Posterior Subcapsular Ccateract

I had a vitrectomy for a R.D. 15 weeks ago but have not been able to see 20/20 distance vision as before (the R.D. was treated with viterectomy, air buble, lazer and cryotherapy and did not come close to involving the macula); I am very myopic but have alway had correctable to 20/20 or even 20/15 vision with my rigid gas perm. lenses.  My Retina surgeon says everything went very well and did extra picture studies of my retina to confirm, at my insistence as my vision was not improving.  My optometrist can not explain the lack of visual acuity and is puzzled; she did a topograph of my cornea and despite 30+ years of RGP lens wear, the cornea looks good.  She is sending me to a cataract/corena specialist as she seeing a very small "posterior subcapsular cataract" in that eye now which I understand can be a complication to the vitrectomy and is not the normal age related cataract.  Is this a correctable condition via surgery (laser or IOL implant)?  Please give me any options or risks associated with possible surgery. Is this condition progressive?  Without examining me, is this treatable and with what success rate?  Thank you so much for your time. - huberd

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

Your vision could be reduced due to vitreous floaters, macular edema, epiretinal membrane or cataract - just naming the major culprits off the top of my head.  Make sure macular OCT scan looks totally normal, first.  That would rule out macular edema or membrane. If major floaters are not present, and cornea is fine then start looking for a possible cataract.  Try a PAM (potential acuity meter) to see of your retina is still capable of 20/20.  If no PAM available, you should be able to see 20/20 looking through pinhole at office.  The pinhole test should give you a rough idea what you might be capable of seeing with a perfect cornea and no cataract.  If you can't see 20/20 with the pinhole - then you probably  have a retina or optic nerve problem.  These are just general statements and may not apply to you exact case.  These can be tough cases.  Sometimes all the test come out normal and we end up just doing the cataract surgery because we have exhausted every other  possibility of improving the vision.  As far as risks of cataract surgery - you need to wait to find out if you really need it first.  If you do need it - the procedure should be a walk in the park compared to the retinal surgery you have already  had.  I just want you to know that your situation is very typical and not unusual at all.  I would not call the cataract a complication of the vitrectomy and air bubble - just a common after effect.  Good luck with everything - it sounds like you're just a little bit off 20/20 right now.  If the detachment had not be repaired you could have no vision.  Just putting a positive spin on things.

MJK MD

[Michael J Kutryb, MD]

Your vision could be reduced due to vitreous floaters, macular edema, epiretinal membrane or cataract - just naming the major culprits off the top of my head.  Make sure macular OCT scan looks totally normal, first.  That would rule out macular edema or membrane. If major floaters are not present, and cornea is fine then start looking for a possible cataract.  Try a PAM (potential acuity meter) to see of your retina is still capable of 20/20.  If no PAM available, you should be able to see 20/20 looking through pinhole at office.  The pinhole test should give you a rough idea what you might be capable of seeing with a perfect cornea and no cataract.  If you can't see 20/20 with the pinhole - then you probably  have a retina or optic nerve problem.  These are just general statements and may not apply to you exact case.  These can be tough cases.  Sometimes all the test come out normal and we end up just doing the cataract surgery because we have exhausted every other  possibility of improving the vision.  As far as risks of cataract surgery - you need to wait to find out if you really need it first.  If you do need it - the procedure should be a walk in the park compared to the retinal surgery you have already  had.  I just want you to know that your situation is very typical and not unusual at all.  I would not call the cataract a complication of the vitrectomy and air bubble - just a common after effect.  Good luck with everything - it sounds like you're just a little bit off 20/20 right now.  If the detachment had not be repaired you could have no vision.  Just putting a positive spin on things.

MJK MD

[huberd]

Thank you so much for the input, the last 15 weeks have been quite stressful;  I was seeing 20/25 or better with a pinhole test in my retina surgeon's office just 3 weeks ago; but with my corrective lenses in, I am only seeing 20/50 with additional diopters of power doing nothing.  Initially they thought I may have developed some form of astigmatism but my optometrist said she found very little astigmatism and that the power in my two contacts should be very similar - of course I can't see any real distance in my recently corrected eye although my very near vision is quite good;  weirdly enough, without contacts my vision is nearly identical in both eyes.  I will ask the cornea/cataract specialist about the tests you mentioned.  If I did have a Posterior Subcapular Cataract that needed to be removed, is it not harder to surgically correct given it's location toward the back of the lens?  Would this involve removal of the lens and a interocular implant?  Does this surgery generally have good outcomes?     huberd

[Michael J Kutryb, MD]

Very routine surgey - most cataract surgeons have done hundreds or thousands.  They are no more difficult - and sometimes easier than regular nuclear cataracts.  In general - the risk is just a very small amount higher after previous vitrectomy - but still very low.  Yes, you will get an implant (IOL).  The Zeiss IOLMaster (a diagnostic test to measure you for the optimum implant power) will give you the best chance of getting an IOL that will provide the best possible distance vision.   About one or two cataracts I perform each weak are patients who had previous retinal surgery - it's fairly common.

MJK MD

[huberd]

Thank you so much. I can reast a bit easier now ...if that is indeed the problem.   huberd

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

You are welcome. I ask everyone that follows these Eye Forums every "week" to over look my "weak" spelling (going without spell check is tough) and my typing on the "fly". Such gaffes perhaps inject a degree of mirth ("Hey, look, I can spell better than that doctor").

JCH III MD Spelling dyslexic