Eye drops
Anaesthetic eye drops and dilating eye drops are put in. Allow about twenty minutes for the pupil to dilate.
Home / Cataract / Secondary cataract
Secondary cataract
and the YAG laser
A few months or a few years after cataract surgery, vision can become hazy again. The cataract has not come back: the natural lens was removed and does not grow back. What has thickened is the thin membrane that holds the implant. A laser session lasting a few minutes is enough to put it right.
20 to 30%Of operated eyes
A few minutesLength of the session
At the practiceNo operating theatre, no incision
PermanentA single session per eye
Understanding
A membrane that clouds over, not a cataract that comes back.
The term ‘secondary cataract’ is misleading. It comes from the similarity of the symptoms, not from the mechanism.
During cataract surgery, the clouded natural lens is removed, but the envelope that held it (a very thin bag called the capsule) is kept. It is the capsule that receives the implant and holds it in place, exactly where the natural lens used to be. Keeping it is essential: it makes the operation safer and the result more stable.
In 20 to 30% of patients, a few cells left on this capsule multiply over time and migrate behind the implant. The membrane thickens, wrinkles and loses its transparency. The exact medical term is posterior capsule opacification, or capsular fibrosis.
It is not really a complication, but a natural and expected stage in the healing of the inside of the eye. It can appear a few months or several years after the operation, and how often it occurs depends on age, the type of implant and any tendency to inflammation.
The cataract has not come back.
The natural lens has been removed for good: it cannot cloud over again. Only the membrane behind the implant is involved, and treating it has nothing to do with a second cataract operation.
After cataract surgery, if vision becomes hazy again
The implant has replaced the natural lens. The thin membrane that holds it, the capsule, was kept during the operation and stays clear.
Months or years later, this capsule can thicken behind the implant and become cloudy. Vision becomes hazy again, gradually. The implant itself is not at fault and stays in place.
A laser opens a window in the centre of the capsule, during a consultation, with no incision and no anaesthesia other than eye drops. Light passes freely again. The procedure does not need repeating.
Incoming rays Point of focus Scattered light Clouded capsule Laser opening
Symptoms
The same signs as cataract.
It is precisely this similarity that gave capsular fibrosis its misleading name. It comes on gradually, often over several months, which makes it all the harder to notice.
Hazy vision
A constant feeling of fog, as if looking through frosted glass.
Reduced acuity
Vision deteriorates, when it was sharp after the operation.
Halos and glare
Particularly troublesome at night and when driving.
Reduced contrast
Colours look dull and shades are hard to tell apart.
Discomfort in bright light
Full sunlight becomes uncomfortable, and vision worsens in it.
Difficulty reading
You need more light, and your eyes tire sooner when reading.
Indications
When should it be treated?
There is no medical treatment for capsular fibrosis: no eye drops, no supplement and no change of glasses will make the capsule clear again. The only solution is the YAG laser. But it is not called for at the first sign.
What points towards treatment
- The real impact on your daily life: driving, reading, screens, recognising faces.
- A drop in visual acuity measured during the consultation, consistent with the appearance of the capsule.
- Halos or glare that limit your activities.
- The need for a clear view of the retina in order to monitor another condition.
What suggests waiting
- Early clouding that does not interfere with your daily activities: monitoring alone is enough.
- An eye operated on recently, in which inflammation and refraction have not yet settled.
- An implant that is not yet securely fixed in the capsular bag.
- A drop in vision that could have another explanation: AMD (age-related macular degeneration), glaucoma, a corneal problem. In that case the laser would correct nothing.
The YAG laser is irreversible.
Once the capsule has been opened, there is no going back. That is why the procedure is not done at the slightest discomfort, nor too soon after cataract surgery: the eye first needs to settle, the refraction to stabilise and the implant to be firmly fixed in the capsular bag. This caution is not a precaution for its own sake. Laser treatment done too early carries a risk of the implant shifting, prolonged inflammation or retinal oedema (swelling of the retina).
The session
A consultation, not an operation.
Unlike cataract surgery, which takes place in the operating theatre at Clinique Les Martinets, YAG laser capsulotomy is done at the practice, during an ordinary consultation. You are seated, as for a slit-lamp examination.
At the slit lamp
You are seated, with your chin and forehead resting on the supports. A contact lens is sometimes placed on the eye to steady your gaze and focus the laser. You need to keep still for the whole procedure.
