Secondary Cataract (Posterior Capsule Opacification)
After cataract surgery a secondary cataract or posterior capsule opacification may develop, which refers to abnormal cell proliferation and scarring of the remaining lens capsule. This process, also called capsular fibrosis, is the most common late cause of blurred vision after cataract surgery. It does not occur in every case but can develop at any time. It most commonly appears 2–5 years after surgery, causing gradual blurred vision or light scattering.
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The risk of developing secondary cataract (posterior capsule opacification) can be reduced with modern, high-quality intraocular lenses implanted in perfect position within the capsular bag. Nevertheless, it cannot be completely eliminated even in this way: the younger the patient, the greater the likelihood of its occurrence.
In some cases, the lens capsule is already scarred and cannot be cleaned at the moment of performing the cataract surgery. In such cases, laser treatment for posterior capsule opacification (capsulotomy) can be performed earlier, even as soon as 3 months after surgery.
What are the symptoms of posterior capsule opacification?
After-cataract is a common cause of blurred vision that develops after cataract surgery, leading to gradual vision deterioration. Symptoms can vary greatly depending on the location and uniformity of the cell proliferation and scarring on the lens capsule. If the process is uneven, it can cause glare or light scattering complaints very early on. In contrast, uniform thickening of the lens capsule leads to gradual vision deterioration.
How is posterior capsule opacification treated?
Posterior capsule opacification is treated with a YAG laser, during which an opening is created in the thickened posterior capsule stretched over the implanted intraocular lens, thereby eliminating the obstacle in the path of light. In rarer cases, the anterior capsule may also scar; this can similarly be enlarged with a laser. During laser treatment of posterior capsule opacification, high precision and proper technical execution are critically important. Treatment can be performed with conventional or modern laser equipment and older or new techniques.
1. cell proliferation in the central portion of the lens capsule causes vision deterioration. 2. after laser treatment, the central area is clear and vision improves
Laser treatment of after-cataract can be performed safely, effectively, and without complications, provided it is carried out by an experienced specialist using modern laser equipment and the appropriate technique.
After an ideal capsulotomy, the opening created is appropriately large, no fragments have torn from the capsule, the capsule edges do not hang into the visual axis, and the implanted intraocular lens is undamaged.
What are the complications of conventional treatment of after-cataract?
With conventional laser equipment and the older procedure, the treatment has three common complications.
One is that the laser effect can damage the implanted intraocular lens in multiple places, which can lead to light scattering or other visual complaints. The laser should only affect the lens capsule, which is mere fractions of a millimeter thick, but with conventional laser equipment and the older technique, this is not always achievable.
Another complication is an irregular and excessively small lens capsule opening, which thus still does not allow light to enter properly at the peripheral areas. This occurs because conventional laser equipment is only capable of making cuts, which sometimes tear further than intended. However, we cannot enlarge the opening in the necessary direction for fear that the intraocular lens will shift from its position. The irregular and small opening is particularly troublesome with premium intraocular lenses (multifocal, extended depth of focus), as it will impair the function of these lenses.
A third common complication of conventional capsulotomy is that fragments can tear completely or partially from the capsule, causing disturbing floaters. After a complete capsule fragment tears away, it enters the vitreous cavity and thus causes floaters. After irregular incisions in the capsule, the larger capsule fragment does not tear off but curls up and hangs into the opening area. In this case, a larger spot that quickly swims across may appear before the eye with eye movement.
Why choose PRO capsulotomy?
The safest treatment of posterior capsule opacification is possible with the reflex-type modern laser equipment and the associated new technical procedure, PRO capsulotomy. This revolutionary and globally unique laser device is uniquely capable not only of gentle incision of intraocular tissues without external incision but also of immediate vaporization of the tissues to be removed. During the latter process, the material enters a plasma state, which immediately converts to gas and liquid, then is rapidly absorbed from the eye.
PRO capsulotomy, by exploiting the more favorable tissue effects of this innovative laser procedure, results in uniform opening of the lens capsule. As a result, the opening created in the posterior capsule will be round and appropriately sized, and no vision-impairing damage will form on the previously implanted intraocular lens. Unlike the conventional procedure, with this method the risk of capsule fragment detachment is also very low, but if it does occur, we can even treat it with the same device.
During capsulotomy, no external incision is made and there is no dressing after treatment. The painless treatment takes only a few minutes and can usually be performed on the day of examination. Vision improvement is noticeable within minutes after laser treatment and is fully established when the pupil dilation effect wears off.
Frequently Asked Questions (FAQ) about secondary cataract (posterior capsule opacification)
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