ke4yyd

I had cataract surgery on June 9, 2007in my right eye.   During the pre-surgery prep an abrasion occurred on the cornea. Surgery was performed and I was examined again late in the day.  The Dr. said a contact lens was place on the eye as a bandage.  On the next day I experienced severe pain and went back to the Dr.. The bandage had come out and another was fitted and placed on the eye.  I had quite a bit of pain, sensitivity to light  and vision fluctuations.  Several days later the bandage was removed and the Dr. said the abrasion had healed and the surgery was fine.  However I continued to have pain and light sensitivity which seemed to be amplified by the medications.  At the time I was using PredForte, Accular and Zymar.  I had used Accular before and was used to the temporary stinging common with that drug but now the stinging would last for hours.  The Dr. changed from PredForte to Lotemax.   The light sensitivity was so bad that I had to wear two pair of sunglasses when out side and one pair while using the computer or watching television. I still had fluctuation vision.  A month after surgery I had outpatient back surgery , at which time I stopped taking all eye medications. The post surgery required that I take 5 day regimen MedPak of Prednisone. The MedPak seemed to help more than any of the eye drops At the end of that period, my eyes had much less pain, the light sensitivity was reduced and my vision settled down.  I experimented with my eye drops and found that by using any of the drops including OTC dry eye drops aggravated my light sensitivity.  So I stopped taking any eye drops. I had to have a skin cancer removed by a dermatologist and he felt that I was allergic to BAK, the preservatives in the eye medications. I have to this day refrained from taking any eye drops except preservative free for dry eyes.  

Due to post size limitations I will continue on follow up below.

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

Hello ke4yyd    First it's important to find out which eye is so sensitive to light. Often it's mainly the unoperated eye with a cataract. You need to test both eyes in bright light and at night to see if it's the operated eye or the other eye with cataract that is causing the problem.  Most patients with a lens implant in one eye and a cataract in the other have some light sensitivity and glare and problems with ngiht vision. Most or all of this usually clears after the other eye is fixed.

Most eye drops have preservatives except for single use artifical tears. Pred forte and lotemax are antiinflammatory steroids. You should not need them this far after surgery. Zymar is an antibiotic. Your eyes don't seem infected so you don't need an antibiotic.  Best stay with the lubricating tears without preservatives.

The corneal abrasion should not have caused any change in the implant power determination. Most surgeons and most patients are happier with a little resideual myopia as you have. It lets them see without glasses in the mirror, shop and computer distance.

-0.75 is within the standard diviation of implant formulas. Yes you could most likely have lasik to correct the residual myopia. Since you need glasses for the other eye and will need glasses for intermediate and near vision in the operated eye (and the other eye when it's done), you would to decide if its worth the time, expense and chance of complications to have that done.

Arcing is a form of entoptic phenomena. Look it up on Wikipedia for a full discussion.

20/15 corrected vision after cataract/implant surgery  is a "success" story.

JCH III MD  Eye Physiciand & Surgeon

[ke4yyd]

Most of my pain problems have cleared up.  The light sensitivity has decreased but on some days it is worse than others.  The light sensitivity is in both eyes. I often have a dull ache in my right eye.  I still use two pair of polarized sunglasses to drive.  My eye was examined for glasses and my eye required a -0.75 correction to get 20/15 vision.

I have put off the second eye surgery hoping the complications with sensitivity would clear up.  I have some questions.

Are there any medications that are preservative free besides Accular that can be used in my eyes?  If not, are there oral medications that can be used in place of PreForte or Lotemax and Zymar?

I was disappointed that I needed glasses for distance when I chose a distance replacement lens.  Could the abrasion have altered the cornea so that the calculated replacement lens was not as accurate?  All my aquaintances that have had cataract surgery have not had to wear glasses for distance vision.  Is  -0.75 within the normal expectations needed for correction after cataract surgery for distance vision.  My RX for that eye prior to surgery was -1.75.  Could I have Lasix to further refine my vision to 20/20.

[ke4yyd]

One other comment.  I have a flash of light noticeble at night when I make a quick eye movement.  I have had floaters and little flashes for years but these flashes are more pronounced.  Would this be what someone on another post called "arching"?  I can't find anything on the internet about arching.

[ke4yyd]

Thanks for your reply,  For further clarification,  since I am allergic to the BAK preservative in eye drops and they will be needed when my second eye is done are there oral antibiotics and steriods that can be used instead of the drops.  I know there are preservative free Accular drops.  When I stopped using the eyedrops and was taking the oral prednisone after my back surgery my eye pain and sensity improved dramatically.  

Thanks again nfor your reassurance.

David

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

Hello ke4yyd   You know when you take prednisone most everything feels better for a while. It's the late complications that are terrible to deal with.

Very frankly I have not found BAK preservative allergy to be a big problem except on some types of contact lens wearers and perhaps some glaucoma patients. Post operatively you'll be on some type of steroid drop and that should suppress allergy/inflammation. I don't like to throw numbers around lighly but I've done over 10,000 cataract/implant operations and just have not found that (BAK allergy) to be a problem.

Eye drops give a much higher intraocular level than pills and are much preferred.

JCH III MD  Eye MD