Cataract Surgery Vision Issues

Hi, I'm 45 years old and had a cataract removed from each eye in June, 2007. During the surgeries no IOLs were inserted into either eye and the rear part of the lens capsule was left in place. No LASIK or other eye surgery has been performed to correct my vision.

Prior to the surgery, I was very nearsighted and also had astigmatism in both eyes. Following the surgery, I’m now far-sighted (** without IOL **) and have astigmatism still – Rx before and after:

                         Prior to Surgery              After Surgery
                     Sphere    Cyl.   Axis      Sphere   Cyl.     Axis
  right eye -> -11.75   -3.25   007       +4.00     -1.75    005
  left eye   -> -11.00   -4.75   164       +4.25     -3.00    165

Six months after the surgery, I have vision problems including ghosts around objects and bursts around lights. Protein is also building up on the remainder of the lens capsule. My night vision is especially affected by these issues - overall my vision is worse than before.

My surgeon exercised caution throughout this time from the surgery prep to the follow up care (partly because I've had two partial retinal detachments). I appreciate this extra care, however, I think enough time has passed that my current vision problems should have already been addressed or should have resolved on their own.

Some questions I have are below:

(1) My surgeon has told me the protein buildup on the lens capsule is usually removed by laser – I understand that this effectively removes the rest of the lens capsule. With the lens capsule gone and no IOL present, is it likely that the vitreous fluid will "leak out" and cause retinal detachment?

(2) Are IOLs available in my current Rx strength? In my case is it too late or too risky to implant an IOL?

(3) At this point, is it better to seek a second opinion to help determine what I should do next, or should I rely solely on the advice of my current surgeon?

Thank you for your time. Regards,

CatJC

[John C Hagan III, MD, FACS, FAAO]

In retrospect you wouldhave been better if an IOL was inserted in your eye for two reasons: 1. to correct the residual hyperopia and 2. It has been shown in the medical literature that even if a person requires no IOL power (zero or plano) that it is best to insert a zero power IOL because it stretches the posterior capsul reducing the incidence of opacification and need for Yag laser capsulotomy. AND it reduces the risk of retinal detachment over a case like yours where no IOL was inserted.

I would NOT have the yag capsulotomy.  I WOULD see a second highly respected cataract/refractive surgery specialist and talk about putting an IOL in each eye to  correct the hyperopia and at the same time consider limbal relaxing incisions to try and eliminate the astigmatism.

After this you will NOT see clearly because the posterior capsule is opaque. With the IOL in place the Yag capsulotomy will be much lower risk.

I would also suggest that you see your retina surgeon and run the above scenario by him/her. I think they will agree with me. Your retina surgeon should examine your eye before the IOL surgery to see if any weak areas need laser or cryopexy and should also examin you about a week after each IOL surgery and a week after each eye has YAG capsulotomy.

If you have YAG capsulotomy now it will raise the risk considerably of doing and IOL insertion later.

I think you can be helped a great deal by following a plan like I've outlined. The key issue is getting your retina Eye MD to cooperate with a highly experienced IOL/refractiver surgeon.

Let me know how this all turns out.

Good Luck

JCH III MD

[John C Hagan III, MD, FACS, FAAO]

You can print this out and take it in to your retina surgeon and also the second opinion cataract/IOL surgeon.

The reference about the zero power IOL is in the American Journal of Cataract and Refractive Surgery.

JCH III MD FACS FAOO

[catjc]

My response:

Thank you, doctor! I've been second-guessing myself for some time because I didn't press my eye surgeon to insert an IOL (even a zero-power lens) during the initial surgery.

I still need glasses to see clearly for distance and for close up work, although prior to the surgery the surgeon suggested I might not need glasses for distance after the cataract removal. It was too good to be true, but after wearing glasses for almost 40 years, I was looking forward to the prospect of not needing them (for distance).

I’ll print out your reply and bring it with me to an appt I’ve made to see a different cataract specialist, and I’ll discuss your reply with the opthamologist who performed the retinal detachment repairs. I’m going to discuss the IOL implant, the prospect of the Yag capsulotomy and the limbal relaxation procedure with them. The appointment with the cataract specialist and my regular check back with my retina doctor are in January.

Thank you again for your advice and your quick response!

CatJC

[John C Hagan]

Good luck, I'm very hopeful for you and what can still be done for you.

JCH III MD