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IOP increase after cataract surgery
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IOP increase after cataract surgery

My normal iop is 12/13 in both eyes. The morning after cataract surgery in my left eye it was 17. That was considered good because of the common spike after surgery. A week later it was 18 and the untreated eye 15. I took durezol for a month.

Ten days after stopping durezol ie five weeks after surgery the left eye was still 17 the right had returned to normal 12.

I understand these are considered modest increases in fact I would barely make it at 6 hg/mm rise into the statistics on iop.

But in fact it's clear the surgery and/or steroids affected my pressure. I'm just curious as to mechanisms and when my left eye might return to its pre operative normal of 12/13.

Is this likely to be due to 1) steroids and slow recovery from them 2) some form of trabecular damage though mild if so from what? Retained material that will slowly re absorb?

Thanks.
14 Comments Post a Comment
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233488_tn?1310696703
The pressure in your eyes (in everyone's eyes) varies constantly during a 24 hr cycle (diurnal curve). This is just like your blood pressure and your blood sugars. This minor variations are normal and you should not consider yourself have a certain constant IOP

Cataract surgery generally lowers the IOP and that is considered a good thing as it reduces the risk of glaucoma or improves glaucoma in those that have it.

JCH MD
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I had an FOV in Nov. 2012 and another in Dec.2012 in same eye due to a vitreous hemorrhage. My eyes were previously at +75 with need for glasses and last May '12 I had 20/20 vision. My questions are: why did my eyes go so quickly to at .+75 distance? After having had the vitrectomy my left operated eye is now Myopic -3.5 or more (that is the highest contact lens I could get to equal out my eyes), my right eye is now +.25. The difference in the two eye strengths make it difficult to use the -3.5 contact. I am now wearing a -2.00 which is more functional but no good clarity at distance but at least makes wearing it help equal out my eyes, rather than feel like I am living in a fish bowl. I see my ophthalmologist May 2nd to discuss cataract surgery..what kind of IOL is best/ strength of IOL and is the sugergy more complicated without the vitreous gel? My retinal surgeon says the zonales and sac are intact. I wait for you comments. Thank you!
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233488_tn?1310696703
Define FOV
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Floater Only Vitrectomy (FOV) surgery
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After having the FOV surgery back in December, my left eye slowly started clearing, less blurry and blood spots dissipating. Close up I could read clearly, but distance was blurry..my Retinal Dr. said that I was becoming myopic and that was due to the surgery. What causes myopia when one was far sighted initially...only needed .+75 distance glasses started wearing in May of 2012 after my floaters became very bad..Dr. said it was a collapsed vitreous that caused shadows, in both eyes. I also had black dots like bulls eye spots and clear worm like floaters that would be straight or curl and move about the eye.
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233488_tn?1310696703
It sounds like you are developing cataracts, a well known and common condition after vitrectomy. I am not at all a proponent of that floater only vitrectomy. I would get a second opinion, almost alway increase myopia after vitrectomy is due to early cataract formation.

JCH MD
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1932338_tn?1349223998
I agree with Dr. Hagan...just a couple months after my vitrectomy I developed a cataract.  
My symptoms were this...30 days after vitrectomy my vision improved from 20/200 prior to surgery, to approx. 20/40 (but with blank spot in middle).
Then, 60 days post vitrectomy the vision declined to 20/400 however, I could see clearly anything within 12" of that surgery eye.  It's called "second sight" I believe and is a feature of a cataract.

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Have you had cataract surgery to correct your vision? Did you have vitrectomy in both eyes or just one? THANKS for any info. Going in to see my Dr. on May 3 and getting another opinion for cataract surgery and types of lens that are best to correct the diopter difference in the eyes. -3.5 in left operated eye and +.25 in right unoperated eye. I could possibly be getting a cataract in right eye since it has gone from +.75 to a +.25 since my vitrectomy in December of 2012.

Thanks for any info.
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1932338_tn?1349223998
Yes, I did have cataract surgery in the one eye only...the eye that I had a vitrectomy/ERM peel on for scar tissue.  

I waited about 10 months to have the cataract surgery though because I wanted to make sure the surgery eye had "settled down" inside as much as it could after surgery. (my retina swelling as shown on the post surgery OCT's went down some, but then stabilized at about 380=still thicker than normal but seems to be the best it's getting) .  Also, I wanted the time to research Cataract specialists and went to 6 for consultations before I found the one that I wanted to do the surgery.

