I don't know the doctors in that area but will ask. As a general rule, academic centers have some of the most experienced doctors that serve in a tertiary care capacity (get all the tough cases funneled down to them). you may want to see someone at Tulane or LSU. Sounds like she may have had herpetic keratitis in that eye after the surgery which occasionaly happens. If that is the case, it makes sense that it is taking longer to clear.
HV
If she had "excessive amount" of fluid on spinal taps then she probably does have pseudotumor cerebri. If she is overweight for her age, you should consult with a nutritionist and possibly even a behavioral therapist for kids to see if you could put her on a healthy diet and and exercise regimen (without damaging her self-esteem). Weight loss is the only thing that could truly cure this condition (she's younger than any patient I have seen with this though so I'm not sure if the same applies). Good luck.
HV
That means she does have inflammation in the eye. I wonder why. Consider getting a second opinion if this does not resolve within the next month. In the meanwhile, follow the doctor's directions.
HV
3 months is a long time to be on the prednisolone. Call the doctor and ask what is going on with the eye that she still needs the prednisolone. Is there inflammation in the eye? Was there retained cortical material in the eye? Her symptoms sound like there is inflammation in the eye so we have to figure out why. Does she have any autoimmune problems?
HV
What drops is she taking? The near vision thing is sometimes done depending on what the patient's preference is (not needing glasses for reading vs. distance vision). Get a copy of the operation report and you could see if there were any problems during the case but it doesn't sound like it. Flashes and floaters sometimes do happen after cataract surgery and she needs to get repeat dilated exams every 2-4 weeks until they are resolved to make sure there are no tears or holes in the retina. What kind of pain is she having? That's also a bit unusual.
HV
Thank you sooo much. I do try to watch her snack intake. The pills have cut her taste for a lot of foods, but she still loves chocolate!! :) She doesn't like wheat bread, or pasta, or an array of veggies. The only veggie she likes is broccoli and she tolerates sweet potatoes. So thanks for wishing me luck.
The Neuro-opthalmologist did an eye exam on her in July 2010 (her first). My daughter had been complaining of headaches a lot. At the time she weighed about 75 lbs, so she is overweight, but she's tall. Right now she's about 95 lbs and is 4'4. So I am concerned about her weight. The Diamox has changed her tastes for certain things but she has a sweet tooth that I limit. :) Once she saw her optic nerves were swollen she recommend an MRI to rule out a Brain Tumor. The doctor saw some nasal congestion on the MRI, but that was all. She said a spinal was needed when the MRI came back normal. When she had the first spinal they removed a lot of fluid. She had an excessive amount both taps. We live in the city and she's never been camping. She has never taken steriods or any meds except antibiotics for colds and cough medicine. No one has ever mentioned "Nerve Magin Clarity" or "Buried Optic Head Drusen" to me before. She sees the only Neuro-opthalmogist in the state Tere Vives and the Neurologist was Ann Tilton, both are practicing out of Children's Hospital down here.
Why does an 8 year old have papilledema, this is unusual. Questions for the neuro-ophthalmologist:
1) Was her opening pressure elevated on spinal tap?
2) Were there any abnormalities on MRI? and were the cranial sinuses checked to rule out thrombosis?
3) Is there a chance this may be an infiltrative or an infectious cause of optic nerve swelling as opposed to elevated intracranial pressure?
4) Have all the bad causes of papilledema been ruled out with bloodwork and MRI/MRA scans?
5) Is there a chance this is just buried optic nerve head drusen? or are there clear signs of papilledema such as bleeding or loss of nerve margin clearity?
Questions for you:
1) had she been exposed to any medications before this started (steroids, vitamin A, others)
2) Is she really overweight?
3) Any other health problems?
4) any chance she was exposed to deer or other animals that may carry ticks (camping trip in last few months etc)
HV
Hi Dr. Vosoghi, I had another question for you but not about catarac's. Is this your only speciality? My daughter will be 8 next month was diagnosed with Pappiledema last year. She underwent 2 spinal taps in a week (1st on Monday 11/1/10 and the second one that friday 11/5/10) because the first one leaked. She could not hold her head up and suffered excruciating headaches the whole time. The Neurologist put her on Diamox 250mg for twice a day. She was then moved up to 3 times and now 4 times a day. She still suffers from headaches. We go back to the Neuro-Opthalmologist on the 13th of April. What questions should I ask? She doesn't know how long this is going to be with her, she's told me that, but my daughter is miserable when she gets those headaches. She says it hurts when she turns her head and when she looks to the left.
Thank you sooooo much Dr. Vosoghi for all of your great advice and info. I'll write back in a month or so to let you know how my mom is doing. Take care.
The doctor who did her surgery said post-op that she had a virus in her eye and started her on meds for that. Then when she sought a second opinion that doctor told her she has an infection in her eye, and the third doctor who's in the same office she saw him when the second doctor was out of town, he told her she had arthritis of the eye which flares up often. Do you have any collegues down here in Metairie, LA or New Orleans, LA that you would recommend?
The doctor she is currently seeing is the second opinion and her new doctor because the one that did the surgery on her was very rude to her when she asked him questions. I wish you were here in New Orleans. I'm going to get the surgery report and I'll let you know what it said. Thanks for all your help, I really appreciate it. :-)
Her doctor said she has something like arthritis of the eye that's why she has to take the Prednisolone for another month four times a day. Nothing was said about anything left in her eye or that she has inflammation. As far as she knows she does not have any autoimmune diseases.
She was first on Accuvail and Prednisolone AC 1%, now she's just on the Prednisolone. She's had 3 episodes with her eyes turning red, along with excruciating pain in her eyeball, and she can't stand light or glare. It'll be a while before I can get her to the doctor for a copy of the report. Anything else I can do or say to help you?