Wrinkles in the Capsule (maddox rod effect?)

Hello,
I too had a fold in the bag. I had the light rays you speak of. If you can email me at jimmymel224@gmail.com it would be best to tell you my entire story by phone. It would be too much to type and proof read. It's a complicated story.
Jim from Pennsylvania

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?

I continue to experience the Maddox rod effect and notice increasing PCO. I'd be happy to chat with either Jimmy or Elliott to share what I have learned to date.

Hello Tillymack

Further to your message, here’s my experience with capsular wrinkles, the maddox rod effect, and the Yag laser. (Much of the below I probably noted in past postings but there may be others that might find this posting useful).

To summarize, I had cataract surgery on both eyes, three weeks apart, in March/April this year. I was happy with the visual acuity. I learned after the second surgery that the light streak I was experiencing at a 45 degree angle was due to wrinkles in my right eye capsule. I also had wrinkles in the left eye.

From on-line research I learned that the light streak was ‘on all fours’ with the maddox rod effect (subsequently confirmed). I was told at that time that if the light streak issue did not self correct within 3 months that the Yag Laser could be used to remove the wrinkle and the maddox rod effect. Although considered a very safe procedure, I was aware of rare adverse effects from the yag so I decided to wait until my vision was affected by pco.

In early July, I noticed a significant decrease in the vision in my right eye. My surgeon confirmed pco and, unknown to me, I also had a similar level of opacification in the left eye (that eye not fully corrected to provide me with ‘mini-monovision). I therefore had the Yag laser procedure on both eyes.

Other than the dilation and freezing drops, nothing else was put into my eyes for the yag procedure - painless and quick, probably less than a minute per eye.

I was told that they’ve used the Yag as little as one-month post surgery if someone develops pco that quickly but generally the risks, while rare, are generally even less the greater the time lapse after surgery with 3-months being kind of a ‘safer’ time marker according to what I read on-line.

If one develops pco where the vision becomes compromised after cataract surgery, then one has little choice but to have the yag as the opacification does not self-correct and will only get worse in time.

The Yag immediately (or within a day or two, can’t recall) returned my vision to 20/20 in my right eye and it did remove that maddox rod 45 degree angle light streak. However, the laser caused a new glare disturbance in both eyes: multiple thin light-streaking rays in different directions.

I was aware of the far more serious potential complications that can occur after yag procedures; nevertheless, these rare and unexpected light streaks were disappointing, less annoying than the maddox rod streak though.

It’s been two months since the Yag procedure and, while I don’t think there has been an improvement in the streaks, I don’t think about it much anymore. It’s not affecting my night driving or my life. I haven’t found much information about this issue other than some speculation that it may be due to hole size, their location, or possibly lens damage.

However, I just had an appointment with my optometrist who said the lens is fine and so is everything else. She thinks that this glare issue could be related to the preventative iris iridotomy surgery I had years ago which makes hole(s) in the iris that she said are close to the implant. I don’t plan on doing anything about it. I may see my surgeon in a year’s time just to see if he might know or confirm the cause or my own knowledge. (My surgeon told me after my yag procedure when he had a tech to a scan of my retina that I had an epiretinal membrane in my left eye. I subsequently learned that it was there prior to my cataract surgery; that it’s very mild and has been stable and it’s not on the macula so that was a big relief).

So, if you are experiencing pco and it’s affecting your vision, I think you have to consider the yag. If it hasn’t been 3 months since your surgery and you can still function fine with the decline in vision, you may want to wait until the 3-month mark to even reduce the rare risks even further but best to speak to your surgeon or ophthalmologist about that. If you trust and are happy with him/her, who is someone that is highly qualified in cataract surgery, then you probably best to stick with the same individual.

If the opacification is in both eyes, you can always request that they do one eye at a time and the other a month later if you're concerned about the laser. The surgeon will probably tell you as mine did that the yag is about the safest procedure they do - still if you fall in that rare instance of a serious adverse affect, that’s little comfort.

Another thing I read about the yag is that some rare but post-yag adverse consequences may not occur for months later (e.g retinal detachment).

I also read that the Yag can be used effectively to eliminate wrinkles but if the issue is glare, the yag can make the glare worse. That’s what I read in this attached article (potential issues after cataract surgery) which I may have sent earlier.

Best wishes. Let me know how it goes

Mark (Elliott)

Hi Mark,
That's lots of great news! So glad to hear it! Congratulations 🙂

I don't see a link to the article regarding potential issues after cataract surgery. Could you send to me again? Many thanks.

Hopefully, the link will now go through. (I'm not that good with technology). If not it was in eyeworld.org April 2023, an editorial where two cataract surgeons discuss 'potential issues after cataract surgery'.
https://www.eyeworld.org/2023/potential-issues-after-cataract-surgery/

Thanks very much for the link!
It's so helpful to have the details of your experience.
Re. The Yag immediately (or within a day or two, can’t recall) returned my vision to 20/20 in my right eye and it did remove that maddox rod 45 degree angle light streak.
Did the same thing happen to your left eye?

re "Did the same thing happen to your left eye?"

I hadn't noticed any opacification in my left eye but that may be because for the mini-monovision effect it was not fully corrected (it was set 1.25 diopters less). The mini-monovision effect allows me to use my computer, read my smart phone, and see very clearly without reading glasses. I do need reading glasses for smaller print but it's great to be glasses free and still see far distances at 20/20.

The Yag did create these thin light rays in that eye too but, as I noted previously, overall I don't find the light rays effect in both eyes as obtrusive as that maddox rod effect had been in the right eye prior to the yag. And, even now after only two months, it's not as annoying to me as it was right after the yag....I guess my mind has adjusted somewhat and, who knows, maybe it will even improve more over time. I'm just grateful that it's not something more serious. I think one of the doctors in the article that I attached in my previous post kind of hinted at a truth with surgery - perfection is an ideal.

Congratulations!