Successful retinal surgery but loss of peripheral vision

[gwenaelle]

Hi
This is Gwenaelle. It has been a long time since I went to the forum. The last weeks have been very busy. Please excuse me for my mistakes, but English is not my native language. This is a little update
My husband had the cataract surgery on his left eye three weeks ago, and everything went very well. (The cataract was an unavoidable consequence of the vitrectomy he had one year ago because of a retinal detachment on his left eye one year ago).
The choice of an IOL (left eye) was not easy, because his right eye (the healthy eye) is very near sighted. In order to avoid too much difference between two eyes, my husband chose an IOL for the near vision: - 2 (The final result may be a little higher: - 1.75). Anyway, the result is great, and he is very satisfied. The good surprise also is that he does not have to wear a contact lens on his right eye, in spite of the big diopter difference. Also, another good surprise is that his monofocal IOL gives him not only the near vision, but also the intermediate vision, and even a little further! Which is really great!
But, unfortunately, he realized that he lost the peripheral vision on his left eye, and therefore he has a tunnel vision. His retinal surgeon told him recently that “the laser killed the retina”. (My husband had his emergency retinal surgery one year ago, but he noticed the reduced visual field only two weeks ago, after the cataract had been removed). He is very disappointed because we did not know that the loss of the peripheral vision could happen because of the laser used during the retinal surgery. I read it nowhere, our doctors did not mention that. Did you hear about that risk with the laser? Is there any chance that my husband can recover his peripheral vision?
Thank you very much for sharing your opinion and experience.
Gwenaelle

[gwenaelle]

Thank you so much, Dr. Oyakawa, for this information.
Gwenaelle

[Ray T Oyakawa, MD]

Lasering the peripheral retina results in loss of retinal tissue.  Usually, this is done in the far periphery and most patients do not notice.  However,  if you laser more toward the center you will have loss of more central visual field.  The area lasered depends on the location of the retinal tear(s) that caused the retinal detachment.  The area lasered does not function even though it was normal (except for the tear(s))prior to treatment.  The laser is need to "weld" the retina to the wall of the eye.

Dr. O.

[gwenaelle]

Hi Dr. Oyakawa,
Thank you very much for your answer.
I don't understand why the laser damaged the retina of my husband, whereas you said that in most patients it does not happen. We would like so much to understand. His eye was "healthy" before the detachment (no disease etc...), and the detachment was not small, but not huge neither.
Do you know maybe why in this case my husband needed more laser?
Thank you very much,
Gwenaelle

[gwenaelle]

Hi Homecrafter,
Thank you very much for your email.
What you write is interesting and could be the explanation. We did not think of that. My husband noticed his loss of peripheral vision one year ago, just after the retinal surgery. Surprisingly, the silicone that his surgeon put in his eye during the vitrectomy allowed him to see relatively well during three months (until the silicone oil removal), and already at that time my husband had noticed that he had lost the peripheral loss, but at that time the most important thing was that the retina stayed reattached and we thought that his eye sight would improve later. We don't understand why the laser "killed the retina" according to his surgeon. Nobody ever mentioned that risk to us. It would not have changed anything because it was an emergency to reattach the retina, but we would like to understand what happened.
Thank you very much, Homecrafter, I hope everything is well with you,
Gwenaelle

[homecrafter]

I am not a Dr. but I want to put in my 2 cents.  From what I've read, Cataract surgery following Vitrectomy surgery can be more difficult because of several reasons.  I'm sure one of the forum Doctors will correct me if I'm wrong, but one of the reasons is that the thicker/supporting Vitreous fluid has been replaced with a thinner saline solution.  I believe that this lack of support for the sac that the lens is in poses more of a surgical challenge for the Cataract surgeon.

So, I was just thinking that perhaps something went on with the Cataract surgery that was not typical since he was a previous Vitrectomy patient ???

May I ask what his retina swelling number on the center of the retina was just prior to Cataract surgery ?  The OCT test would show that number.  If the retina was still showing signs of swelling from the Vitrectomy (sometimes it always stays higher than normal)  maybe the additional trauma to the retina from Cataract surgery re-inflamed the swelling... and is causing some problems ?  

Just guessing here, but if you are like me I appreciate any and all feedback from anyone.

Let us know please.  

[Ray T Oyakawa, MD]

Most patients do not notice the slight loss of peripheral vision.  However, if more  of the retina is lasered you can have more loss of peripheral vision.  

There is no treatment for this.

Dr. O.