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Question:
I have macular degeneration and had cataract surgery about 3 years ago. My eyesight has worsened and I've been advised to have a YAG laser capsulotomy. What are the risks and/or benefits for someone with macular degeneration?  

Answer:
Posterior capsule opacification (PCO) is a common condition that develops months to years after cataract surgery. At the time of cataract surgery the cataract is removed and a clear covering of the cataract is left behind (the posterior capsule) as it forms a protective covering and keep the new lens implant placed at the time of cataract surgery in a stable condition. 

Over time, the capsule can cloud with build-up of various proteins within the eye. This capsule cloudiness can create many of the same symptoms that you had when a cataract was developing. The clouding is easily fixed by the Nd:YAG laser capsulotomy (neodymium-doped yttrium aluminum garnet). 

This laser procedure can be performed in the office or at a surgical center and just takes a few minutes to perform. The risks are small but can include dislocation of the lens implant and cystoid macular edema. The former is unlikely if the lens implant was properly placed at the time of cataract surgery. The latter is also very rare but with macular degeneration, there is a slightly higher risk of the macular edema. If macular edema does develop, it typically resolves either on its own or with topical anti-inflammatory medications. 

I would suggest you continue with oral eye vitamins to lower the risk of macular degeneration progression and use an Amsler grid to follow any potential worsening of macular disease (a paper grid given to you by your eye doctor). If your doctor suggests you have the procedure and it will help your vision, I would give it strong consideration, as it is a safe and effective way to treat the PCO even in the setting of macular degeneration.

Answered by: W. Barry Lee, MD  Dr. W. Barry Lee

Categories: Eye Diseases, Eye Surgery

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Answered: Apr 23, 2012

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