What is a Capsulotomy?

Weeks to years after cataract surgery, some people notice their vision in the operated eye becomes cloudy. This is because of changes in a membrane known as the posterior capsule. The natural lens of the eye is surrounded by a layer known as the lens capsule. You can think of this as a type of human clear wrap like Saran Wrap.  During the surgery the centre front portion of this capsule is removed by the surgeon but the rest is left in place as this diminishes surgical complications. Sometimes the remaining portion of the capsule behind your implant becomes cloudy or wrinkled and therefore what you see is blurred or cloudy. Using a laser beam, this cloudy part can be opened so that your vision is restored to what it was not long after the cataract surgery.

 

The procedure itself takes less than a minute and you will not feel anything. You will be in the office for around two hours as you require drops prior to the procedure and an eye pressure check after the procedure.

How is this procedure done?

  • You will be given numbing eye drops.

  • You will be positioned comfortably at the laser. The laser machine looks similar to the examination microscope your doctor uses to examine your eyes at each visit. The laser itself makes some noise and flashes a light as bright as the flash on a camera.

  • A band will be placed behind your head as a gentle reminder to keep you from moving backwards during the procedure.

  • The doctor will put a lens on the surface of your eye to be lasered. You are able to blink gently.

  • The doctor will position a green light in front of the other eye and you will be asked to look at that light throughout the procedure.

  • The laser will then be used to open the posterior capsule.

  • Following the procedure, you will receive more pressure lowering drops and anti-inflammatory drops.

  • You will be asked to wait 45 minutes after your procedure for a pressure check. You will receive a prescription for your post op drops at this time and if you wish, you can use the time to purchase your drops at the pharmacy.

Risks of Posterior Capsulotomy

  1. Retinal tear or retinal detachment: There is a very small risk of retinal tear following this procedure.  Untreated, a retinal tear can lead to a retinal detachment. The symptoms of a retinal tear are flashing lights and new floaters. A few floaters are normal after this procedure. If you have flashing lights with new floaters or a curtain over the vision on the evening after your procedure, please come into our office by 9:30 am the following morning. There is no need to call and book an appointment.  We will assess you and if there is a retinal tear you will be sent to the retina specialist for a retinal laser treatment. If you develop this problem on a weekend, you will need to go to the emergency room at Sunnybrook, St. Michael's or the Toronto Western Hospital.
     

  2. Sudden increase in eye pressure:  Alphagan eye drops are used before the procedure to prevent a pressure rise. If your pressure does rise you will be sent home with pressure lowering eye drops to be used for a few days.
     

  3. Swelling in the back of the eye (macular edema): There is a very small risk of macular edema following this procedure. This can occur between 3 weeks to a year after the procedure and can cause worsening of the vision. This condition usually resolves with a six week course of eyedrops, but may require an injection and  sometimes there is a permanent decrease in vision.
     

  4. Inflammation: All patients are given an anti-inflammatory steroid eye drop to use for four days including the day of the procedure.
     

  5. Backwards movement of the implant through the opening: The opening is made relatively small to prevent this as well as to diminish the risk of retina complications.

     

     

     

     

     

     

     

     

     

Posterior Capsulotomy FAQ

  • Does the laser hurt?
    This procedure is completely painless

 

  • How long will I be in the office?
    On average you will be in the office for 90 minutes to 2 hours. Your pre-op eye drops must take effect and your pressure needs to be checked 45 minutes after your procedure.
     

  • Can I drive to the procedure?
    It is best not to drive yourself to this procedure.
     

  • I am very nervous. Is it possible for me take something to help me stay calm during this procedure?
    If you are extremely anxious, we can give you a prescription for Ativan to use prior to the procedure.
     

  • Do I need any medicine after this?
    You will be given a prescription for an anti inflammatory steroid eye drop.
     

  • What kind of follow up do I need?
    You will be seen one week following the procedure at our office. Before leaving the office on the day of the surgery, book a follow up appointment to see Dr. Goldberg/ Dr. Hinton. 
     

  • Is this procedure covered by OHIP?
    Yes, laser capsulotomy is covered by OHIP.
     

  • How long will it take until I see better?
    Most people see better within 24 hours. You may require an eye glass prescription update in order to maximize your vision.

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Suite 810

Toronto ON

M4S 1Y2

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Fax: (416)482-0831

 

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