catch 22 IOL or vitrecomy first

I am 38 years old and have small posterior subcapsular cataracts which were found about 6 years ago - the last eye Dr i saw said I probably had them when i was born, but i'm not so sure -I saw eye Dr's at least once a year before the cataracts were spotted and no one ever mentioned them. I have high myopia of -10 and hashimotos disease. Due to a combination of high myopia, and possibly the thyroid causing large eye - I have had a PVD in right eye six years  ago which caused severe floaters.

I have now decided to have a vitrectomy for the floaters - i know the risks but have tried to live with them a happy life and cannot, every eye Dr I've seen has agreed to operate and all have agreed the floaters are severe. My cataracts are starting to cause some problems in certain lights. The floaters in the lefty eye are mild.

If i have the surgery privately i can have combined IOL insertion and vitrectomy.The plan would probably be insert IOL for distance and leave contact lens in left eye which would not be operate don till the cataract gets much worse. However, the surgery is very expensive. I can have surgery for free, on the national health, however the different surgeon does not like combined surgery and will only do vitrectomy then IOL much later. My concern is that the IOL insertion later might cause more floaters - also i am worried that leaving vitreous close to a lens, that is only to come out a few months later, might leave residual floaters.

I am wondering about having the IOL first and then the vitrectomy so that during the latter sugery the surgeon can get clsoer to the lens . I would be very grateful for opinions on this idea, i feel the ideal is combined surgery, but i just can't afford it.                  

[JodieJ]

I am not an eye care professional, but I've had 2 vitrectomies and cataract surgery, and I've done some research about the issue you are raising.  I don't think that there is a consensus about the merits of combining vitrectomy and cataract surgery.  Some surgeons favor a combined procedure; others claim that the visual outcome is better with two surgeries.  With combined surgery, usually the retinal specialist performs both procedures (which might not be an advantage.)  With two different surgeries, usually the cataract surgery is done first only in cases where the retina is difficult visualize because of the cataract.

I'd recommend discussing your particular case with your retinal specialist.

  

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

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[lucymyope]

Hi Jodie

Thank you for your post. So in your opinion if two surgeries are required (one for cataract, one for floaters...with no other areas needing to be dealt with, touch wood) would ibe usual to do the vitrectomy first. The problem for me is that I live in France and I'm not fluent in French. I'm just a bit concerned that if the vitrectomy is done first (it would be a core vitrectomy whereas the private surgeon would perform a full vitrectomy) that vitreous with floaters in my be left to protect the lens as the surgeon will steer away from the lens...to me, this is a worry because the lens will come out anyway, in the cataract surgery later - basically, i dont want to have to undergo a 2nd vitrectomy which results from the cataract suregry creating more floaters. Therefore I wondered about having the cataract surgery first, so that when the vitrectomy follows, the surgeon doesnt need to steer clear of the lens. I'd be really grateful for opinions as due to the language barrier its difficult to discus this with the state surgeon.          

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

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[JodieJ]

I'm not at all knowledgeable about vitrectomies for floaters--my vitrectomies were for an epiretinal membrane.  My second surgeon, Dr. Steve Charles of Memphis, also performs vitrectomies for floaters, and his website has a feature allowing you to submit questions to him.  (Google for the website.)  Send me a personal message if you have a problem communicating with him.

I can think of a couple of advantages for postponing cataract surgery in your case until it's really needed (which might not be for many months after your vitrectomy.)  At age 38, your natural lens works better than any implant available.  And cataract surgery does increase the risk of retinal detachment.  But you really need a professional opinion from a retinal specialist about your best course of action.  



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[lucymyope]

thank you very much for your help Jodie

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

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[MrRLK]

Hi Lucymyope, I've had vitrectomy right eye, bubble for detached retina, and before that I had very bad floaters from the PVD (Left eye had laser cerclage).  I'd say they were disabling.  But the vitrectomy cleared them out!  I'm also very myopic at -15 or so.  Also I have very large eyes (my surgeon says they are huge!).  

I would suggest vitrectomy first as did other posters.  My reason is different, I would be more nervous about complications, such as PVR (excessive scar tissue).  Lots of studies out there show that one of the factors may be previous surgery for cataracts.  As you know, PVRs really limit a good outcome, and I think you want to be cautious.

I would do the vitrectomy first, wait for the eye to settle down, then do the cataract.  But of course, consult an experienced surgeon.

Thanks