INFORMED CONSENT FOR LASER CRISTALLINE LENS CAPSULOTOMY

You suffer of a clouding of the capsule of the crystalline lens. Your ophthalmologist proposes a laser treatment for this condition,

This document contains the 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 capable of carrying a large amount of energy that will be delivered in a specific location of the capsule in order to create the 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 anaesthetic 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 EVOLUTION

In the vast majority of the cases, this treatment is well tolerated and you will leave immediately after treatment and resume, in the next hour or two, your 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 your ophthalmologist.

A control will be necessary at a date which will be stated by your ophthalmologist.

COMPLICATIONS OF THE TREATMENT

The non serious complications are:

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

* Arterial hypotension may occur in susceptible individuals. It will quickly disappear when 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 mobile 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 always treated preventively with hypotensive eye drops.

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

These incidents are of no concern. If you are prone to arterial hypotension, please report it to your ophthalmologist in writing it at the bottom of this document.

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 systematically preventively 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, you are 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.

* Retinal detachment. It is a rare and unpredictable distant reaction to the impacts. It requires delicate surgery of replacement of the retina.

LIMITATIONS OF TREATMENT

The peripheral visual field is reduced by the size of the window that can not be too large, otherwise it might cause retinal complications.

Like any living tissue, the capsule may react in variable ways immediately or 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 abnormalities such as a blurred vision due to corneal, retinal or vitreous pathologies.

PRECAUTIONS TO BE TAKEN

During pregnancy, no complications due to eye laser treatments have been reported to the mother neither for the child to be born.

YOU SHOULD CONTACT YOUR 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.
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