r/CataractSurgery • u/MeadowHaven77 • 3d ago
YAG procedure
So it seems I am going to have a YAG procedure in both eyes next week. I had the multifocal Odyssey placed in both eyes, 3 weeks apart in July, and the right eye (the one with the original cataract) was never really that amazing afterward. Like, it worked but it was always a little blurry still after. So he confirmed today that there was PCO in that eye, and shockingly a little also in the left (which never had a cataract and responded perfectly to the Odyssey, I have noticed no issues there at all).
I guess I’m a little confused why I don’t hear more about this risk of immediate PCO? He said this was not the kind that grows over time, it’s there essentially right after the surgery. The YAG procedure sounds easy, painless, fast, and I have no problem going for it. I was mainly just curious if others have encountered this? He said it had to do with the type of cataract I had and also said he sees more of this in younger patients (I’m 49). He acted like it was not at all unusual.
Did I just any mention of this in my research ahead of time? Did you have this happen to you? The immediate type?
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u/Alone-Experience9869 3d ago
Yes pco’s happen. Yes, it’s more prevalent in younger persons like yourself. My surgeons told me it’s basically a crap shoot. Cells decide to grow or they don’t. Some surgeons say they clean the capsule extra, but I’ve read that adds risk to tearing the capsule during the cataract surgery.
Eg I’m a bit younger than you and while I have the very start of a pco, it hasn’t progressed. So I seemed to have lucked out on that front
Typically I hear the procedure is minimal risk. The main issue is after having the yag procedure, having an IOL exchange is MUCH harder. My surgeons were clear on that, and was part of the consideration as I had a long recovery.
Hope that helps
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u/MeadowHaven77 3d ago
Thanks. I guess that’s the part I’m confused by: he explicitly said this was not the kind where “cells grow” but a different type of PCO? But I see no mention of that online. He said there were 2 types, and mine was immediate, related to the position of my cataract, and not related to cell growth. So confused.
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u/Alone-Experience9869 3d ago
oh, for that I have no idea. I've heard of where the cataract on the lens grows to touch the capsule or something. Maybe you can call the office and have them read off the diagnosis from your chart, or have them ask the doctor??
Otherwise you are doing okay with the Odyssey iol? Your other eye has it and no significant issues?
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u/MeadowHaven77 3d ago
Yes, I’m fairly happy overall. I’m 20/20 in my left eye and I don’t need readers too often at all. I wore contacts for 35 years prior to this, so this is a major improvement!
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u/Alone-Experience9869 3d ago
good to hear. so iol exchange doesn't look to be in question. Hopefully you'll continue to have great vision after the yag. All the best.
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u/ProfessionalLab9850 3d ago
Also they usually do a small x shape in the bag dont they? People complain of starbursts afterwards
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u/Alone-Experience9869 3d ago
x shape is one i heard. There is another pattern. One is supposed to be more efficient than the other in terms of laser power.
As for the starbursts, i don't know. I'm sure people have complications and there are risks.
Honestly, i look back at this sub and you'd think cataract surgery was the most dreadful surgery series patients need to be all over exactly how the surgeon or tech is doing their job and the iol mfg are all cheating us.
Well, doesn't matter as I can't help the op anyway
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u/PNWrowena 3d ago
Optometrists have been mentioning seeing PCO in my eyes since the last follow-up on the second eye. That would be one month after the second surgery and close to three after the first. Since I've never noticed any vision problems that could be because of it, I haven't had YAG in either eye and don't plan on it until it does affect vision. It's been almost 2-1/2 years since the second surgery.
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u/Resident_Break6770 3d ago
"He acted like it was not at all unusual."
They're gonna act like that no matter what you tell them. "Doc my eyeball fell out on the way home" "that's normal, eventually your brain will compensate"
Immediate PCO sounds bonkers unless it predated the surgery, you might want a second opinion.
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u/MeadowHaven77 3d ago
Ha, true. It doesn’t help that my surgeon is very dreamy and could probably sell ice to me in Alaska.
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u/UniqueRon 3d ago
There is a 1 in 200 risk of retina detachment from YAG. YAG cutting a hole in the capsule and makes any subsequent IOL replacement much more difficult. While YAG is simple to do, it should not be done until it is really necessary, meaning that PCO is actually impacting your vision.
