Mr Jaheed Khan tells us about laser treatment for posterior capsular opacification (PCO) after cataract surgery
Jane: Thank you very much. You mentioned a little bit about laser treatment after cataract surgery.
Jaheed Khan: Yes.
Jane: How soon after does it develop?
Jaheed Khan: Well. That does depend. It usually takes about three, possibly six months to be noticed. Some people notice the symptoms much later, but with the majority of people will notice a secondary blur, like a second cataract and it is not necessarily…
Jane: A second cataract. I have heard the term ‘after cataract’.
Jaheed Khan: ‘After cataract’, yeah. It is not a complication as such. One of the issues of cataract surgery is when we place the lens inside the bag which the lens sits in, the clear bag that it sits in can mist over and if it is misting over then we can clean it with a laser, so we do not have to go back to the operation theatre.
We perform laser in the outpatient setting, and we make a little opening on the back surface of the lens.
Jane: That is here at Clinica London.
Jaheed Khan: And that is done here at Clinica London with the Lumenis Duet laser, yes. It is a painless procedure. It takes 5 minutes under eye drops anaesthesia and is very easy to do.
Jane: What is it called?
Jaheed Khan: So, it is called a YAG laser capsulotomy, and the condition is called a posterior capsular opacification (POC).
Why is it that some people get it and others don’t? That is partly because, in some of our younger patients, some cells tend to grow in a sheet on the back surface of the lens and sometimes that is very difficult to remove at the time of surgery. We know that the secondary lasers will give you the best outcome, but with good lens design actually, our posterior capsular opacification rates have reduced dramatically. We used to see a lot of it, but now it has become less of an issue.
Jane: What sort of percentage should you say?
Jaheed Khan: It is around 1 in 5.
Jane: 1 in 5? 20%?
Jaheed Khan: Yes, depending on the type of lens and some lenses are better at not developing this.
The lens design has simple things like making the edges of the lens, the intraocular lens rounded or square, I should say, has stopped the development of what we call posterior capsular opacification, so the subtle things are preventative.
Jane: With posterior capsular opacification or PCO…
Jaheed Khan: PCO, yeah.
Jane: You do an outpatient laser treatment.
Jaheed Khan: Correct.
Jane: What happens during that treatment?
Jaheed Khan: Similarly, first of all, we confirm the diagnosis. It is important to know that whatever is causing blurred vision is that, but if that’s the condition, you need dilating drops, and you need to be able to sit still on a lamp which delivers the laser.
Now, the laser is not painful. It does not warm the eye up. It does not blind you. It is just a very bright light, and we focus that laser on that capsule – we do not focus it on the lens – we focus it on the capsule, and we make a tiny little opening in the capsule, and that clears the back surface of the lens. After a few day, your vision becomes much clearer. You will notice some floaters because the capsule that we have made a clearing from tends to float around in the gel of the eye.
Jane: For how long?
Jaheed Khan: Generally for a week or so and it usually falls to the back of the eye and then gets gradually reabsorbed. So you may have some floaters for a week, but after that your vision is much clearer and you will not need this again.
Jane: Thank you very much. That is a very clear description of cataract surgery and the aftermath.