While I am every bit as excited as the patient after successful cataract surgery, and inherently optimistic as well, it is necessary to caution patients that the above-mentioned phrase does not always apply. Barring even the unforeseen, most patients, at some point in the future, will require a procedure called a Capsulotomy for the condition of posterior capsular opacification.
The good news is that this condition, and its successful management, is likely to be one of the most easily remedied medical situations that any patient will encounter. To explain further, the capsular bag, the clear, saran wrap-like, outer covering of the lens, which holds the lens implant, becomes gradually opacified with time in all patients. The rate at which this happens varies greatly among patients as the result of a number of factors. The common denominator of posterior capsular opacification,( otherwise known as “secondary cataract”, or “after cataract”) is the growth and abnormal proliferation of native lens epithelial cells. Although virtually all cloudy lens material is removed after cataract surgery, there are ALWAYS some microscopic epithelial cells present and it is IMPOSSIBLE to remove all of these tiny cells, particularly those at the far edges of the lens capsule.
Nevertheless, a patient may have excellent vision after cataract surgery for many months or years without this being a problem. Other patients, however, depending on age, other medical conditions, specific ocular conditions, type of implant, type of cataract and the ability of the surgeon to remove as much of the cataract as possible, all have some bearing. At times, the capsular opacification may be such that a Capsulotomy is warranted as early as weeks to a few months following otherwise successful cataract surgery.
As alluded to above, the treatment of this condition is exceptionally easy as a Capsulotomy is a quick (perhaps even less than a minute), painless, out-patient treatment that is typically covered by insurance, requires no limitation of activities and is virtually risk-free. In addition, once successfully completed, there is never a need to repeat the procedure as this is a one-time occurrence.
In summary, most patients can expect excellent vision following cataract surgery without the need of any secondary procedure in the immediate future. Eventually, however, a Capsulotomy will be performed, should the vision decline and the patient desires a visual “tune- up.”