Once you have a vitrectomy, the cataract surgery is riskier and I wanted more than just the average cataract surgeon...and believe me there IS a difference.

Ask lots of questions in regards to your personal lifestyle and IOL "target" choice...go over pros and cons.  Sometimes you have to "lead the doctors" with all the detailed questions as they are so busy they don't volunteer much of what you will need to know to make an informed decision.

I went with a surgeon that used Tecnis lenses, but many used Alcon sw60's and I guess those are good too.  I decided to target about a -.50 in the surgery eye because my good Right eye is about a +.75 and only the beginnings of a cataract so I will leave it alone as long as I can.

Be careful not to get more than a 2 diopter spread between the eyes... I ended up a -.75 in the IOL eye (hitting the exact target is near impossible, so there was about a .25 diopter margin of error in either direction...keep that in mind when you factor in "worse case scenario" on what you can live with.

Most people seem to target distance=plano=diopter of 0.  If my eye was healthy without residual retina damage from the scar tissue surgery I might have targeted Plano instead of -.50 ish.  Also, is your surgery eye your dominant eye ??  Again, most Dr. say to target Distance in your dominant eye, and if you want "mini-monovision", the non-dominant eye should be the one to target a little near-sighted.

With my -.75 in my IOL eye and +.75 in my good/virgin eye...my eyes have learned to blend the vision pretty well after a couple of months.  That is only a 1.5 diopter spread and when I finally do an IOL in my good eye I will target Plano=0.  That should bridge the gap of diopters between the eyes some.

Hope all of this helps, I remember how every little detail that Dr. Hagan or Jodi and the other posters gave was of great value to me when I was in my research phase.
Keep reading and ask lots of questions before surgery...don't kick yourself later for rushing into something before you feel comfortable.

Keep us posted !  Good luck, you can do this.  
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1932338_tn?1349223998
Oh, and to answer your other question...the cataract surgery is more complicated surgery without your thicker vitreous. The thick vitreous you had before the surgery helped equalize the pressure the cataract surgeon places on your lens sac and zonules during the lens surgery.  The zonules may stretch more with the thinner saline solution in there...hence the surgeon needs to be more careful and even used different techniques such as lowering the bottle during the surgery to reduce the pressure he places on the sac and zonules.

Even if you don't understand the details, it is a good "test question" to ask potential cataract surgeons... ask them if they use any different surgery techniques on a patient that had a previous vitrectomy/saline solution vs. vitreous fluid.
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This thread varied from the original topic which is ok because someone else got help.

The answer that IOP varies was not helpful. My normal is 12/13. The operated eye went to 17 the day after sirgery and a week later it was 18 and the unoperated eye 15. That indicates to me it is likely a steroid response, delayed a bit and modest by week one in the unoperated eye because it got steroids by diffusion through the sinus and/or bloodstream as measurable amounts of steroids do go into the bloodstream from drops. What it was a month later I don't know. Steroid response is considered negligible if a rise under 6 and modest from 6-15 and high responder if more. I find this frustrating as potent steroids like durezol don't report the lower pressure increases simply because they are not clinically dangerous. But that ignores the fact that aqueous outflow is nonetheless impeded. My guess is I'm sensitive and will be happy if my pressure returns to normal of 12/13 by my three month follow up. I'm not considered a high responder nonetheless it's my eye and I would like to know what's going on with it. Obviously steroids are necessary for post surgery recovery.

To the vitrectomy I agree having researched the vitreous which is an active and complex important membrane that is between the most oxygen loving tissue in the body ( retina) and the most oxygen vulnerable (lens). When you remove the vitreous you get a cataract because of the increased oxygen diffusing into the posterior chamber. It would be nice if eye surgeons told their patients how this works and considered risks etc. FYI once you have a vitrectomy and an IOL your risk of glaucoma is 10--15% so you must have yearly pressure checks.
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Thanks for your comments. My Doctor said he would shoot for plano in my left eye, it is a -3.5 now and my right eye is +.50. Will that balance out my eye's..as of now it is quite as strain as the eyes are more than 2 diopters. What exactly makes the eyes myopic after a vitrectomy anyways? Is it the shape of the capsule or just the lens becoming cloudy etc?

Thanks again for all the information. I plan on seeing another Opthamolgist. Although the Dr. I saw comes with very high marks. But more information is better than less.

He would also use the femosecond laser to do the cataract surgery. Any comments on this?
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