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Positive Photopsia after YAG Capsulotomy
Hello to all.
After cataract surgery (L) on 1/23/23, I had a positive photopsia from a wrinkle in the capsule. Sky to ground, 40 degree single large “ray”, pretty much at night with leds, etc. Had yag procedure 5/9/23 because with time it never resolved. When I walked out of the office was seeing multiple thin rays. Hoped was due to dilation.
Nope, still have them, with inside leds, and most outside light sources after dark. Starts with one thin vertical ray, another ray appears, to make an X, then it’s a starburst of multiple rays, thin, but multiple. They can rotate, and the primary wave can often have a rainbow sheen to it. From a side eye view, the rays look thin, slightly curving, hydra-like, often seeming to cross over my face.
I have a pvd in both eyes, a “fish hook” image I can see from the retinal area of the detachment, and can see the vitreous sac “moving” as I turn my gaze side to side. I’ve pretty well adapted to that. Also have very dry eyes.
I would appreciate feedback from folks experiencing similar complications, what you were told caused them, and ways taken to resolve.
I have an Alcon Clarion lens, due to small cataracts causing night blindness, set for distance, +23.5. Minor astigmatism.
It’s depressing, since I see 20/15 distance, and the visual complications are severe enough that I have not even attempted to drive…
Have the after check with dilation coming up soon, hope a reason is found. Thank you.
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Please let me know. I asked my doctor about the yag hole sizes, and she said they were fine. She has no idea where the starbursts are coming from. By any chance did you undergo any vitreous changes? PVD, etc.? Thank you
I look forward to hearing your update
Hi Fathead,
Your post is EXACTLY what happened to me, down to the staff and doctor saying everything looks great!
This is something I can take to the doctor and see if they know what to do or give me the “deer in the headlight stare”.
Could you let me know your doctor?
For my yag procedure I had a total of 10 spots. The energy was 2 mj.
From what I could find the total spots is between 10 and 30. The power is between 2 mJ and 6 mJ. I’m was on the low end on both number of spots and power. Wondering what other people had.
In reply to @jimmymel
My LAL adjustments and lock-ins are done now, but my doctor asked me to wait for 4 to 6 months before scheduling a new yag tune up. He said that starbursts could decrease during that time (I don’t really believe so, because they haven’t changed a bit for the last two months), and he warned me that such yag operation is irreversible (of course) and we should only do it with great care. He might be afraid of something else he doesn’t want to tell me!?. I bit the bullet and I plan to call him back after that waiting period. He would do it free of charge, of course. Will let you know by then.
Please let us know how it went
I have the LAL lens, had a diagonal line after surgery in both eyes, which solved prior to adjustment. Had one adjustment to achieve mini monovision. However, had blurriness, DR recommended YAG, done one month past last surgery. Immediately had overwhelming starbursts at night, they see nothing wrong. Will have final adjustments soon. Cannot drive at night due to starbursts. So discouraged.
Have your starbursts resolved and what procedure was used to resolve?
Your posterior capsulotomy (PCO) is likely not large enough especially if you are a younger patient with a pupil that is still capable of dilating larger than the hole made by the PCO. This caused my starbursts which started immediately after the PCO and weren’t there prior. My starburst were markedly improved by 90% the day the PCO was enlarged. I still get them in very dark conditions with bright pinpoint light sources but it is much much improved. My goal is to give it a full year to see if I just get used to them or if my maximum pupil dilatation naturally decreases with age and the starbursts total resolve over time. I’m am 59 now.
Either your doctor is truly unaware of positive dysphotopsia from a PCO or he/she doesn’t want to make the PCO hole too large for fear of the lens becoming unstable in the capsule. Even then there are techniques to stabilize the lens if this happens.
I have followed a very experienced cataract surgeon on YouTube and I think he is very talented in dealing with any and all lens implant complications. His channel is @ShannonWongMD and I highly recommend it. I have written him and he does see out of town patients and practices in Austin TX.
She had researched this condition and has now agreed to slightly make the hole larger.
Thanks for your feedback, I’ll post how it goes.
Did you get the hole larger and has it helped?