I had cataract surgery a three weeks ago and I had a Acryfof Toric lens implanted. At my post op appointment, I complained to my Dr. that I was seeing wavy lines. Upon examination, he discovered that a part of the cataract was still in my eye! I asked how often this happens, and he said," very rarely." He decided to remove the remaining cataract immediately in his office using numbing drops. He said " you'll feel some pressure." The numbing drops didn't work! It was like a torture chamber and I couldn't stand it! After I started moaning, he stopped. I told him I didn't feel pressure, I felt intense pain! After he examined me again, he said he had gotten 75% out but that 25% remained. He scheduled another appointment for the following week to see if the remaining piece of cataract would dissolve by itself. It didn't. My husband came with me for the next appointment and the Dr. decided to take the reaming part out under anesthesia. After my very first surgery, I was seeing better and had removed the lens from my glasses. After the third procedure at the surgery center instead of getting better vision, I got worse. I went from 20/25 to 20/80! The Dr. said I had some edema in my eye. This is not the outcome I had anticipated! I asked him why my vision got worse instead of better and he replied..."it happens." He said he'd set me up with another Dr. if I would like another opinion in case me missed something. . It has been 2 weeks since the third procedure. My next appointment is in 2 weeks. Have you ever heard of anything like this happening? It has been a nightmare!
1. Part of the cataract is always left in the eye and that is the capsular sack that holds the IOL in place.
2. In your case some "nucleus" (hard) or "cortex" must have been left in the eye. Nucleus doesn't disolve so it must be cortex.
3. Try to remove cortex in the office is a stretch and it does happen that some is left behind but it is generally done in the operating room with anesthesia.
4. All that manipulation could cause the cornea to swell (edema).
5. There is a chance that things will still turn out good for you. See what the consultant thinks
I had my 2nd cataract surgery done last week. The first one (left) went well, the second one (right) not so much. My vision has only improved somewhat ... I still have all the symptoms I had before the surgery ... yellowish haze, dim, grainy and blurry. Plus the focal distance is off between the L & R eyes (meaning objects in the left eye seem a little further away than in the right eye). To me it's as if some (maybe 50%) of the cataract was not removed. Does this occur often? Can the doctor see if there is cataract still in there? Can the remaining cataract be safely removed? ( for some reason when I first tried posting this it, ended up in a different discussion so I apologize if you see both the posts).
Yes, an ophthalmologist can look at your eye and see if there is a clouded remnant of your old cataract still in there. As Dr Hagan stated before, it's possible that the capsular 'bag' that your old lens was removed from could be clouded.
Have you had a followup with your cataract surgeon, other than the day-after-surgery visit? If so, did you describe the problem that is still happening with your right eye? What did the doctor say?
If the problem is a clouded capsular bag, there is a laser treatment (YAG laser capsulotomy) that may be able to help. But it's premature to discuss any treatment until the cause of the remaining vision impairment is identified.
It's also possible you have some issue with your retina such as an epiretinal membrane or scarring; this can cause blurring and a disparity in size between objects viewed between the right and left eye. If your cataract was severe, your doctor may not have been able to see much detail on your retina before, since the cataract would have been in the way. I don't know if an epiretinal membrane or scarring can cause a color difference ('yellowish haze') or dimming, though.
You should return to the cataract surgeon with a written list of all of the vision problems you see with your right eye, and ask for the doctor's opinion of what is causing them.
Since you are having symptoms you should probably not wait for weeks for your next followup visit - call and go back as soon as you can, if you have not already done so. Please let us know what you find out. Good luck!
Thank you so much for the quick response ... yes I have an appointment scheduled for late next week but I plan to call tomorrow to see if they can move it up for me. I agree that I don't want him to use the YAG without first being sure the cataract has been completely removed or if there is some other issue. I've been doing as much research as I can before seeing him (such as this site) to help me make an informed decision when I'm there. I will definitely post a followup after I see him. Thanks again for the input.
Here is my followup from this todays exam ... He assured me that none of the cataract is still in there and that everything looked good (no YAG laser needed).
I do still have some inflammation (normal) and also, as you suggested, he says I have an epiretinal membrane, along with some increased thickness of the back wall of the retina (hope I explained that correctly).
He did switch one of my eye drops from Ketorolac to Prolensa to help address that. He also increased the Prednisolone to 5x a day.
He suggested that more healing time and good glasses should help to minimize the focal disparity issue.
I am scheduled to return next Thursday to check everything again.
I'm glad you were able to be seen quickly and get some answers to your questions. It's also good you do not need the YAG procedure, and hopefully the medication adjustments will reduce the remaining inflammation.
Once your eye inflammation is gone and the cataract surgery is fully healed, you can gauge how much of a problem the epiretinal membrane symptoms are for you. Glasses may be able to help with the disparity in the size of images between your two eyes.
Ultimately you can decide whether you can adjust to the vision you have after healing and good glasses. There is a type of surgery available to remove an epiretinal membrane but it comes with certain risks, so patients who can do well with the membrane in place often decide to leave it alone. This is especially true if it is stable, and not getting worse, and if vision is pretty good despite the membrane.
Good luck to you with the healing and inflammation; please keep us posted on how your vision is once your current surgical healing is complete. Fingers crossed that your vision keeps improving!
One additional thing also came to light while I was waiting for the doctor.
Out of boredom I picked a small book next to me about Glaucoma (which I also have) and observed that the text (which was small and close together) had a small wave (distortion) on one line when viewing with the problem right eye. The left eye is good ... totally straight.
This freaked me out a bit because I quickly remembered the Amsler grid test which I had just read about the day before. The distortion is small but with everything happening it worries me that much more. I did mention it to the doctor when he came in.
I'll post again in a week or two with any updates. Thanks again for all your help and input.
A common symptom of epiretinal membrane (ERM) is the type of distortion you described. My father has an ERM and he has the same type of distortion, visible with any type of straight lines like window pane dividers, small lines of text, etc.
If the doctor already told you that you have an ERM it is a likely cause of your distortion. Still, it's good that you mentioned this symptom to the doctor.
You may want to jot down an updated list of symptoms you are seeing next Thursday am, before your appt, just so you don't forget to mention anything at your next followup. Good luck!
Good morning Flossy93 - This is an update on my progress. After two my more visits the doctor added prisms to my lens ... first to the problem right eye ... bringing things a bit closer ... then to tweak further adding to the right eye to push things out. This is not perfect, but has gotten the images from both eyes to be fairly close in alignment and minimize the double vision. But because of the ERM, the right eye vision is still blurry and distorted. I am able to deal fairly well with this ... but watching TV and especially driving can be difficult. At this point I'm afraid that this is the best I can expect without having surgery. Hopefully time will also help my brain to better process the two images. My next follow-up appointment is at the end of April and I'll will post again if there are any new developments.
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