Larger pupil

[mike230]

I am a post RK patient of 1989 who had a crystalens HD500 placed in my right eye 8/2008.  I also had an LRI at the same time.  Got a great refraction (plano).  one month later I had the start of a detached retina in the upper corner of my eye and was caught at a very early stage. The retina was successfully repaired and a 23 gauge vitrectomy was performed to get rid of all those nasty floaters.  The retina surgery was performed 9/26/08.  
Right now, I encounter a contrast issue and under certain lighting conditions, I can read clearly the 20/15 line.  My issue is my pupil is a little larger than my other eye.  I was also told the gas bubble that was in my eye could have caused a light filming on the back of my lens which that along with any adhesions near the iris and lens could be easily treated with the YAG laser, any input or shared experiences is welcomed.  Thanks to all.
Mike

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

Often the method #1 works. I would generally try 1 before 2.

JCH MD

[mike230]

Forgot to mention, the surgeon said I did not need a YAG, the lens was clear.

[mike230]

Dear Dr. Hagan,
I had the examination and the problem is treatable by one of two methods.  #1 method is the conservative manner via pharmaceutical using predforte 1% every 2 hours while awake and cyclopentolate 2% 3x's per day for 4 weeks.  #2 method would be performing a 27 gauge visco dissection surgery which would inject a gel to break up the adhesion, which is causing a portion of my pupil to stay open.
The adhesion is located between the back of my pupil and capsular bag front from a 10:00 to 1:30 position.  The top part of my pupil was octagon shaped, but 2 weeks into the drop method treatment, of course my pupil is still enlarged because of the cyclopentolate, but it is normal shaped.  

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

Good luck Mike

[mike230]

Dear Dr. Hagan,

I will be seeing my MD this Friday.  I feel I am so close to perfect right near the finish line.  My near and intermediate vision is excellent right now.  As far as my distance under the right lighting condition, I can maintain a constant 20/20 & 20/15.  At my last retinal exam, my pupil was responding normally to a flash light and dark situation, but needs some type of jump start to get to close normally.  Thanks again,
Mike  

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

Because cataract and retina surgery must be done with a widely dilated pupil the pupil is some times stretched and the retina surgery can unavoidably damage the nerves to the pupil.  There is not much you can do about that. You can discuss with you Eye MDs about trying alphagan P or weak pilocarpine if you think its a big deal.

Yes you may need a yag capsulotomy some time.

JCH MD