Can cataracts return after surgery? Lens capsule haze - A State of Sight #2

Isaac Porter, MD from Lowry Porter Ophthalmology explains that although cataracts cannot return, a patient's lens capsule can become cloudy after surgery (posterior capsular opacification). This can be cleared with a laser procedure called a yag capsulotomy.

Welcome to A State of Sight, I’m your host, Isaac Porter from Lowry Porter Ophthalmology and this is your update in ophthalmology and eye care. On our last edition on A State of Sight, we covered some of the basics of cataracts and cataract surgery. In this edition, we will answer the question “Can cataracts come back after they are removed with surgery?”

This is one of the most common questions that my patients ask after they have cataract surgery and the answer is no, the cataracts can not come back. However, in the area where the lens implant is there can be a clouding of the lens capsule that can interfere with the vision, similar to the cataract that was there before.

To understand this better, let’s take a look at a diagram of the eye and see where the cataract sits inside the eye. The cornea is the clear shield that covers the front of the eye, and behind that is the iris then the natural lens. Remember, when this lens becomes cloudy that is what we call the cataract.

At the time of surgery, we will break up and remove the cataract but leave the bag or the capsule that surrounds the cataract holding it in place. We will use that bag to hold the lens implant in a natural position, similar to the position that the cataract was to begin with.

As time goes by, that bag often becomes cloudy. Estimates show that between 10 - 30% of patients will notice this. There have been advances in lens technology and in surgical technique to try to decrease this occurrence, however it still happens. This is due to cells clouding the back of that capsule or bag.

The good news is that this can be treated much more easily than the original cataract surgery. We can treat this in the office using this YAG laser with a medical procedure called a YAG capsulotomy.

For this procedure, we will dilate the patient’s eye and have them sit at the microscope with their chin and forehead touching the microscope. This is similar to the slit lamp that we use to examine the eye in the office, however, this one is special because it has a laser built into it.

We will use a special contact lens on the patient’s eye after numbing their eye and have the patient look at a target light. Meanwhile, I use the laser to create an opening in the bag to remove the cloudy area. Once this is finished, there is nothing in the area besides the new lens implant, which is now clear from the front through to the back.

Afterwards, patients go home and use drops usually about a week before they will return for a follow up appointment where we will check their vision and prescription and hope to see an improvement in their vision.

Thank you very much for joining us on A State of Sight, again, we hope to have a discussion on Twitter and Facebook. Until next time, good health and good sight.