Posterior Capsular Opacification (PCO) and YAG Laser Capsulotomy

About posterior capsular opacification (PCO)

After cataract surgery, nearly 1 out of 10 patients have thickening of the back of the lens capsule which holds their artificial lens implant in place. This is called posterior capsule opacification or PCO.

PCO decreases the amount of light travelling through to the retina. The retina is the light sensitive layer of the back of the eye that allows you to see.

This decrease of light results in your vision becoming blurred. It can also make it difficult for you to see in conditions of bright light.

If you have PCO that affects your vision, your doctor may recommend laser treatment to help clear it.

Treatment for PCO

We treat PCO using a type of laser called YAG laser. YAG laser is a beam of focused light that can be targeted accurately.

• In patients with PCO, we direct the laser at the thickened capsule behind the lens implant.
• The YAG laser delicately cuts a hole through the capsule without affecting other parts of the eye behind or in front of the capsule. This procedure is called a capsulotomy. Making this hole in the capsule improves the patient’s vision by allowing more light to pass directly to their retina.

During YAG laser treatment

The laser treatment usually takes a few minutes.

• We use eye drops to dilate (widen) your pupil before the treatment. This can make your vision blurry for a few hours. We may also use anaesthetic drops to numb the front of your eye so you do not feel any discomfort.
• We ask you to place your head on the headrest of the laser machine.
• The doctor may use a contact lens to help keep your eye in the correct position and to help us to focus the laser.
• The doctor activates the laser and uses a series of laser pulses to make the hole in the centre of the capsule behind your laser implant. Each laser pulse lasts a fraction of a second.
• During this time you may see flashing lights or hear some clicks from the laser machine. You are unlikely to feel any pain from the laser itself.
• Your eye may be a little sore afterwards but this will soon wear off.

Risks involved with laser treatment

We consider the laser procedure to be safe.

Serious complications are possible but these are rare.  For example, the laser can cause the following:

• detachment of the nerve layer at the back of the eye (retinal detachment)
• swelling of the centre of the retina (macular oedema).

Most people experience significant improvement in their vision after having laser treatment, and do not experience problems.

After YAG laser treatment 

You can expect the following after your laser treatment.

• Most patients notice an improvement immediately or shortly after the treatment.
• Some patients need a short course of steroid eye drops after their laser treatment.
• Occasionally the doctor may ask a patient to stay in the department for a few hours after laser treatment, so that we can check your eye pressure. If your eye pressure is high, we will give you extra drops to lower the pressure.
• It may take a few days for your sight to fully recover.
• Your vision is likely to be restored to the level you had following your cataract surgery unless you have another eye condition affecting your sight. You will still have to use your glasses as before.
• Laser treatment does not require any cuts of stitches, so you are likely to be able to return to your daily activities straight away. Patients do not usually need a follow up appointment.

Floaters

• Floaters are harmless clumps of debris from the capsule that move around and may be seen as dots, circles, lines, clouds or cobwebs.
• You may notice a few ‘floaters’ shortly after the treatment.
• Floaters usually go away or become less noticeable over a few days or weeks. Some floaters persist but they do not usually affect the vision

Problems after laser treatment

Get in touch with your nearest eye emergency service immediately if you experience any of the following after your laser treatment:

• rapid loss of vision
• a dense cloud moving inwards from the edge of your vision
• multiple new floaters
• brief flashing lights.

Emergency help, hours of operation and referral system

Kingston Hospital Eye Casualty, Galsworthy Road, KT2 7QB

8.30am to 4.30 pm (last appointment at 4pm).

Closed on weekends and bank holidays.

Booked appointments only.  Call to book on 020 8934 6799.

Western Eye Hospital Emergency Department, 153 Marylebone Rd, London NW1 5QH

8am to 8.30pm, every day.

Walk in service, no referral required.

020 3312 6666.

Moorfields Eye Hospital, 162 City Road, London EC1V 2PD

24 hours a day, every day.

Walk in service, no referral required.

020 7566 2345 or 020 7253 3411.

Moorfields Eye Clinic at St George’s Hospital,Tooting, London SW17 0QT

4.30pm to 8.30pm on weekdays, 24 hours on weekends.

Referral via an emergency GP or booked appointment required.
Call to book on 020 7702 5542.