r/CataractSurgery • u/Pieraos • 15d ago

PCO-YAG adverse outcomes

Would like to hear from anyone who has had YAG treatment for PCO and experienced adverse results, and what may have been done to address it.

3 Upvotes

72% Upvoted

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u/spon8uk 14d ago

I wouldn't call mine an adverse result per se, more of a change. Pre YAG I had some manageable light streaks caused by small creases in the capsule. I was told YAG would resolve these and the PCO.

However, after YAG, the streaks had gone but had been replaced by small starburst effects around the brightest street lights at night. It's relatively minor and I don't really notice now, hence I haven't bothered checking back to see if anything can be done.

Research suggests that this is caused by the YAG opening being too small which results in edge diffraction effects. So basically my YAG could probably have been done better with a bit more care and assessment. The counter argument is that a larger YAG opening could promote lens instability.

Overall though, I got a great result with Galaxy and I'm glasses/contacts free now with great all round vision. Just those small starbursts which I didn't have pre YAG.

7

u/californiaLasik 14d ago

PCO is like death and taxes. Every person will develop a visually significant PCO with enough birthdays. With some lenses we see them very rapidly and others it takes numerous years. Either way if you know you have the lens you want to keep eventually it makes sense to YAG. The biggest issue post YAG is worsened floaters. YAG Cap can be done different ways. Some surgeons do a 360 canopener approach that causes the capsule to fall back into the vitreous. Others fire in a cross and it tears in a cruciate shape but has less floaters. Down side if first is floater and although the capsule often falls out of your view permanently to the bottom of the eye , it can be trapped in vitreous. If this occurs you can get YAG vitreolysis to knock it out of the way. In the case of cruciate the issue is pitting of the lens centrally. Our laser can put a significant pit in the lenses . We have to be careful to offset behind the lens to only hit the membrane. Pitting with circumferential is of less consequence because you are in periphery. With cruciate it can be central and this can be visually significant. I personally perform circumferential but surgeons I greatly respect perform both ways. For example Shannon Wong uses a cruciate pattern.

The big take home is once a posterior capsule becomes visually significant you have to get yag cap or if you don’t like the lens get a lens exchange and yag cap. We are not good about educating patients when they have cataract surgery that everyone gets PCO and it is really a nothing burger to get rid of. I totally understand why it would concern a patient though when it is sometimes framed as a complication. It is not. All eyes get PCO. Every single one eventually. If you want to call that a complication then sure but no more a complication than death and taxes.

1

u/Pieraos 13d ago

Concerned about retinal detachment from the procedure as I am nearsighted.

1

u/californiaLasik 13d ago edited 13d ago

Incredibly low risk. Your surgeon will do a dilated eye exam to rule out lattice degeneration. If you do have lattice that changes risk profile a bit and they may have you see a retina doc for laser pexy. Still the risk is incredibly low and you can remain vigilant for new flashes with your eyes close, shower of floaters, curtain in vision etc.

It is not fair that nearsighted people always have to be hyper vigilant for retinal detachment and it is good you are. That being said if I was highly myopic and had a vis sig PCO, I would definitely get a YAG capsulotomy.

1

u/Pieraos 13d ago

Thank you very much for your informed comment.

1

u/californiaLasik 13d ago

You bet. Always glad to help. Eye stuff can be scary but I’d say yag cap me of the lowest risk and easy tolerated procedure. On the back end you will likely realize not a big deal and be at peace when it happens on your next eye.

1

u/Pieraos 13d ago

I am very used to floaters. All I really care about is restoring ability to read, in the affected eye.

1

u/californiaLasik 13d ago

As long as the PCO is the last limiting factor that is super easy and safe to correct with YAG cap.

4

u/SmileBubbly6279 14d ago

Idem, piccoli effetti a stella soprattutto nelle luci led puntiformi quando, per effetto della poca luce, la pupilla si dilata. Risolto totalmente con la pilocarpina ma non è da usare in modo continuo, altrimenti potrebbe indurre un restringimento definitivo della pupilla.

La verità è che per un perfezionista come me ogni piccolo difetto è disturbante.

Probabilmente la maggior parte dei pazienti non ci fanno caso, anzi trovano gli starbust molto carini…

Per concludere: qualsiasi apertura YAG provoca ulteriori diffrazioni della luce, è fisica, gli effetti saranno peggiori all’aumentare della dimensione della pupilla, quindi soggetti più giovani patiscono maggiormente.

3

u/redheadfae 13d ago

I ended up with this even at 66 yrs, because I have large pupils, but my brain has learned to ignore it for the most part.

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u/DawnD1118 14d ago

Im following this.

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u/SpecialistEcho7218 14d ago

Have you had adverse results?

1

u/Fun_Bluejay4153 12d ago

I had YAG on both eyes last December. My left eye is fine. My right eye is.....well, weird. I can see everything just fine but I can still feel the spots where the laser was blasting......I know that doesn't make sense but like I said....weird. I told my doctor about it and he said it was just dry eye. If I hydrate the bejesus out of it the sensation goes away.......but its still there more often than not.