noticeable just a few hours after as long as the patient does not have any eye issues that would impede proper visual recovery.
People frequently report that they see "floaters" for the first few days after treatment, a phenomenon that passes in a few days but may occasionally last for a little longer.
The Nd:YAG laser posterior capsulotomy is a non-invasive and very safe procedure. Occasionally, the intraocular pressure of some patients increases temporarily, which usually happens during the first few hours after the treatment is performed.
To avoid this complication, anti-hypertensive eyedrops are applied immediately after the laser. Furthermore, to counteract the postoperative inflammatory repsonse, anti-inflammatory drops are prescribed for a few days as mentioned before.
Frequently asked questions
The Nd:YAG laser posterior capsulotomy is a definitive treatment that is usually perfomed in a single session. However, there are a few cases where opacity recurs, which means the ophthalmologist will have to repeat the procedure again.
Recovery is very fast. Practically as soon as the procedure is finished, you can see a visual improvment, and particularly after a few hours, once the effect of the drops used to dilate the pupil starts to wear off. The only thing that a patient might notice is floaters, over the first few days, but this is temporary.
After cataract surgery, there are always some epithelial cells remaining in the crystalline lens within the capsular bag despite exhaustive polishing which is done in an attempt to leave it more transparent at the end of the surgical procedure. Over time, these cells multiply and migrate towards the posterior capsule causing the opacification thereof. On the other hand, the design of certain intraocular lenses may influence the migration of the epithelial cells inside the capsular bag, which is why we must take this detail into account when it comes to choosing the intraocular lens model to be implanted.