Definition & Overview

A capsulotomy is a surgical procedure used to treat posterior calcium opacification or PCO, a complication caused by cataract extraction surgery. It is one of the more advanced laser-based techniques used in cataract treatment and works by removing the lens capsule in the event that it clouds following cataract extraction. This procedure is safe and simple and is very effective in restoring visual acuity to its original state before cataracts.

Who Should Undergo and Expected Results

Capsulotomy is recommended for patients suffering from posterior calcium opacification (PCO), a post-surgical complication that affects about 10% to 20% of patients who undergo primary cataract surgery. The condition typically sets in months after a cataract extraction procedure, causing some symptoms such as glare, double vision, or a difference in the vision of both eyes.

Cataracts refer to an ophthalmologic condition wherein the lens of a person’s eye becomes cloudy. It is a progressive condition that gets worse over time and puts the patient at risk of total vision loss in the affected eye.

The standard treatment for cataracts is the surgical extraction of cloudy lens, which has a 98% success rate and very low risk of complications. During this procedure, the affected lens is removed and replaced with an intraocular lens (IOL), leaving the thin membrane that surrounds the natural lens of the eye (lens capsule) intact.

Although the surgery has high success rates, there are few cases wherein patients experience some complications, the most common of which is the clouding of the lens capsule that can affect the patient’s vision, making it worse than it was before the cataract extraction procedure. In such cases, capsulotomy is highly recommended.

Following capsulotomy, patients can expect to recover their visual acuity and experience improved contrast sensitivity and reduced glare. These benefits can be experienced as early as the following day after the procedure, so patients are instructed to consult their doctor immediately if they do not experience any improvement in their vision. Also, the effects of the condition are expected to last for the long term and since the laser procedure removes the central portion of the lens capsule, the PCO can no longer recur. Moreover, provided that no other ophthalmologic conditions are present, patients can expect to recover the quality of their eyesight from before their cataracts first developed.

How is the Procedure Performed?

A capsulotomy is performed using advanced laser technology and takes just a few minutes to complete. It is painless and does not cause any discomfort during and after the procedure. Thus, it is performed in an ophthalmologist’s office on an outpatient basis using topical anesthetics to ensure patient comfort.

The procedure begins with the doctor dilating the affected eye using dilating eye drops. Laser beams are then used to target the posterior capsule and to create a hole in the back lining of the lens capsule, effectively removing it from the patient’s line of sight. This allows light to pass through to the retina. The entire procedure can be performed without touching the eye itself.

A capsulotomy does not require a long recovery period. In fact, patients can return to their normal activities almost immediately after the procedure. However, it is normal to experience floaters, but these are expected to resolve within a few weeks following the procedure. Ophthalmologists also typically prescribe anti-inflammatory eye drops to reduce the risk of post-procedural complications.

Possible Risks and Complications

YAG laser capsulotomy procedures pose very minimal risks to patients. Perhaps its biggest risk is retinal detachment, in which the retina becomes separated from the back of the eye. While this is already a possible complication of a cataract extraction surgery, its risk increases by 1% percent following a laser capsulotomy. This risk, however, is still quite low, affecting just 2% of cases.

Other risks associated with a capsulotomy include:

  • Macular edema or swelling of the center of the retina
  • Corneal edema or swelling of the clear covering of the eye
  • Displacement of the intraocular lens
  • Damaged intraocular lens
  • Bleeding in the front of the eye
    Due to the risks linked with the procedure, a capsulotomy is only usually prescribed for patients who experience severe vision problems that affect their work and quality of life due to PCO.

It is not performed as a preventative measure as it cannot prevent or reduce a person’s risk of suffering from a PCO after a cataract extraction surgery.

References:

  • Knobbe C. “Cataract Surgery Complications.” http://www.allaboutvision.com/conditions/cataract-complications.htm

  • Karahan E., Er D., Kaynak S. (2014). “An Overview of Nd: YAG Laser Capsulotomy.” Med Hypothesis Discov Innov Ophthalmol. 2014 Summer; 3(2):45-50. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346677/

  • Raza A. (2007). “Complications after Nd YAG Posterior Capsulotomy.” Journal of Rawalpindi Medical College (JRMC); 2007;11(1):27-29. http://www.journalrmc.com/volumes/1394515200.pdf

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