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Mom's eye after cataract surgery
My 75 yr old Mother had successful cataract surgery in early August 2023. At first, it was a bit scary as her vision was blurry for 1 to 2 weeks post-op but slowly got clear and crisp!
Please note that the surgery was also scary for her since she is blind in her right eye since birth, due to optic nerve damage. Still, it needed done, and her doctor is one of the best in our area and highly respected.
Now, to the strange part. After 2 full months of great, clear vision after the cataract surgery, she started feeling like something was in her eye for a few days. Then, this past Sunday, she said her vision was blurry and foggy like before. So, she went back to the doctor yesterday and he examined her eye. He said the lens was in place and looked great. But, there is a small circle of swelling on corner of her cornea. He isn't sure what the cause is, saying possibly a virus (?) He asked if she ever gets cold sores. She does NOT and never has. She did have a cold about a week ago. The doctor has prescribed her prednisone and steroid drops to be used 4 times a day. He will re-check in a week. If things are no better, he is sending her to a corneal specialist in Philly. He reassured her she won't go blind. Still, she is scared, sad, and fearful her vision won't get clear again. With one eye, we need that eye clear so she can function and get back to normal life. Any insight and positive feedback is appreciated.
Please note that the surgery was also scary for her since she is blind in her right eye since birth, due to optic nerve damage. Still, it needed done, and her doctor is one of the best in our area and highly respected.
Now, to the strange part. After 2 full months of great, clear vision after the cataract surgery, she started feeling like something was in her eye for a few days. Then, this past Sunday, she said her vision was blurry and foggy like before. So, she went back to the doctor yesterday and he examined her eye. He said the lens was in place and looked great. But, there is a small circle of swelling on corner of her cornea. He isn't sure what the cause is, saying possibly a virus (?) He asked if she ever gets cold sores. She does NOT and never has. She did have a cold about a week ago. The doctor has prescribed her prednisone and steroid drops to be used 4 times a day. He will re-check in a week. If things are no better, he is sending her to a corneal specialist in Philly. He reassured her she won't go blind. Still, she is scared, sad, and fearful her vision won't get clear again. With one eye, we need that eye clear so she can function and get back to normal life. Any insight and positive feedback is appreciated.
My Mom's vision is almost 100% back to normal! If things stay this good, she wants to cancel surgery. She'll be contacting her doctor tomorrow. I'm sure he'll be as thrilled as we are and will bring her in to re-examine her. This is amazing!
My Mom's vision is almost 100% back to normal today! She said the fogginess is gone, too. We are elated! She'll need to call the doctor tomorrow and let him know so that he can re-examine her and cancel the surgery. She can see so beautifully right now. So, as for now, she is cancelling the surgery.
I do not have an answer, but I found this interesting due to my own experience with an IOL exchange. Initially I assumed the reason my vision was blurry after surgery was because the replacement lens had been misplaced or because there was trauma from a difficult extraction of the previous lens. But weeks have turned into months and the description of my issue is precisely as your mom's doctor has described hers --"small circle of swelling on corner of her cornea." I am also prescribed steroidal drops and, more recently, also rhopressa (not for glaucoma).
My surgeon claims the lens is in perfect position and that my cornea is clear except for the small area of swelling, but that is enough to totally distort my vision in that eye. I cannot read text on my laptop. No one has ever mentioned herpes and I, too, have never had it, to my knowledge. Please share whatever information you are able to get. Thank you.
My surgeon claims the lens is in perfect position and that my cornea is clear except for the small area of swelling, but that is enough to totally distort my vision in that eye. I cannot read text on my laptop. No one has ever mentioned herpes and I, too, have never had it, to my knowledge. Please share whatever information you are able to get. Thank you.
5 Comments
I belive you posted that your surgery was on or about 8/15/23. Later you posted after several weeks the cornea swelling (edema) was 85% clear. By not it should be 100% clear. I would suggest you consider getting an independent 2nd opinion for an eye surgeon with fellowship training in corneal surgery. I also do not understand why you are on rhopressa if you do not have elevated intraocular pressure (IOP), It's possible that the prolonged use of steroid drops has caused "steroid glaucoma".
