Floaters after Vitrectomy

A question I recently received:

“I’ve had vitrectomy surgery in both eyes for floaters…followed by cataract surgery in both eyes….and recently capsulotomy by YAG laser in both eyes….vision is 20-20…..however the left eye has 3 large floaters…from the capsulotomy as well as 3 or 4 smaller ones…..I’m considering another vitrectomy…..the floaters float about in and out of vision…could your procedure help…they are debris from the capsule…not vitreous floaters I had before.”

The YAG capsulotomy is a very common procedure performed for people who have undergone cataract surgery with a lens implant. The artificial lens is placed into the original “capsule” which held the lens before surgery. The capsule is relatively dense basement membrane between 2-20 microns thick. Fragments of the capsule liberated during a capsulotomy can behave like a more typical floater caused by vitreous gel condensation. Because they are denser, tey are more of a challenge and require very focused energy and repeated shots to “fluff it up” and vaporize the material. The pieces should be relatively small if typical of what I’ve seen before. It would seem like a vitrectomy would require a accepting a moderate amount of risk for something so small. Likely the laser could fragment and obliterate it if it is not too close to the retina. It is certainly less risk and to do the laser procedure would not prevent you from later doing a vitrectomy if it didn’t work. Your situation is interesting: 1. You develop floaters… 2. Underwent the “Gold-standard” vitrectomy procedure to remove floaters… 3. Developed cataracts as a common side effect of vitrectomy… 4. Capsule opacifies, and you undergo YAG Capsulotomy which is a common side effect and treatment after cataract surgery… 5. You develop floaters. A rather circuitous route, I’d say. So back to your specific question… If the floaters can be seen, and they are not too close to the retina, you might do well with the laser procedure. I think it would be preferable than returning to the operating room, especially if the fragment is small. Cheers, Dr. Johnson

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