No. Once a cataract is completely removed, it does not come back. However, a secondary cataract, also known as a posterior capsular opacity, can develop. A posterior capsular opacity is essentially a scar tissue that forms behind an implanted lens following cataract surgery. Sometimes, this scar tissue can be seen immediately after cataract surgery, but more often, it develops over time, from months to years afterwards. As it grows, it can adversely affect vision, just as a cataract does, and will need to be treated.
A posterior capsular opacity can be treated by a laser procedure called a YAG capsulotomy. It is a painless procedure that takes about 5-10 minutes and is usually covered by medical insurance. The laser literally makes an opening in the scar tissue, centered on the visual axis. Patients can then see clearly through the opening. This solution is typically good for life and should not need to be repeated.
In creating this opening, the removed scar tissue is left behind, floating in the vitreous (a clear, jelly-like material that fills up the space behind the lens). Sometimes, there is one piece of scar tissue, but other times, there are several smaller pieces. If light hits any of the pieces, it can cast a shadow on to the back surface of the eye. Patients see these shadows as floaters within the eye. This side effect of seeing floaters after a YAG capsulotomy is very common. The floaters usually only last days to weeks, and then disappear, but on rare occasions, they can remain for months.
The benefits of a YAG capsulotomy include (1) fast visual recovery, usually within a day, (2) no incision, which translates to decreased risk for infection, and (3) no pain.
To see if you have a posterior capsular opacity, make an appointment for a comprehensive eye exam with one of the doctors here at San Jose Eye Institute.