Posterior Capsule Opacity and Cataract Surgery Complications

Written by Dr. David Evans   Last modified on November 16, 2018

I was chatting with a member of the Better Vision Guide team this week who was telling me that his father recently underwent cataract surgery on both eyes (eight weeks apart). A couple of months after the first surgery he experienced some minor vision issues that seemed to him like his cataract was returning. His overall quality of vision continued to be much better than prior to cataract surgery, but his vision had become a little hazy. The doctor determined that he had a posterior capsule opacity (PCO).

Cataract surgery is one of the most commonly performed and successful surgeries out there. The American Society of Cataract and Refractive Surgeons (ASCRS) estimates that approximately three million Americans have cataract surgery every year. Although there are risks associated with cataract surgery — as is the case with any medical procedure — it has a fairly remarkable success rate exceeding 98 percent. Be that as it may, PCO can be a factor in the months following surgery.

What is PCO?

The eye has a thin clear membrane that surrounds and holds in place the natural lens. This membrane is called the lens capsule.  During cataract surgery, this capsule remains in place after the natural lens is removed. The IOL is then placed in the capsule. Posterior capsule opacity occurs when lingering epithelial cells from the extracted natural lens grow on the lens capsule. This growth of epithelial cells causes the capsule to become hazy, and can interfere with vision clarity. Some cataract patients confuse this haziness with another cataract; to such an extent that PCO is often referred to as a secondary cataract. This is why my friend told me that his dad thought the cataract was coming back. But the reality is once your natural lens is removed, it’s impossible to redevelop a cataract.

PCO is the most common complication associated with cataract surgery, but the good news is that it’s quite easily corrected through a quick, painless procedure known as YAG laser capsulotomy.

YAG, You’re it

To perform the procedure, your doctor will first dilate the eyes with drops, then point a special YAG laser toward the back of the lens capsule. During the procedure, the laser beam shoots through the lens capsule and removes the hazy parts.  The procedure typically takes around five minutes and requires no incisions or direct contact with the eye. Normal activity can be resumed immediately after treatment, and vision should begin to improve within a day.

Your doctor will likely prescribe some anti-inflammatory eye drops for you to apply after treatment, but unlike your initial cataract surgery, YAG laser capsulotomy should not require any additional follow up. That said, the treatment does boast some risk of complication. Patients should be aware that retinal detachment is a very rare complication of YAG capsulotomy. If you have any concerns about this minimal risk, speak with your eye doctor about what alternative measures may be available.

Additional Cataract Surgery Complications

Although PCO is the most common complication associated with cataract surgery, it is not the only potential issue that can arise from treatment. Minor cataract surgery complications can include eye swelling, increased intraocular pressure and drooping of the eyelid (also known as ptosis). More serious complications can include a rupture of the lens capsule causing the artificial lens to shift position — which can lead to double vision or a loss of visual acuity. Severe vision loss associated with cataract surgery is extremely rare, but may occur as a result of bleeding or infection in the eye.

The most important thing to remember after cataract surgery is to communicate with your doctor about any issues or problems you may be experiencing. Certain issues may not develop immediately after treatment, so be sure to maintain your scheduled checkups and contact your doctor immediately if you experience any drastic change in your vision.

All’s Well that End’s Well

My colleague’s father is schedule for his YAG surgery next week and has not experienced any issues with his second eye. He’s glad he opted for cataract surgery and recommends the procedure to friends and family.

If you are interested in learning more about cataract surgery, you can check out some of the following articles featured on Better Vision Guide:

How much does cataract surgery cost?

Can I have cataract surgery after LASIK?

Cataract surgery recovery

Laser cataract surgery

And as always, please feel free to contact us with your specific questions or comments.