Yes, you are correct, and that is what I fear. I was switched from Dureazol to Lotemax two weeks ago. The surgeon said the cornea expert said it could help the migration of corneal cells to the affected area(?). I am having excessive tearing and nearly constant eye discomfort, as well as poor vision.
Will "steroid glaucoma" resolve after steroid drops are stopped? I am in the Yale network now. Do you have any recommendations for how to find a local surgeon with training in corneal surgery?
Will "steroid glaucoma" resolve after steroid drops are stopped? I am in the Yale network now. Do you have any recommendations for how to find a local surgeon with training in corneal surgery?
While steroid glaucoma ususally clears if steroids can be stopped, in a small number of cases it persists and requires on-going therapy. Have you actually seen a corneal specialist or did your ophthalmologist just do a phone consult. I do not know cornea or other ophthalmologists in your area. If you have a univeristy with medical school within driving distance that could be a good start. The other thing if you have a good relation with you surgeon is to say "I'm greatly concerned about the failure of my vision to clear, I would like you to help me to get in to see the best corena specialist within driving distance.' While patients rarely asked me for a second opinion, usually because in difficult cases I was very quick to ask for help, if they did I was never offended. Given the unacceptable delays in getting medical care these days, I would start tomorrow (Monday 10/23/23) make it happen.
Thank you. I spoke with my surgeon and he said he would make an appt. for me with a cornea specialist (at Yale) for this week. He said to reduce Lotemax to 2 X/day and stop the Rhopressa. I am wondering if I should try to make an appt. with a cornea specialist outside of Yale or wait until after I see the one at Yale. This whole thing has been a pretty distressing situation with, what seems to me, to be inadequate communication from start to the present. I appreciate your input.
It would likely take you much longer than a week to get into a different corneal specialist.
MEDICAL PROFESSIONAL
If this is her only useful eye, unless she is dramatically betteer, I would work on getting in to a corneal specialist as soon as possible. Concern about 'cold sores' raises the possiblity of Herpes Simplx. Steroids is not optimal treatment for that.
44 Comments
Cold sores was excluded after she said she never gets them.
Do you have any idea why this happened suddenly after the vision was so clear? Btw, dr had her vision at 20/40 so that she still needed the glasses for added protection to always safeguard that eye, which she is glad for.
My Mom is so nervous as you can imagine.
Would you give the drops and steroids a week as suggested by the dr and have him re-check as he said?
Do you have any idea why this happened suddenly after the vision was so clear? Btw, dr had her vision at 20/40 so that she still needed the glasses for added protection to always safeguard that eye, which she is glad for.
My Mom is so nervous as you can imagine.
Would you give the drops and steroids a week as suggested by the dr and have him re-check as he said?
Sorry, I am assuming the HSV is ruled out. I just want my Mom to see clearly again.
HSV is not ruled out if has not had before. There is Primary HSV, and some people also do not recognize HSV when it occurs. Consider making the cornea appoint starting today unless both of you feel it is getting dramatically better.
We're taking her back to the doctor today. I'll update. Thanks.
Dr. saw her this morning and things are a little worse, so he is referring her to corneal specialist.
I hope he can get her in ASAP, not something you want to put off a week.
I forgot one detail. The swelling is in the center of the cornea. They're getting her in ASAP. Thank you!
The cornea specialist he wanted is scheduled out to March, even with Dr. requesting she be seen asap. He is sending her to another dr who completed a cornea fellowship at Wills. Waiting to find out soonest appt. available.
I want you to know both as a physician and as a patient, I am appalled at the waits to see physicians especially critical subspecialists. I think Wills has an ER if nothing else. Most geneneral ophthalmologists have subspecialists they refer to regularly that they can call and say "I'm really worried about this patient will you see today or tomorrow? Or if you don't see this patient today or tomorrow I'll never send you a patient again.
I agree. I appreciate your replies and support. The new appointment here in Lancaster, PA is on Monday. I'll be taking her. I'll update. I hope you don't mind. I figure our situationand journey might one day help someonein a similar situation.
