Post detached retina surgery why has my myopia increased

[Dp707]

I had a blow to the left eye in January 2015 and floaters and a shadow at top of visual field oct 2016. Diagnosed as partial retinal detachment Jan 2016. Sucessfully repaired Feb 2016, also had vitrectomy.

Before I was -4.5 myopic both eyes. Now I am  about -9 in the left. However the blurr in the left eye isn't full correctable with contact lenses, slight multiple images and difficulties making out say O and Cs. I've had several opinions some say it is a cataract others damage to the lens sac from the probes used in the op, I.e the back of the sac has been snagged. My questions are; why has the eye gone more short sighted? What is causing the uncorrestable blurriness? What is the solution? I'm already booked in for cateract surgery, and trying to decide on NHS or private, single focus or multi focal. If the sac is damaged though will this solve the problem.

[JohnHaganMD]

First of all its not likely that your sac was "snagged' during your surgery. Far more likely that the sac was injured when you eye had the blow to the eye. The increased myopia is due to the cataract, as they grown often they make the eye more myopic. This is called false or "pseudo" myopia since its not due to the eye changing shape. You are not a good candidate for a multifocal IOL due to your injury/surgery and I would suggest you consider avoiding. Your surgery will be more complicated than normal because of the injury and sac (technically the capsule) problem and you need to find an ophthalmologist that specializes in complicated cases. Most regular cataract surgeons are not trained to deal with this type of problem.

[Dp707]

Thanks for your quick and helpful reply John. The only thing is though my vision in the eye was still perfect with correction apart from floaters and the shadow up until the op but after when the gas dissipated I had more extreme and not totally correctable fuzziness on the eye test chart
Also although I thought myself the fuzziness didn't totally equate with the description of effects from a cateract I saw a specialist who also claimed it wasn't a "standard" cataract and said he could see damage as though from the 3 probes inserted during the op. When I look at an eye chart the letters are sort of diverged into 3 overlapping shapes as well. That's the best description I can give.

[Dp707]

Ps do you still think lens replacement would solve the problem if the capsule is damaged. It sounds like I do need lens replacement anyway if you say the increased myopia is definitely due to a cataract, although I get reasonable say 17/20 vision with a -9 contact lens

[Dp707]

Pps is there a particular reason to not have multifocal e.g risk of complications

[JohnHaganMD]

1. No way I can tell what the cataract looks like and what the shape of your retina and macula is. 2. A vitrectomy causes cataracts to develop or if present to grown. 3. The "ports" into the eye are a long way from the capsular bag so I think it's trauma. 4. Multifocal are not a good option for anyone with retina or macular pathology because the optics are not as good and are more prone to glare and complications. Also the multifocal have to be in perfect position to work whereas a monofocal IOL can be off center and work fine. 5. cataract surgery is generally always elective and if you want to wear contact lens for a while that is usually fine.

[Dp707]

Ps I also have to decide whether to have the -4.5 eye lense replaced I don't like the idea of this as the corrected vision is great and worried about complications if I have it touched