Is posterior capsule wrinkle after cataract surgery unusual?

[Icanseenow]

I had cataract surgery 4 days ago and am very happy with the results.  The doctor got the power exactly where I asked (0.25D to 0.5D myopic).  I am now 20/20 at 20 feet, best at 10 feet and can read the computer at 30 inches.  It does help to use 1.00D reading glasses for the computer.  The only problem is that there is a horizontal streak from bright lights, like individual light bulbs.  The surgeon said that this is caused by a wrinkle in the posterior capsule, which is caused by the pressure of the haptics.  I got the B&L SofPort AO IOL.  He said that it might go away, but probably not.  He said that it could be fixed by YAG laser if it is still there after 4 weeks and it bothers me.  My questions are:
-- Is this wrinkle an unusual occurrence?
-- Is the risk of the YAG laser treatment on the posterior capsule worth the removal of the streaks?
-- I believe that it is easier to do the YAG laser treatment whey the capsule is clear than when it might eventually cloud, so maybe it is not a bad thing to have it done now.  Comment?

[Forum-OD-MP]

1) no, i would not consider that a 'usual' occurrence.  bot does not sound dangerous

2) 2) little risk in yag IMO

[aimee37]

You stated you were very pleased with the outcome of your surgery except for that issue.  It can take longer than 4 weeks for the eye to completely recover from such invasive surgery.  Give this plenty of time and thought before you subject your eyes to any more sugeries.  As with any surgery, there are risks and YAG is no different when it comes to risks.  Discuss them with your surgeon and give yourself plenty of time to think it over afterwards.  Like your surgeon said there is a chance this may resolve on it's own.  Best of luck to you!!

[aimee37]

I am 6 days post op cataract surgery. I,too, have horizontal lines of light from any light source. I kept hoping they would improve, but none so far. I plan to call my surgeon tomarrow. I had the surgery mainly because of night vision problems when driving-now that problem is worse. I'm wondering if I should have the other eye's cataract removed. I wanted so bad to be able to drive again at night. Can you drive at night now? Please let know any update. I'll keep you posted on what I learn from my Doctor.

[aimee37]

The horizontal streaks that I have are much less distracting than the large starbursts that I had with the cataract in the right eye.  The left eye starbursts were not as bad as the right and are still worse than the streaks.  The starbursts blocked all of my vision around the light, but the streak only blocks that narrow line.  I have not tried night driving yet.  These are just observations by looking at various bright lights at home, but I think that night driving will be much improved over what it was with the large starbursts.  I am still eagerly awaiting getting the cataract removed from my left eye because my VA is sooooo much better in my right eye now.

[aimee37]

I saw the eye Dr. today. My diagnois was same as yours.He wants me to wait 90 days for the laser tx. Apparently it is somewhat rare. I felt the staff there, who did his pre-screen, just thought I was being an odd-ball until he confirmed to them that I do have a legitimate problem. So, he used my case as a teaching tool. My other eye is still set for Monday.

[aimee37]

I found this article this afternoon.  I haven't read it yet, but the second photo on the second page might be what my surgeon was talking about.
http://www.iovs.org/cgi/reprint/37/5/906.pdf
I saw my optometrist this morning and she didn't seem to know about this possibility.  She is young, but good.  Perhaps she has just not had time to see this.  My surgeon, with nearly 30 years of experience, recognized it right away.  Of course, he only does cataract surgery related stuff, so he sees a lot of results.  There are 5 doctors at the clinic and each has their own specialty.  He said he could do the YAG procedure in 4 weeks, but my optometrist also recommended to wait 3 months.  I will decide at the 4 week point what I will do.

[aimee37]

I experiance the same problem with my surgery with the wrinkle.  I experimented and found that I could observe my own lense and capsule by looking at a diffused light (clear blue sky on a bright day) through a pinhole made in a piece of tinfoil.  Never look at a light souce directly!!!  A pinhole makes a perfect lense with near infinate depth of field.  The wirnkle will be at a right angle to the jets of light you see normaly.  Remember what you will see that is behind the pinhole will be flipped on the back of your eye.  You can also see any other distortions in you lense and capsule this way.  If you haven't had cateract surgery yet you can even see the shape of you cateract.