Updating after Mom's appointment. The doctor saw the corneal swelling as the other doctor did, but with lots of detailed pictures that were taken and a thorough examination, he said he also sees the cornea is detaching from the back. (?) I hope I have this right. He put in an air bubble and gave her instructions to lay flat for 24 hours as much as possible, as well two other types of drops. He is hoping to avoid corneal transplant with trying this approach first as it is less invasive and worth a try. He had her lay flat for about 30 to 40 minutes after placing the air bubble and then a eyedrop to dilate. He said this can sometimes make the eye pressure rise, so he checked that too before we left. Everything was normal with that and he said the corneal swelling was already starting to lessen. We are cautiously optimistic this might work, but he said there are no guarantees. If this doesn't work, then a corneal transplant in a month or two would be the next step. It's good to finally have some answers.
I actually wrote a paper on this. The problem is called decemet's membrane detachment. LINK https://pubmed.ncbi.nlm.nih.gov/1480380/ I also used air in the anterior chamber. If it doesn't work usually a corneal transplant is not necessary. Corneal transplants are huge surgery, extremely long healing time and many possible complications. The more modern technique is to remove from the patients eye the endothelium and descemet's membrane and replace it with healthy tissues from a donated eye. It is call DSEK LINK https://eyewiki.aao.org/Descemet_Stripping_Endothelial_Keratoplasty
Descemet was the term he used, yes! He also explained the more modern approach to corneal transplant, so I think the procedure you mentioned is what he was referring to. I'm praying for this to work so we can avoid further surgery. It makes me nervous since this is her only useful eye.
Thank you for your great insight and information. It's very much appreciated.
Thank you for your great insight and information. It's very much appreciated.
The doctor referred to the procedure as DMEK. I'm hoping the air bubble placement is sufficient and we won't need to proceed with anything else, but we'll see. He is having her come back in on Wednesday morning.
The two acronyms DSEK and DMEK and are naterially different. They are far less invascive and less dangerous that corneal transplant. Somewhat disconcerting that the treating ophthalmologist did not pick this up as usually not a difficult diagnosis in most cases.
The air bubble that was placed on Monday afternoon had helped a lot. On Tuesday, she was able to see texts and words on the tv again and her mood was so uplifted. We were hapy to see such an improvement in just one day. On Wednesday I took her to her appointment for him to check things. She did mention that it was just a bit foggy, unlike one day prior. She notices on one side of her eye, it is not as clear. So Doctor took more detailed pictures, did an exam and said it's 60% better but showed us a small area that is not reattached yet.
He is doing everything he can to avoid DMEK and said the the aor bubble was down to almost nothing and said he did make it a little smaller . He said we could do a bigger air bubble and that's what we did. Pressure has been good before and after.
We are hoping the 2nd air bubble can get the last part to reattach like the rest. She remains hopeful and the Dr is optimistic that it's going to work. Again, the doctor said she's still a bit of a mystery to him as he has never seen a spontaneous, late detachment two months after a suvcessful cataract surgery and 2 full months of great vision.
I'll update again later.
He is doing everything he can to avoid DMEK and said the the aor bubble was down to almost nothing and said he did make it a little smaller . He said we could do a bigger air bubble and that's what we did. Pressure has been good before and after.
We are hoping the 2nd air bubble can get the last part to reattach like the rest. She remains hopeful and the Dr is optimistic that it's going to work. Again, the doctor said she's still a bit of a mystery to him as he has never seen a spontaneous, late detachment two months after a suvcessful cataract surgery and 2 full months of great vision.
I'll update again later.
Yes I have never heard of a descement's membrane detach 2 months aftere successful surgery
She was born with a cataract in her right eye. That was removed. That's the eye that has optic nerve damage, also congenital. I'm not sure if these details add anything to the mystery or not. The doctor mentioned there is a genetic condition sometimes but after looking in both eyes, says no, he does not feel it's genetic.
We go back to the doctor today. I'm praying for good news.
We go back to the doctor today. I'm praying for good news.
I forgot to mention in the right "blind" eye, she is able to see a little on the side, so it definitely helps with peripheral vision, but the eye is basically useless other than seeing a little on the side. She always says if that vision extended over her whole eye, that she would see very well in it.
Thanks for sharing your expertise and wise advice. You are such an asset to society and this forum! I read your bio online and you're quite an amazing doctor.
