Sometimes months or years after a cataract operation, a slow deterioration in vision may occur again- a posterior capsule opacification (PCO, secondary cataract) has formed. This is caused by epithelial lens cells remaining in the capsular bag during surgery. They slowly grow towards the posterior capsule in the direction of the visual axis and form an increasingly dens cell layer. As a result, the vision becomes blurry and cloudy again.

In the development of modern intraocular lenses, the prevention of posterior capsule opacification plays a major role. The material and design of intraocular lenses are constantly developed and improved. Posterior capsule opacification has been one of my main research areas for years; in the course of this I have carried out many clinical studies with my study group and published our results. I am happy to let my patients benefit from this knowledge and my experience.

Posterior capsule opacification laser treatment

Posterior capsule opacification is treated with a laser (Nd:YAG laser capsulotomy). The posterior capsule is opened by the laser so that the visual axis is free again and vision is clear again. The posterior capsule laser can be performed in our private practice. The treatment is completely painless and usually only takes a few minutes. A secondary cataract cannot come back—once the posterior capsule is removed, the cells can no longer grow.

Cloudy and blurred vision, a feeling of glare, reduced contrast perception, poor vision at dusk or reading problems can be symptoms of an aftercataract. The symptoms are similar to those of a cataract and only appear gradually, usually years after the operation.
Lens epithelial cells grow very slowly – it usually takes years before signs of a secondary cataract appear. In rare cases, posterior capsule opacification can form just a few months after cataract surgery.
During cataract surgery the opacified lens is aspirated and an intraocular lens is implanted in the remaining capsular bag. A few epithelial lens cells always remain in the capsular bag, these can slowly proliferate over months and years and grow along the intraocular lens on the posterior capsule. Due to this layer of cells less light can enter the eye and vision becomes cloudy. Modern intraocular lenses are developed to inhibit posterior capsule opacification. However, some patients (20% on average) may develop posterior capsule opacification that requires laser treatment.
If you previously had cataract surgery and saw well afterwards, but your vision is slowly deteriorating again, then a secondary cataract may be the cause of the deterioration in vision. Your ophthalmologist can diagnose posterior capsule opacification relatively easily during an ophthalmological examination.
The posterior capsule opacification laser treatment can be performed in our private practice. First, the pupil is dilated, then the corneal surface is anesthetized with eye drops (local anesthesia). The posterior capsule laser is mounted on a slit lamp, which means you sit upright, your head is supported with a head rest and you can fix a lamp. Your ophthalmologist then uses a few laser impulses to open the posterior capsule. The treatment itself only takes a few minutes.
The treatment of the posterior capsule opacification is not painful because the capsular bag, which is opened by the laser, is not innervated. The surface of the cornea is anesthetized before the treatment so that you do not feel the contact glass that is placed on the eye during the treatment.
On the day of the posterior capsule laser treatment, the vision can be still clouded by the dilation of the pupil. You should see well again the next day or the day after that. Because the eyeball was not opened as in cataract surgery, you can live your daily life without restrictions. You will usually be prescribed anti-inflammatory drops for a week to prevent a rare swelling of the center of the retina (macula edema).
Once removed posterior capsule opacification cannot come back. Because the cells that form the posterior capsule opacification can no longer continue to grow without an intact capsule – which is opened during laser treatment.
The posterior capsule laser treatment is generally very low-risk. In rare cases, the eye pressure can rise or the corneal surface can be injured. Swelling of the center of the retina (macula edema) should be prevented by prescribing anti-inflammatory drops.

Auf einen BlickAuf einen Blick

  • Symptoms: slow detoriation of vision after cataract surgery
  • Causes: growth of lens epithelial cells
  • Diagnostics: Eye examination (slit lamp)
  • Behandlung: posterior capsule laser treatment
  • Prognose: good vision possible day after laser