Low vision after vitrectomy/IOL

[wh7qq]

65 yr old wh/male in good health but with CAD, hypertension, hyperlipidemia, and elevated glucose (~105) with severe myopia in both eyes (-8.0 correction).

I underwent a vitrectomy/ oil and laser retinopexy for retinal tears (4) last September.  The retina doc was happy with the result and predicted a good correction when all was said and done.  The follow-up vitrectomy to remove the oil was done in March and immediately post-op, I noticed strange patterns in my central vision but I had a well developed cataract by then and I wasn't sure of what I was seeing.  After cataract surgery and IOL implantation, I have blurriness in my central vision even though the basic correction seems good. Neither the cataract doc or the retina doc can see any problem with the retina and the retina doc did a flouresceine angio and an ultrasonic tomograph.  Both see a very small area of cloudiness and stria on the capsule.  The plan is to do a capsulotomy in August but the cataract doc says not to expect any great increase in vision.  The effect is very much like I put a small dab of vasoline in the center of a camera lens...translucent and blurry but with strange, changing patterns that are visible even in a dark room after plenty of time for dark adaptation. The result makes reading impossible with that eye as the effect on an Amsler grid is an oval area about 6 boxes either side of the dot horizontally and 3 either side vertically that is blurry.

Retina doc still says the retina looks "pristine" and can see no reason why I couldn't have a 20/30 correction.  The cataract doc pegs my current acuity at 20/200 and based on an MN test, predicts the same, post capsulotomy.

Suggestions?  Should I seek additional opinions...perhaps a neuro-opthamologist?  I am located in Hawaii but can fly to the mainland if needed.

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

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[JodieJ]

It's possible that your visual impairment is due to retinal damage, either from the tears or from the surgery to repair them.  If the damage involved the inner layers of the retina, it might not be visible during a dilated exam.

[wh7qq]

Thanks for the response Doctor Hagan.  The IOL is a single focus lens, I believe it is acrylic.  I am not sure of the manufacturer.  As the central cloudiness and wierd patterns appeared right after the oil removal (Mar. 1) and months before the IOL implant (May 29), that would seem to exclude the implant as a possible cause.  While there is some "haziness" and striations on the posterior capsule, due to its being so small, neither doc is convinced it is the cause but there isn't much else to hang a hat on.  I am scheduled for a capsulotomy late in August to rule it out.

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

Is the IOL a premium IOL (multifocal type) like ReStor. They have been associated with "vaseline" vision which is exactly like you describe. If its a high quality IOL but made out of silicone it may have been damaged by the silocone oil in your eye. These are likely causes.

other cause could be a opaque spot on the posterior capsule but that should be easy to see.

Macular pucker, membrane, hole, edema are possible but the OCT should have shown this.

FInd out what type of IOL if multifocal or silicone perhaps get a second opinion as if the iol needs to be replaced its much safer without a hole in the posterior capsule.

JCHDM