yag laser doubts

[ledbrv]

On february 18th I had a cataract surgery on my RE. Everything was perfect but in less than a month my RE developed a PCO.
Yesterday (11/30), my doctor and I agreed that I should do a yag laser capsulotomy.
My far vision is not so bad, but the RE near vision is very bad (and yes, it was much better after surgery).
I read a lot and work with computers so I a good near vision is important to me.
I have schedule the yag laser procedure on 12/15, so I will do this procedure in about 10 months from my cataract surgery. As i read on many posts, 10 months past the cataract surgery is considered safe for the yag laser, right ?
Also I learned here at medhelp that yag laser is a very safe procedure, but has its risks, retinal detachment is one of them. I also learned that retinal detachment risk is higher on high myopic eyes, but I wonder what is considered high myopic. My RE is now plano, but I had -5 of myopia before cataract surgery, so my RE is a myopic eye corrected by an IOL. Is -5 of myopia considered high myopia ? I had my retina examined twice this year with no sign of tears.
Thanks in advance for any comment.

[Saskanuck]

I am a 50 year old woman who has had cataract surgery on both eyes.  left eye was -20, rt eye was -16.  The rt eye was done June 15th, and I have a secondary cataract already.  My retinal ophth did both surgeries and he now says I need the YAG laser procedure on the rt eye, to be done Oct 9th.  I went to my optometrist to be fitted for glasses, and she recommends that I not get the procedure because she can correct me to 20/25 in that eye.  I had a bleed in my left eye 2 mos after the first cataract surgery in Dec 2011, and I have myopic macular degeneration and subsequent hemorrhages.  My eyes were stable for many years until the cataract surgery.

So I am now scared to get the YAG procedure because of the risk of retinal detachment and what my optometrist has said.  What would you do in my case?  I know I will need it eventually, but is there a benefit to waiting longer for the YAG, or should I go ahead with the October date?

[cecilia436]

Hi, Dr. John

Thanks so much for taking your time to answer my questions. It was really helpful.

Many thanks
cecilia

[John C Hagan III, MD, FACS, FAAO]

Even though much of your myopia was corrected by lasik and IOL insertion you still are at high risk due to the long eye and having had surgery. Nevertheless the risk is still relatively small.

This is how I handle cases like yours. I refer them to a retinal specialist Eye MD and tell them I plan on doing a yag capsulotomy and ask them to check the retina to see if there are any holes, tears, or thin areas that need treatment with laser or freezing (cryo) prior to the Yag. I also ask for a second opinion about doing the yag capsulotomy.

If any areas need treated they are treated and the retina MD tells me when I can do the laser. If there are no areas that need treatment the retina eye MD almost always tells me he/she agrees with doing the yag capsulotomy and that the patient understands the increased risk of RD.

Then I have the patient see the retina MD again about 7-10 days post laser for a repeat dilated retina exam. It has worked very well over the years with very few RDs.

JCH MD

[cecilia436]

Hi, Dr John,

I have PCO on my right eye. I had cataract surgery 2.5 years ago. A LASIK surgery eliminated most of high myopia in 1999 (around -12 diopters). I went to the doctor's and he told me I should do Yag laser capsulotomy, but I'm really concerned about it, because another doctor had told me I shouldn't, because I'm at a high risk and because this opacification has already stabilized, stopped. My vision is very poor now. Can opacification get any worse over the years? Should I have the yag capsulotomy or is it a loop (yag - retinal detachment-floaters-vitrectomy, and so on)?
thank you very much.
cecilia

[tomfar]

I had catarac surgery in both eyes the week of Thankgiving when i was visiting my son in California. The surgeon told me i needed a Yag laser in my left eye when i returned home. the right eye had streaks going thru all on comming headlights which was very annoying. I waited about 4 months before i found a doctor to check me. I contacted the surgeon in Cal and he told me a Yag laser would eliminate the streak problem. I had the Yag done in both eyes these past 2 weeks, yesterday i had the eye that had no streaks done and now today i have streaks in that eye, and the eye that had streaks after surgery still has the streaks after the Yag. My thoughs are be careful when you deside to have Yag laser. Did anyone have this experence after having a Yag?

[John C Hagan III, MD, FACS, FAAO]

Yes, it is much less likely to bother you a month from now, even a week from now.

Yes AL means axial length.  

JCH MD

[ledbrv]

I had the Yag laser capsulotomy done on my OD yesterday evening. As you said it was quick and painless. So far, about 24 hours after the procedure, the result is pretty good. I would say that my OD vision now is about 95% it was right after cataract surgery. Images now are much more clear, I also notice a improvement on contrast and colors. Reading and work with computers is also much easier now. The only complaint I could do is a little glare at night when I look at car headlights and similar light sources, but it is a minor issue. I wonder if the result could improve even more after a few days, but in resume, so far I am very satisfied with the procedure outcome.

By the way, If I understood right the IOLMaster biometry I did before surgery, my OD axial length is 26.80mm. On the IOLMaster reports there is this line "AL: 26.80mm (SD=0,03mm, SNR=241,5)". Here "AL" stands for Axial Length, right ?

Thanks in advance for your clarifications.

[ledbrv]

Hi Dr. John,

After answering so many questions of course it is expected that you forget one question or another. I should have mentioned that you told me early this year that yag laser is very safe (if I am not wrong you expressions was "yag laser is soooo sweeet!!"). So, once again thank you for your comments.

About the high myopic question, I can say that I am at the beginning of the high myopic range, right ?
Well, it has passed 10 months from my surgery, my doctor did not see any problems, my surgery recovery was very good, and this PCO is disturbing a lot my near vision, and my far vision could be better, like it was right after surgery, driving at night for exemplo, although possible, is not comfortable, so I will take my chances with the yag laser. I will post here the results.

Again, thank you for your comments.

[John C Hagan III, MD, FACS, FAAO]

Yag laser capsulotomy is the safest, quickest, most pain free and very inexpensive treatment most eye surgeons do. Like driving an automobile it is not risk free.

Most doctors would say high myopia is greater than about -4 to -6 myopia.

JCH MD