Post Cataract Surgery: flickering and light streaks

That’s a good point. It may not make sense to have the yag laser treatment unless you get pco as well.

I’m sure you’ve come across this article, but just in case you haven’t, i thought I’d share here.

crstoday.com/articles/may-2021/when-to-yag-and-when-not-to

It seems like most articles list 6-8 weeks as the minimum amount to time to wait for yag treatment (for wrinkles in the capsular bag), but 90 days seems to be a little more prudent.

I had a follow up visit with my ophthalmologist a couple of days ago. She confirmed the wrinkle in my capsular bag, and she seemed to be very confident that the wrinkle was causing the light streak. Her recommendation was to wait for our 1 month post op visit before considering treatment with the yag laser.

Similar to you, I’ll likely take a conservative approach and see if it resolves on its own. If I decide to have the yag, I’ll provide an update.

Thanks mdjones for the update. Likewise, I will keep you in the loop if I decide to do the Yag but I will give it at least another month or two before making an appointment with the surgeon or another surgeon. As someone who has had retinal issues - holes and tears - in the past, I may be too reluctant to do the Yag until my vision is adversely affected by PCO which, in many cases, is just a matter of time after cataract surgery.

I read on one of the threads that someone's halos/light streaks etc took 5 months to self-correct. I don't know if that's likely with capsular wrinkles as often those halos, streaks etc are not due to capsular wrinkles.

Here's an interesting video on youtube titled "I see a line of light through my lens implant!" , showing the Yag used successfully on a person's capsular wrinkle. It gives one some hope. Best regards,

Hi Elliott,

I learned today that I developed a wrinkle or fold following cataract surgery 10 days ago. My lens is a Tecnis toric monofocal. I noticed the light streak the first day post surgery but initially thought it was astigmatism. I share your thoughts and concerns. I am reluctant to pursue the yag laser treatment due to the known risks, which seem to outweigh the benefits.
How are you doing? I hope your wrinkle self corrected. If not, have you come to a decision about how to treat or notice the problem less with the passage of time?

Thank you for sharing the results of your online research. I'm surprised there is so little about this condition. I follow two Facebook groups and a few members reported wrinkles or folds. None mentioned having yag as yet.

Hi Tillymack

Coincidentally, I just had an appointment with my cataract surgeon this morning. It has been 3 months since the surgery on my right eye (and I had my left done 3 weeks after the right).

My surgeon confirmed what my opthalmologist told me: the straight line at a 45 degree angle was due to a fold in the capsule and that the Yag laser can be used to correct the situation. (I also have a minor glare issue on the left eye but that doesn't really bother me).

As you may know, cataract surgeons use the Yag laser to address a very common complication that occurs in about 50% of cataract surgery patients within 5 years of surgery - posterior capsular opacification (pco).

While my surgeon offered to do the 5 minute Yag procedure this morning, I decided to postpone it for a later date being concerned about potential complications given my eye history which has included retinal tears/holes.

My surgeon acknowledged the potential complications; however, he also stated that they are rare. But he also stated that I might minimize the risk by waiting an additional few months, although he did say that 3 months is generally an adequate time and that they have used the Yag one month out from surgery.

I think it's only a matter of time that I will probably wind up with pco, particularly given the type of cataract I had in that left eye (posterior sub capsular) so I think the YAG will be in my future anyway. I just wasn't prepared to go ahead today and may even wait until pco affects my vision which is currently excellent.

I don't think the wrinkle and 'light' issue will self-correct as it has been three months (but I forgot to ask the surgeon that).
While it has not got any better, I believe I have become more accepting of it. If I decide to go ahead with Yag within the next few months, I will let you know.

By the way, if I didn't mention it in my previous submissions on this site, there are two cases I came across on my internet search dealing the Maddox rod effect that you can google:

"Waterfront aberrations causing Maddox rod effect from posterior capsular striae" - (could only get the first page)

"Posterior capsular folds creating a Maddox rod effect following cataract surgery"

All the best,

Elliott

Hi Elliott,
Thanks for keeping me in the loop. I read the 2 articles you mentioned and watched the video clip. It looks so easy. Wish we could follow up with the patient! Like you, I requested to wait and see if there’s any improvement without the yag treatment. Doing some research online, I met someone on FB who found the light streaks much less bothersome after 7 months! Are you bothered a great deal by the light streaks? In my experience and lifestyle, I see them mostly outside when walking my dog after dark (street lights, car head lights, garage lights) or inside if I choose to look up at light fixtures mounted in the ceiling.
Here are a couple of articles that might be of interest:
Surgical management of positive dysphotopsia: U.S. perspective
Journal of Cataract & Refractive Surgery 46(11):p 1474-1479, November 2020. | DOI: 10.1097/j.jcrs.0000000000000307
PCO: What’s Wrong with Doing a YAG? Review of Ophthalmology 10 MAY 2018
There are also worrisome YouTube videos from Germany by Karl Brasse showing yag treatment gone wrong and possible corrective measures that could be taken.
Best wishes, Judy

Thanks Judy for the reply. In reply to your question, while the light streak from the wrinkle in the capsule does bother me, I seem to becoming more accepting of it and that's why I decided not to take the Yag laser yesterday on my appointment with my surgeon.

I am focusing more on the positive in that I have excellent vision otherwise and, despite my history of retinal holes/tears (lattice degeneration and myopia), the light streak is a relatively minor (and apparently repairable) issue in the scheme of what can go wrong with cataract surgery.

As I mentioned in my previous post, in response to my concern about potential complications from the YAG, my surgeon suggested it may be reduced if I hold off doing the YAG for a few more months since it has only been 3 months since the surgery on my right eye. A high percentage of cataract surgery patients will inevitably have to have the YAG anyway if they develop the very common PCO complication.

I also recall in that article that I mentioned in a previous posting 'Potential issues after cataract surgery' that Dr. Tipperman noted that while the YAG is effective in the repair of a capsular wrinkle, he also seemed to suggest or state that the YAG may make the situation worse if someone has glare and streaks in all directions due to some other reason (presumably the IOL) but best to refer you to that article for clarity on that point.
Best wishes,
Elliott

Did your yag treatment successfully remove the membrane? Hopefully yes! If not, are the streaks becoming less problematic?