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After-Cataract” Surgery with a Laser

(Laser Capsulotomy)

Lasers are devices of modern technology capable of producing high-energy light beams that can be used for some types of surgery. There are also low-energy lasers that have many other practical uses-from measuring the visual acuity of patients with cataracts to reading bar code labels at grocery checkout counters.

Each type of laser is named for the substance used to create its light energy. Those used for treating eye problems derive their power from argon, helium, neon, carbon dioxide, krypton, ruby, yttrium-aluminum-garnet (YAG) or other sources. Each one creates a different color light beam, which affects different eye tissues in different ways. No one laser can be used for every purpose.

Lasers and Eye Surgery

Lasers offer significant advantages in many types of eye surgery. Light can be focused precisely on extremely tiny structures and it can make much finer surgical cuts than are possible with a scalpel. Often, no incision on the eye is necessary, so laser surgery minimizes the risk of ocular infection and the problems related to wound healing. Most laser surgery is painless.

The YAG Laser and Cataract Membranes

Cataract surgery (removal of the cloudy lens) always involves a surgical incision into the eye. When the surgery is done by the method called “extra-capsular,” the back part of the “capsule” (the clear membrane that encloses the lens) is left in its normal position. This capsule is used for holding the implant (IOL) that is inserted during most cataract operations that are performed.

Whether or not an implant is used, the capsule can later (many weeks or months after the surgery) become cloudy and cause blurry or poor vision; it is then called an after-cataract (or secondary cataract membrane, or capsular membrane). This cloudy membrane can be opened by laser treatment.

To cut tissue, laser energy needs to be absorbed by the tissue. Usually this depends on the type and degree of its pigmentation. The powerful YAG laser, which can vaporize clear tissue, is used for making the small cut in the capsule membrane that permits you to see clearly again. This operation is known as a posterior capsulotomy. Prior to the development of the YAG laser, it was necessary to insert a tiny knife into the eye to open the cloudy membrane. Even now, this sometimes needs to be done.

How is Laser Surgery Performed?

Laser surgery is convenient.  It may be done either in the doctor’s office or in the outpatient eye department of the hospital or clinic, and does not require hospitalization or general anesthesia.

You’ll be comfortably seated in front of a laser instrument. It is important to stay calm and not move during the treatment, so you may be steadied by the doctor’s assistant.  Sometimes a local anesthetic is injected behind the eye to keep it from moving during the treatment. 

The doctor directs the laser beam by looking through the slit lamp (clinical microscope) at the area being treated.  Each time the laser is “fired,” you’ll see a flash of colored light and hear a quick tapping sound.  A gonioscope (a special type of contact lens with built-in mirrors) may be held on the eye so the beam can be focused more accurately.  Following the treatment, your eye pressure may be checked, since the pressure sometimes increases temporarily after surgery.  You may need to use eye drops until the pressure returns to normal.

Risks and Prognosis

Surgery of any type involves some risk, and this includes laser surgery.  A laser is “strong medicine” that can do harm as well as good.  A result that is considered successful means that a clear opening has been created but it does not always mean improvement in vision.  There’s also the possibility of only a temporary or partial benefit, or very rarely, an actual worsening.

The chance of obtaining a successful result must always be weighed against the risks, and for capsulotomy, the chance for success is good.