If this fails and she needs the DMEK, I hope that will be successful with no complications. She's very independent and wants to resume her active, wonderful life
I'll update.
Thanks for sharing your expertise and wise advice. You are such an asset to society and this forum! I read your bio online and you're quite an amazing doctor.
If this fails and she needs the DMEK, I hope that will be successful with no complications. She's very independent and wants to resume her active, wonderful life
I'll update.
Thanks for the kind words, 97% of the posters here fail to offer any thanks or note of appreciation.
Dr. Hagan,
The appointment went very well. The Doctor said her vision was better this time and the air bubble is still fairly large. He said it will likely be gone by the end of the weekend. He said things are moving in the right direction and he is pleased with her progress. He could see the area that was still detached on Wednesday starting to attach now, which is good news for us! Her pressure is still good, too. She did well on the tests and her pinpoint visual test was 20/25. She said it's just a little foggy yet, but doctor is feeling very confident this will work. He said the rescue option of DMEK is still there but doesn't think it will be needed and is trying to avoid it with this less invasive approach. He did say that it *might* take another bubble (or two) but to be patient. He wants her to stay sleeping on her back as this is optimal.
We left feeling in very good hands and all questions were answered and welcomed.
Seeing my Mom's relief was palpable and we are extremely hopeful for a good outcome. He will see her back in the office on Wednesday.
The appointment went very well. The Doctor said her vision was better this time and the air bubble is still fairly large. He said it will likely be gone by the end of the weekend. He said things are moving in the right direction and he is pleased with her progress. He could see the area that was still detached on Wednesday starting to attach now, which is good news for us! Her pressure is still good, too. She did well on the tests and her pinpoint visual test was 20/25. She said it's just a little foggy yet, but doctor is feeling very confident this will work. He said the rescue option of DMEK is still there but doesn't think it will be needed and is trying to avoid it with this less invasive approach. He did say that it *might* take another bubble (or two) but to be patient. He wants her to stay sleeping on her back as this is optimal.
We left feeling in very good hands and all questions were answered and welcomed.
Seeing my Mom's relief was palpable and we are extremely hopeful for a good outcome. He will see her back in the office on Wednesday.
Thanks for follow up, prognosis is good.
This morning I talked to her and she said it is foggier, which started last night. I said it's still early morning and maybe it will get clearer as the day goes by. I do see how frustrating it is for her since things are reattaching, so one would think the fogginess would dissipate and also since the air bubble is decreasing 8n size.
I did some googling and thought I would ask if you've heard of success with either strategy.
Here's a link to one of them.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820919/?fbclid=IwAR0DDaKuVI6CYgBqyW2jnkbtKhb0VrqJZ2rerlgZl67gWs-7mxADgbISfCM
The second article talked about using the air bubble, but adding a second step which uses a syringe to aspirate some fluid, thereby allowing the membrane to adhere better.
I don't want to overstep my boundaries with this very nice doctor and bring these up. Googling can sometimes be foolish and not give us accurate or valid information.
She goes back to see him Wednesday. Still hoping this fogginess clears.
I did some googling and thought I would ask if you've heard of success with either strategy.
Here's a link to one of them.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820919/?fbclid=IwAR0DDaKuVI6CYgBqyW2jnkbtKhb0VrqJZ2rerlgZl67gWs-7mxADgbISfCM
The second article talked about using the air bubble, but adding a second step which uses a syringe to aspirate some fluid, thereby allowing the membrane to adhere better.
I don't want to overstep my boundaries with this very nice doctor and bring these up. Googling can sometimes be foolish and not give us accurate or valid information.
She goes back to see him Wednesday. Still hoping this fogginess clears.
For the last 23 years of my practice I have been in a large group with three exceptional corneal surgeons. Thus I have not managed one of these cases in a long time, and even when I did then they were extremely rare. I do not have the expertise or experience to comment on venting procedures. I did have one case where air failed twice and SF6 a longer acting gas that does not reabsorb as fast as air was used. However in the case report you found SF6 failed to work. I don't think I can add any more and you should rely on the surgeon with corneal training who can actually see the problem.
Will do. Today, she said it looks like it's as foggy as it was on Monday. She'll call Dr. later and see if she can get in before the scheduled appointment on Wednesday.