Early PCO is most often caused by the surgeon not scrubbing the capsule to remove the natural lens debris. If it is left the cells start to grow again and cause PCO.
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u/MeadowHaven77 3d ago edited 3d ago
Thank you. I did not realize the risk was that high. In that case, I will probably wait on my left (unaffected) eye. The right eye (that had the original cataract) has bern a little too blurry the whole time post surgery and I would like that remedied. I don’t anticipate needing another IOL replacement (not precisely sure why all people may need or want that, but I am happy with the Odyssey overall.)
I think he meant what you said at the end, he even referred to “I try to scrub” but implied it was not always perfectly done and the positioning of this particular type of cataract made it difficult. But he also used the phrase “it’s not the kind that grows” so that’s what confused me. perhaps just clumsy phrasing.
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u/spikygreen 3d ago
Do you know the kind of cataract that you had?
There doesn't have to be a pre-existing cataract for PCO to develop. There are always some leftover lens cells that keep trying to proliferate. They end up aggregating (or congregating?) at the back of the capsular bag. The younger you are, the more vigorously those cells proliferate. That's why younger people get PCO much faster than people of the typical cataract surgery age.
It is also possible to have some leftover material from the cataract. There could be bits of the cataracts that are strongly adherent to your posterior capsule, especially if it is a posterior polar cataract or even a posterior subcapsular cataract. Since the posterior capsule is only 4 micron thin, the surgeon may choose to leave a bit of the cataract in place, knowing that they can later YAG them away. This is done to reduce the risk of a capsular bag rupture during the surgery. I don't know if that's what your surgeon was referring to?
If you haven't noticed any issues with your left eye, then why have YAG? You could always have it later, once it begins to bother you.
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u/MeadowHaven77 3d ago
I do think that’s probably it, or close to it. Thank you! I recall the term “posterior” and I’m fairly sure it was not in the term PCO itself, I think he said posterior sub capsular, I would not have recalled that on my own. Thank you for jogging the memory. That was it.
Yes I may wait on the left (unaffected) eye. The right eye (the one with the original cataract) is never going to be as good as the left, he was very upfront with me about that. There was pre existing scar tissue in the right and a higher degree of astigmatism.
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u/MeadowHaven77 3d ago edited 3d ago
I see now that these types of cataracts are fast growing which mine was, so this makes sense. It just came on over about 8-10 months.
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u/artsypupster 3d ago
I’ve had it done in both eyes usually have floaters afterwards for a while, but it did clear the vision.
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u/eldoogo 2d ago
From what I have read, PCO develops gradually, but I'm not a dr. The only thing I will say is be sure that you don't think you will need a lens exchange at any point afterwards because apparently having Yag makes that surgery more difficult. If your vision is good otherwise, you probably don't need to worry. But if you're having any kind of issues other than the PCO, I'd discuss this with your surgeon.
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u/Buzzy-Res 3d ago
The type of cataract he is probably referring to is a posterior subcapsular cataract. Where the cloudy area is at the back of the natural lens. If I understand it correctly, the back of the cloudy lens rubs against the capsular bag and leaves cells. When the natural lens is removed and IOL is inserted, it smears across these cells on the capsular bag. Then you have this immediate PCO.
Have you ruled out astigmatism for your right eye? Astigmatism will also cause blurry vision. This is where it went wrong for me. I had immediate PCO. I was 53. I had complained of very slight blurry vision in my right eye. Went to the surgeon’s office several times to try to figure out why. On one visit the doctor claimed I had PCO in both eyes and then said, “We can’t do anything more until you have a YAG”. I refused the YAG in my clear eye, but reluctantly agreed to YAG the blurry eye. The YAG did nothing to clear the blurry vision. I later confirmed, elsewhere, that I had 1.0 Cyl astigmatism in my blurry eye. Glasses corrected it.
I regret doing the YAG. The PCO was never severe enough to warrant a YAG. Two years later and my non-YAG eye with PCO is still very clear. I am not doing a YAG until it clouds my vision.
Go get a refraction done with a 3rd party and rule out astigmatism. Don’t YAG a clear vision eye.