The capsulotomy
Short, tightly focused laser pulses cut a circular opening in the centre of the capsule, behind the implant, which the laser leaves intact. No incision is made. The procedure is painless: what you mostly notice is a dazzling light and small clicks, one for each pulse.
Check
Anti-inflammatory eye drops are put in, and the intraocular pressure is checked. No dressing is needed. One session per eye is enough; the two eyes are treated about a week apart.
After the session
What to expect when you leave.
Recovery is not painful, and vision usually improves quickly, within a few hours to a few days. You get back the acuity you had after your cataract operation.
In the hours that follow
- Blurred vision: caused by the dilated pupil and the glare of the lamp, it clears within a few hours.
- Do not drive: come with someone, or plan to take a taxi or public transport home.
- Sensitivity to light: sunglasses are useful on the way home.
Keep using the prescribed eye drops for the time indicated, usually one week.
In the days that follow
- Floaters: seeing moving spots or threads is common. They are microscopic fragments of capsule released inside the eye, and they clear within a few days.
- Mild irritation: temporary and harmless.
- Glare: some discomfort in bright light may persist for a short time.
- Temporary rise in intraocular pressure: usually prevented with pressure-lowering eye drops, and checked after the procedure.
The fee is shown on the fees page.
Risks
A well-established procedure, but not a trivial one.
YAG laser capsulotomy is one of the most routine procedures in ophthalmology, and its complications are rare. They can nevertheless occur, even when every precaution has been taken and the decision to treat was correctly made.
- Persistent rise in intraocular pressure: requiring pressure-lowering treatment, or even longer monitoring in patients with glaucoma.
- Macular oedema: inflammation of the centre of the retina, treated with eye drops, which causes a delayed drop in vision.
- Posterior vitreous detachment, retinal tear or retinal detachment: more common in people with high myopia, they require an urgent consultation.
- Marks on the implant: fine marks can appear on its surface. Most of the time they have no effect on vision; displacement of the implant is extremely rare.
- Persistent floaters: lasting beyond a few weeks, when they usually clear within a few days.
- Opening too small: this is rare, and may call for a second, top-up session.
Seek medical advice straight away if any of these signs appear
The best way to limit the consequences of a complication is to catch it early. These symptoms should always be treated as abnormal when they appear some time after the procedure.
- A sudden increase in floaters, or a shower of black spots.
- Flashes of light or zigzag streaks, especially at the edge of your vision.
- A sudden drop in vision, or loss of part of your field of vision.
- A veil appearing, or vision that becomes blurred again.
- Distorted images, straight lines that look wavy.
- Eye pain or redness that does not go away.
SFO information leaflets (in French)
These leaflets are published by the Société Française d'Ophtalmologie (French Society of Ophthalmology) and the Syndicat National des Ophtalmologistes de France (French national union of ophthalmologists). They describe the procedure, its results, its risks and the consequences of declining treatment. They serve as the basis for informed consent, but do not replace the consultation.
Frequently asked questions
What I am asked most often.
- Does it hurt?
- No. The procedure is done under anaesthetic eye drops and is painless. What you mostly notice is the light of the laser and small clicks, which can be surprising the first time.
- Do I need to fast?
- No. This is a consultation, not a surgical operation. Eat as usual and take your usual medication.
- How long does the session take?
- The laser itself takes a few minutes. Allow about an hour at the practice, though, for the pupil to dilate and for the pressure to be checked after the procedure.
- Will I need time off work?
- No, apart from the half-day of the procedure: vision stays blurred for a few hours because of the dilation, and driving is not advised.
- Can it come back?
- No. The opening made in the capsule is permanent: it does not close up. Secondary cataract is treated only once per eye.
- Will I get all my vision back?
- In principle, you get back the acuity you had after cataract surgery. If another condition has developed in the meantime (AMD, glaucoma), it will limit the result; the examination beforehand makes it possible to anticipate this.
- Both eyes on the same day?
- No. They are treated about a week apart, so that we can check the first eye has tolerated the treatment well.
- Is it covered?
- YAG laser capsulotomy is a procedure covered by French national health insurance (Assurance Maladie). The details are explained to you during the consultation.
Has your vision become hazy after cataract surgery?
A slit-lamp examination is enough to tell capsular fibrosis apart from another cause of reduced vision. It comes before any decision.
Dr Emmanuel Halimi
Ophthalmic surgeon · RPPS 10100555084 · Medical Council of Hauts-de-Seine no. 92/23003
Page written and approved by the surgeon.
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