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From myopic to hyperopic after IOL implant in patients with RK
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From myopic to hyperopic after IOL implant in patients with RK

I suppose I'm a fairly complicated case. I had RK back in 1992, and a scleral buckle in my left eye implanted due to a retinal detachment in 1989. I recently underwent cataract surgery in both eyes (despite being only 46 years old), and toric lenses were implanted at that time. Prior to the cataract surgery, I was myopic, with a prescription of -6.5 in both eyes. Since the surgery, I have become significantly hyperopic.

It's now been four and five weeks since the surgeries, and apparently a significant miscalculation was done when determining the strength of my IOL's. I'm using drugstore reading glasses at the maximum power available (+2.75) to see distance, and I need to wear an additional pair of drugstore reading glasses (+2.0) in front of those in order to read or see a computer screen. It would appear that the surgeon missed his target (assuming a target of -.5) by something on the order of 3 diopters. The surgery was done by a very well known and highly respected doctor, at one of the premier eye institutes in New York City.

Needless to say, I am extremely disappointed with the outcome of the surgeries, especially after shelling out significant bucks for the toric lenses. I'm scheduled to see my doctor this Monday, to go over my options. As I understand them, those options will be either IOL exchange, IOL piggybacking, or some type of laser refraction. Of course, I could also opt to simply live with the results, and be stuck with using some rather thick and ungainly glasses for the rest of my life.

Any advice as to which of the surgical options might be my best chance of achieving near-normal distance vision? Will my previous RK surgery disqualify me from the laser refraction option? After doing much research, I'm thinking that piggybacking may be my best bet, but I'm not sure that this is an option with the toric lenses that have been implanted.

Any advice you could give will be massively appreciated.
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Avatar_f_tn
I can't advice you about surgical possibilities, but I can assure you that your glasses need not be thick and unattractive.  Progressive glasses made with higher-index aspheric lenses would be light-weight and thin.  One-day disposable contact lenses (with readers worn over) would also be a possibility.

In your place, I'd have a few questions for the surgeon.  Given the error in the power of the first IOL implanted, were adjustments made in the power calculations for the second eye?  (If not, then why?)  And how much residual astigmatism exists?  (Hopefully, less than .5 diopter.)  Since you paid good money for "premium" IOLs (presumably to reduce your dependency on glasses), perhaps you have some bargaining power.

  
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711220_tn?1251894727
Your calculation are very very difficult with both an RK and a scleral buckle.  Also, after surgery your RK incision will change.  Depending on the number of RK cuts, it can take months to become stable.  The swelling of the  cornea from the surgery will make the central cornea flatter and you will end up hyperopic.  However, as the swelling subsides this will regress.  You are hyperopic as expected.

I am sure your physician discussed this with you.  You need to be patient and wait before anything is done.  I have had 6 cut RK patients take about 6 months to become stable.

I had a Crystalens aspheric IOL last Tuesday.  Like you I had a refractive surgery (PRK), retinal detachment with scleral buckle after a failed pnuemantic and then another pneumatic and finally an ERM peel.

I had done an immersion A-scan prior to my PRK and an IOL Master prior to my retinal detachment as well as advanced techniques to measure the corneal power.  I had kept all my preop and post post PRK data.

My target for this non-dominant eye was -.50 to -.75 depending on information used and I am at 5 days post op about -.50 -50 @ x = 20/25 (still dilated with atropine--at my request)..

Dr. O.








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Avatar_f_tn
Congratulations on your spectacular Crystalens results!  Considering your history of retinal problems, your excellent acuity is truly amazing.  (I'm sure that many West Coast residents would like to know the name of your retinal surgeon.)  Let us know about your near vision with the newest Crystalens model.

Thanks also for the information about cataract surgery post RK.  I suspect that marcstk was not given this info.  A 6-month stabilization period might be difficult for someone who could not tolerate disposable contacts.
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Avatar_n_tn
Thank you for your answers. I was not told that it might take six months for my eyes to stabilize. I now understand that my prior RK has led to my current state of hyperopic vision post IOL implant, but is it to be expected to be this hyperopic? In ballpark figures, I'm at least +2.75 for distance vision, and +4.75 for reading.

Would it be your recommendation and then that I not undergo any corrective surgery at this time?

I too question why the results of the first eye were not factored in to the IOL calculations for the second eye. That will be one of my first questions on Monday...

Unfortunately, I am not a candidate for contacts, as I suffer from progressive MS and don't have the use of my right arm. This would make inserting and extracting contacts quite difficult...
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Avatar_n_tn
I am 66 yrs old and had lasik about 9 years ago. Left eye set to read and right eye for distance. Worked fine until I developed cataracts in both eyes--cortisone, etc. as a result of back problems--I guess.
In any case, had Alcon Toric implanted in left eye about 5 montsh ago--again hoping for the ability to use my computer again without glasses. Since I had good results with mono-vision with Lasik, I thougth that I would go for mono with my new lens.  However, came out of the surgery extremely nearsighted. Focus was about 8-9inches away from eye. After a couple of  months, followed surgeon's advice (and at not cost to me) he exchanged the lens with one that I am now reading and using the computer without glasses. I was nervous about the exchange but it worked out o.k. even after I had an retinal edema problem that went away with acuvail and predisone drops.
Last week removed the cataract from right eye and after a week appears lens is AOK for distance. As of now, I am glasses free for driving working in the garage, reading and using computer.  According to my surgeon, even with the lasik calculations, each person's eye muscles handle things a bit different and I am glad the second cataract surgery as well as last weeks surgery on the right eye was right on target.
I see where many are afraid of a lens exchange, but my experience is that an surgeon who is experienced in these can make it happen with good results.
I am glad I didn't follow most of the advice here and just go with glasses, or RK on my left eye after the first lens implant since there was some risk associated with the exhange.
Gerald
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711220_tn?1251894727
I would discuss enhance or IOL exchange with your surgeon.  You did not mention how many RK cuts you had.  The more cuts, the more time it takes to become stable.


Dr. O.
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Avatar_n_tn
Thanks Dr. O. I'm not certain, but I believe I had six RK cuts in each cornea.

I'll discuss my options with my Dr. on Monday, and will report back.

Thanks again for all the help...
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Avatar_n_tn
I had my follow-up visit, and my vision is worse than I expected. Before cataract surgery, both eyes were at about -6.50. Now, my right eye is at +4.00, and the left at +2.75, for distance vision.

The IOL's implanted were Acrysof IQ toric lenses. The IOL implanted in the right eye was rated at 7.0 D., and in the left eye 9.0 D.

The Dr. wants to wait another month before deciding whether to do further surgery. He did do a corneal scan, and said that I have enough cornea to do a laser refraction if that's the way we choose to go. He seemed annoyed that I was pushing for further surgery, though. As if I was expected to be satisfied with my severely overcorrected vision.

Needless to say, this isn't what I expected from the surgery. Can I expect a dramatic correction in my vision over the next 30 days?

Thanks.
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