Senior Member (male)
Join Date: Jan 2013
Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
My secondary cataract sx for the right eye with the Yag laser was some 10 years ago, about 2.5 years after the primary cat sx, so I do not remember all the details, but my recollection is that it was a quick sx (few minutes), and, yes, almost immediately (next day?) my vision became better (20/20), and hasn't changed to this day. But I did not have any retinal detachment or anything then. The problem before the sec. cat. was that the "halos," and "glares" around lights, diodes and oncoming cars' headlights started to come back again in the night, like, those before the primary cat., and also, slight cloudiness. That cloudiness comes from the PCO (posterior capsular opacity). These things can't be corrected by refractive lenses, as you know. So, this sx is pretty minor - compared to what you have gone already. I read that in US, 2% of the population is at the risk of retinal detachment after YAG laser sx, rather than 1% after primary cat. sx.
So, you are right, the capsulotomy sx (not "capsulectomy" - that's something else altogether) removes a small disc from the posterior (aft) capsular bag, within which the IOL is located, using YAG laser. That disc gets absorbed in your vitreous behind the lens in a few days. (I don't know if it gets as easily absorbed if it is saline solution instead, which usually replaces the vitreous during vitrectomy sx., or what the interaction of the IOL is with the saline solution, now that it is exposed to it as opposed to the natural vitreous.) The diameter of this disc is something like the size of your pupil in normal daylight, and I have read that depending on the disc's relative size to the pupil, the light rays can "defract," or bend around the hole's edges, and can give different colors in your vision. The thickness of his capsule is that of one blood cell (extremely thin). So, yes, I guess, cutting a hole must be weakening the posterior capsule, but I don't know about the fibres that may show up post-op, as you say, since lasers, in general, are extremely accurate (sharply focused) and ought to cut a fine edge.
By the way, I don't know how OCT will help anything with PCO, as it is typically used to get the cross-sectional details of the retina, not the capsular bag or lens. And, OCT uses infra-red (IR) of low intensity, no X-rays or radiation that you were thinking; I don't think it is harmful or anything. Plus, I have not heard anything about dilation drops being harmful if taken more than 2 times a year - that sounds preposterous! Where did you get this info from? After these vit surgeries, I have been seeing my doctor pretty regularly to check the progress (1 day, 4 days, 2 weeks, 4 weeks, 7 weeks, etc.), and unless my eyes are dilated he can't see properly inside my eye. So, dilation is a must.
I saw you mentioned Bellevue, WA, for your cat. sx. in the other post - I also had done my cat. sx. in Bellevue, WA, at PCLI with Dr. Oli Traustason - great surgeon, but who has retired long time ago. Fortunately, my insurance paid almost all the expenses for all these surgeries (cat, vit, whatever) - so that's not an issue for me. But, especially, after the RD surgeries, when you get your vision back, I would pay them whatever rather than be ruined with a bad or no vision for life. I have really started respecting these surgeons now! It's money worth spent.