[aimee37]

Have you had your other eyes cataract done yet? I had mine done one week ago today and am now seeing a light streak in that eye. It is not as long as the other eyes streak, but does cross the other eyes streak when I have both eyes open. I have an appointment with my Dr. tomarrow. I think he saw the fold on the appointment the day after this surgery (since he made my return appointment for one week and also told me the YAG could be done in the less than original 90 days he stated on the last visit). At this point I am really disappointed with my surgery because of the light distortion, especially at night. Do you know yet if you will have the YAG at 4 weeks?  

[aimee37]

I had my left eye done 5 days ago and I have the same streak in that eye as I did in the right eye.  The one in my right eye, however, is gone.  I have tested it with a very bright LED in the living room in the evening and with other bright indoor lights and there is no longer any sign of it.  It took about 2 weeks to disappear.  I hope the one in the left eye does the same.  On the first page of this forum and 3 posts below tipster42 has written about the same problem, along with a hyperopic condition.  His doctor just put him on Econopred Plus steroid to treat his inflammation.  I was put on E+ for 4 weeks right from the start.  E+, along with Pred Forte, are both 1% steroids and I think the strongest used after cataract surgery.  I also have a slight amount of starburst in both eyes now, but only about 1/8 the diameter as with the cataract.  I wonder is these various conditions are caused by post surgery inflammation and one of the stronger steroids are beneficial.  I will probably wait longer than 1 month to decide if YAG is necessary, especially since the streaks seems to be gone in the right eye.

On a side note, I tried that pinhole thing posted above by sdduchman and I think I can see what he is talking about.  I did not look at the sky, but at a sheet of white paper with the sun shining on it.  Looking through the pinhole, I could see a dim circular object in the center of the pinhole.  With the right eye, there was no pattern in the object.  Using the left eye, I saw 3 or 4 vertical streaks in the object, exactly 90 deg to the direction of the streaks.  I also saw 2 or 3 very small dark dots that move in the direction that I moved my eye.  I am assuming that these might the creases and the dots are some original lens particles remaining in the capsular bag.  I'm trying to figure out how that little trick works.

[aimee37]

I had my right eye done on 1/8/2007 and the left eye on 1/17/2007.  I have a lazy eye so I couldn't realy even make out the big letter E on the chart with my left eye.  That was not expected to change and did not but I need the lense to be clear so I can detect motion on that side for safety sake.  I noticed the jets of light coming from light sources shortly after the surgery but thought it was normal and would go away.

Icanseenow,
Thank you for the lead on the artical "http://www.iovs.org/cgi/reprint/37/5/906.pdf".

I started try and figure out how I could see my own eye, shortly after the second surgery.  I what looks close to picture b on the second page of the article.  I appears the two crease are caused by the stress put on the capsule by the supporting loops of the IOL.

I now believe this may not be an uncommon condition after the surgery but not one we are told about.

I am now faced with the decision to live with the streak or have an additional expensive and risky surgery to fix the crease.

Since I only have one good eye I am going to another eye clinic for a consult and second opinion on the 8th of March.

The article seems to indicate I have a 30% chance of needing additonal correction in the future anyway.

[aimee37]

I was told by my surgeon that the crease could be fixed by a standard YAG laser capsulotomy if the streaks didn't go away. That is a low risk procedure. I haven't read that entire article yet. I'll read it tomorrow.

[aimee37]

My short post yesterday was because I was using a small internet tablet and using a stylus to type on a little touch keyboard.  The 30% chance of needing an additional procedure (YAG laser capsulotomy) after cataract surgery is about what I have read elsewhere.  My surgeon put it at 25%.  It can be needed anywhere from a couple of months to several years after surgery.  The article said that it is an expensive procedure, but my surgeon said that he does it at no additional cost if needed.  It only takes a few minutes and they seem to do a couple each day.  They do about 40 cataract surgeries per week.  That paper was written in 1995, so the procedure might be a lot simpler now.  I read in one article that the combined risk of complications of the original cataract surgery and the capsulotomy is less than 2%, or about double the risk of the original surgery alone.  Also, most of the complications are not serious and easily treated.  For instance, one of the complications is temporary increased IOP (intra-ocular pressure), which is treated by drops.  My streaks seem to be gone in the first eye and decreasing in the second eye with indoor bright lights, but I still have to see what happens the first time I have reason to drive at night.

