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Laser treatment for the opacification of the crystalline lens 

PAGE 32 LASER TREATMENT

This article is about the clouding of the crystalline lens capsule and its laser treatment. It contains information about the reasons, conditions, results, risks and limitations of the proposed medical act.

WHY LASER THERAPY?

Because the clouding of the crystalline capsule, that occurs almost systematically after cataract operation, leads to a decrease of the quality and quantity of vision.

Laser capsulotomy is the most appropriate treatment for this condition.

THE LASER TREATMENT

The laser beam uses a light ray capable of carrying a large amount of energy. It is delivered to a specific area of the lens capsule in order to create a window that allows the image to reach freely to the retina.

The session is performed on an outpatient basis. After dilation of the pupils, the anaesthesia of the eye is obtained by the instillation of anesthetic drops. The patient sits in front of the laser engine. Laser impacts are applied through a lens placed on the eye. The whole procedure time does not exceed 10 minutes per session. It is painless.

The treatment is carried out in 1 or 2 sessions spaced by several days to several weeks.

USUAL COURSE

In the vast majority of the cases, this treatment is well tolerated. The patient leaves the Eye Clinic immediately after the treatment and resumes, in the next hour or two, normal activities.

The success rate is very high, almost total. In most cases, the visual recovery is rapid, within 24 hours.

The local care is reduced to the instillation of drops in the way that will be indicated by the ophthalmologist.

A control is necessary at a date that will be stated by the ophthalmologist.

COMPLICATIONS OF THE TREATMENT

The non serious complications are:

* Glare, due to the laser session itself and to pupil dilation, will be felt throughout the examination and lasts 2 hours. It is advisable to have sunglasses when leaving the Eye Clinic and not to drive as long as this glare is noticeable.

* Arterial hypotension may occur in susceptible individuals. It disappears quickly by lying down.

* Extended pupil dilation, lasting several days. It is annoying by the glare it induces. This risk is unpredictable and very rare.

* Irritation of the cornea (superficial keratitis): It is a rare hazard, occurring in less than 1% of the cases.  Promptly treated, it cures generally in 24 to 72 hours.

* Vision of floating clouds, which represent the fragments of the capsule floating in the vitreous. They disappear after some weeks.

* A transient increase, during several hours to several days, of the intraocular pressure. It is a frequent hazard that is preventively and systematically treated with hypotensive eye drops.

* Conjunctival bleeding due to the contact lens: rare, benign, disappears in few days.

These incidents are of no concern. If the patient is prone to arterial hypotension, it is necessary to get the ophthalmologist informed.

Severe complications of this type of laser photocoagulation are so exceptional that they are not quantifiable.

* Macular oedema: This hazard is due to the accumulation of water in the centre of the retina. It is a distance reaction to laser impacts and is responsible of a loss of the detail vision, lasting a few weeks to several months, sometimes permanently. Although rare, it is preventively and systematically treated.

* Misplaced impact, reaching the middle of the central area of the retina. This incident can permanently reduce details vision. It is extremely rare and occurs in restless, undisciplined patients who do not control their eye movements and their bodies. To avoid this, the patient is asked to keep the most calm and compliance during this examination.

* Crisis of acute glaucoma. This risk is inherent to all dilation of the pupils and systematically checked.

* Retinal detachment. It is a rare and unpredictable distant reaction to the impacts. It occurs in less than 1 over 10 000 laser treatments. It requires delicate surgery of replacement of the retina.

LIMITATIONS OF TREATMENT

The peripheral visual field is reduced by the size of the window. On the other hand and in order to avoid retinal complications, this window cannot be too large.

Like any living tissue, the capsule may react in variable ways, immediately, months or years after the treatment. One such reaction is the budding of the edges of the window, called Elschnig pearls, reducing the field of vision and sometimes leading to a re-treatment.

This treatment cannot, in any way, claim to improve the vision if it is reduced for reasons additional to the lens capsule opacification, such as a blurred vision due to corneal, retinal or vitreous pathologies.

THE PATIENT SHOULD CONTACT AN OPHTHALMOLOGIST IMMEDIATELY IN CASE OF

* Pain, severe sensitivity to light, redness, tearing, secretions, swelling of the eyes or eyelids

* Sharp decrease of the vision.

* Perception of floaters with flashes of lightning, a black rain or a motionless large dark spot.

By courtesy of Dr. SAFFIEDINE, ophthalmologist in Playa De Las Americas.