After we discussed this journey so far, she reflected back to when it first happened and she went back to her other doctor, opthalmalogist who did the cataract surgery. He saw the corneal swelling and after the drops didn't work. (it was then he decided to send her to the corneal specialist. ) He knew my Mom was worried and he reassured her she wasn't going to go blind. He told her that if she ever needed the DMEK not to worry because it has an excellent success rate and she would be back to herself in a few days. I sure hope this is the case.
After we discussed this journey so far, she reflected back to when it first happened and she went back to her other doctor, opthalmalogist who did the cataract surgery. He saw the corneal swelling and after the drops didn't work. (it was then he decided to send her to the corneal specialist. ) He knew my Mom was worried and he reassured her she wasn't going to go blind. He told her that if she ever needed the DMEK not to worry because it has an excellent success rate and she would be back to herself in a few days. I sure hope this is the case.
I hope that is the case
Dr did the vent and a bigger bubble today. She needs ti lay flat for 24 to 48 hrs.
May be 'the answer'
Three days after the big bubble and vent and Mom says it doesn't seem any better. We're all just very sad snd scared. Maybe the next two days will be better. I'm worried she'll need DMEK and with only one eye, it's very upsetting.
Hope for the best. But if DMEK is needed, know that it is much safer, much more effective, much faster healing than a corneal transplant.
Thank you, Dr. Hagan.
We're getting diminishing returns on re-bubbling. Mom's vision was so bad this time she couldn't see any letters on the chart, not even the huge E. Dr said it's re-detaching. He wants to do DSEK. Will move her up for surgery around Nov 15th. Since she was afraid it would get worse until then, a final " hail mary " bubble was placed to hopefully hold her at bay until then. Appt this week to go over all the info for surgery. He's wonderful!
An interesting thing is that after laying in supine position for 30 min following bubbling and checking pressure, doctor said it was fully attached again. I guess it just won't stay attached and herein lies the problem where we end up at square one.
I forgot to add he showed me the image before bubble and said still central detachment but spread a little. This looked a little wavy unlike the prior image of detachment which was rounded.
That couse of action sounds like a good plan. Reassure your mom that the procedure is relatively simple and has a good chance of success.
Mom had her follow up apointment and the Doctor said he feels DMEK will be best, over DSEK.
The past two days her vision improved just slightly to where she went from very foggy to only a light fog and she was able to text and see more writing on the tv. She thinks it could be due to the doctor stopping the eyedrops that dilate! Surgery is scheduled for next week. Thank you, Dr. Hagan.
The past two days her vision improved just slightly to where she went from very foggy to only a light fog and she was able to text and see more writing on the tv. She thinks it could be due to the doctor stopping the eyedrops that dilate! Surgery is scheduled for next week. Thank you, Dr. Hagan.
Happy to help. I think this will have a happy ending.
My Mom's vision is almost 100% back to normal! If things stay this good, she wants to cancel surgery. She'll be contacting her doctor tomorrow. I'm sure he'll be as thrilled as we are and will bring her in to re-examine her. This is amazing!
Well, now after she put in the prednisone and moxafloxcine drops , her vision is slightly blurry. These are the drops the doctor wants her using prior to surgery.
Any type of drop can blur the vision for a variable period of time. If she woke up with clear vision that is extremely encouraging as cornea edema is usually worse upon awakening and gets better when the eyelids are open. No surgeon wants to operate on a happy patient. Might be good to discuss postponing the surgery.
Her doctor examined her today. Her vision is 20/50. He said surgery is not indicated at this time, so it's cancelled. Yay!! He was very surprised to see this much of an improvement and said it has nothing to do with the last bubble. He wonders if the vent incision helped. He has never seen anything like her case. He has no explanation for it and cannot promise anything, but he said he has a good feeling it might fully reattach on its own since it has come this far now. He said only a tiny bit of swelling. We are all hoping this stays reattached and that the last little bit attaches fully, in time. My Mom is staying cautiously optimistic. What a month it's been! Doctot advises no drops other than muro. He will re-check her the day before Thanksgiving. So the plan is to give it more time to heal on its own. If it fails to fully reattach or things take a bad turn, we can do the DMEK.
Good news. Intuitively I think she will do well
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