[aimee37]

I saw my surgeon yesterday. he confirmed that I have a fold in both my left and right capsule, with the right being more intense. The issue now seems to me to be not that he really expects the folds to go away,but that he wants me to wait 90 days to give my eyes full time to heal. He indicated  it could be done sooner if I find it too difficult to live with. He also indicated it would be a simple procedure to resolve the problem with the laser surgery. He said that I must be senitive to light because the folds don't bother most people that much. I never considered myself senitive to light, but when I try to drive at night and see streaks of light across every headlight from the sky through across my dashboard, it is distracting. Also, at the same time there are straeks from every street lamp and other light source. I will try to wait as long as possible to heal from the cataract surgery, but in the meantime I won't be able to drive at night and the day glare I can tolerate, but is no picnic. I have an appointment to see him again in 6 weeks.

[aimee37]

I checked the progres of the creases through a pinhole yesterday for the first time in about a week.  I had seen little or no change in the two parallel creases in the last 6 weeks.  Yesterday when I looked however I saw that one of the creases had started to disipate so it now only crossed about 3/4 of my iris when it was open wide.  You need to look under dimm light and cover the other eye to open the iris as much as possible.  Today when I looked I saw very little of that same crease still visible.  The second crease still looks about the same.  I am encourage by the change I have final seen in the last two days though.  I am on a timeline as my medical insurance kicks in with a brand new $1000 deductible for the next year on April 1st.  My surgen is not as generous as yours and says there will be a charge.  Unless he is kidding but I do not think so.  Anyway I am still going in to the other doctor for the second opinion tomorrow. I can see some possible cell growth as describe in the article that I do not recall seeing so distictly previously.  It is hard to tell what may be cell growth or and what is just tears after you blink but the ripples in the tears move and disipate shortly after you blink.  The other distortions remain fixed each time you view them.  

If look through a pinhole to look at your eye.
The smaller the pinhole and the closer to your eye you hold it the more detail you will be able to see.
You will also be able to see you pupil change size as the lighing condition change.

CAUTION: take care not to touch the surface of your eye (the pinhole may be rough on the edges) especialy if your eye has not yet healed from surgery!

[aimee37]

I just got back from the 1 week follow-up with my optometrist.  She said that she can see vertical streaks on the posterior capsule of both eyes, but I don't see any light streaks in the right eye with bright indoor lights any longer.  I guess that means that I have tuned out the streaks in the right eye after about 2 weeks.  It appears that these creases are fairly common, but only those of us who are sensitive to bright lights notice the streaks of light.  I required the block for surgery because of this light sensitivity.  I am somewhat confused by the streaks that she sees and that I see with the pinhole.  They are vertical, but my light streaks are horizontal.  My IOL is also horizontal, with the haptics nose and ear side.  That paper shows that my creases should be horizontal.  Oh well, as long as my light streaks go away, I don't care which direction they run.

[aimee37]

Thank you both for your inputs.
I got my second opinion today and have decided to live with the creases and put off any risking more surgery to my only good eye.  When I asked about it the doctor confimed that any surgery done to remove part of the back of the capsule would make any additional lens surgery, if it were ever needed, much more difficult.  This is because the lens is the only thing now seperating the vitreous jelly from the rest of the eye.
At any rate as I have said the creases have recently shown some sigh of improvement.

Icanseenow
The vertical creases with horizontal streaks would be correct.  The streaks are at right angles to the creases.  Simulate a big streak by placing your eye close to a filled beer bottle (or any other fluid).  You can then understand how the lens effect of the crease work.

Maybe more information than you wanted to know.

Anyway thank you both again for the time you have taken to share your thoughts.

Sincerly,
Corry

[aimee37]

I found an interesting article at www.answers.com/topic/laser-posterior-capulotomy that was helpful to me in understanding both the problem and the treatment. I hope it will be of some help to you also. Unless my vision improves before my next re-check, I will probably have the YAG because the glare is such a big problem in driving for me.

[aimee37]

lightbug good luck with your eyes and the YAG if you decide to do it.  Thank you for the information on the article.  I went to see my optomotrist to get a perscription for trifocals.  The exam went well and raised some questions which promted me to do some more research in how eyes are examined.  I thought this article had a pretty good summery as well as hints on some self exams

http://www.lhup.edu/~dsimanek/scenario/labman3/eye.htm

This link also is a good source for an eye charts ect.

http://www.i-see.org/eyecharts.html#make-your-own