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Abstract: Aunt Li underwent cataract surgery in both eyes at a foreign hospital 3 years ago. After a brief medical history and slit lamp examination, it was found that Auntie Li had a posterior cataract. She underwent Nd:YAG laser posterior lens capsulotomy in both eyes on the same day, and was cured with good results.
Basic information】Female, 66 years old
Type of disease】Posterior cataract
Hospital】The Third Hospital of Peking University
Date of consultation】May 2022
Treatment plan】Surgical treatment (Nd:YAG laser posterior lens capsulotomy) + medication (prapirofen drops)
Treatment period】Outpatient laser surgery, 2 weeks follow-up
Effectiveness of treatment】Good results, disease cured
I. Initial consultation
Auntie Li came to our hospital because she had undergone cataract ultrasound emulsification and IOL implantation 3 years ago, and her postoperative result was satisfactory, with a visual acuity of 1.0 in both eyes; on the day of the visit, her visual acuity was 0.3 in the left eye and 0.4 in the right eye; after a brief medical history and slit lamp examination, the doctor found that the posterior capsule of both eyes was cloudy, and told her that she had She was told that she had posterior cataract. Auntie Li expressed doubts and said she had cataract surgery before, how could she still get cataract.
Treatment
Patiently explained to Auntie Li that posterior cataract can be interpreted as some “creeper seeds” inside the capsule of the IOL, which germinate and regenerate, spreading from the corner to the middle of the visual field, and finally like a piece of glass in front of the eyes, blocking the vision and affecting the vision. The main treatment for posterior cataracts that affect vision is laser treatment. After adequate pupil dilatation, under surface anesthesia, Nd:YAG laser lens posterior capsulotomy was completed in 1 minute in both eyes, and Auntie Li said her eyes became brighter at once.
Third, the effect of treatment
After 2 weeks of review, Auntie Li said that she had recovered well after the surgery and her vision had improved significantly, with 1.0 visual acuity in both eyes, normal intraocular pressure, clear cornea, no inflammatory reaction in the anterior chamber, positive IOL position and central posterior capsule absence. Due to the cloudy posterior capsule of the lens before laser surgery, which affected the observation of the fundus, the fundus was checked for Auntie Li during this review and no significant abnormality was seen. Auntie Li and her family were very happy and thanked the doctor for bringing her light once again. Knowing that posterior cataract can be completely cured and will never recur through laser treatment, Auntie Li and her family walked out of the clinic with a smile.
IV. Notes
However, we still need to remind her to pay attention to some matters in her daily life, including the application of glucocorticoids or non-steroidal anti-inflammatory drops for 1-2 weeks in the early post-laser period to prevent inflammatory reactions and to observe the change of IOP. Life and diet can go on as usual without any special precautions. However, if you still feel that you cannot see well and your vision does not improve after laser surgery, you must go to the ophthalmology department of a tertiary care hospital for further examination, which may require optometry and glasses or exclude other pathologies affecting vision such as fundus disease.
V. Personal insight
Posterior cataract is the most common complication after cataract extracapsular extraction, and the incidence can be as high as 30%-50% in more than 3 years, and almost all occur after childhood cataract surgery. The main symptom of posterior cataract is vision loss after cataract surgery, and the degree of impact on vision is related to the degree and thickness of clouding of the posterior capsule of the lens. There are no effective measures to prevent the occurrence of posterior capsule clouding, and the main treatment method for posterior cataracts affecting vision, such as Aunt Li in this article, is laser treatment. After Auntie Li’s posterior cataract is cured by laser, her vision will be improved. If laser is not available or if the posterior capsule is too thick for laser, surgery can be performed to puncture or cut the posterior capsule of the lens in the pupil area. Postoperative eye drops with glucocorticoids or non-steroidal anti-inflammatory drops are used to prevent inflammatory reactions, and changes in intraocular pressure are monitored.