replacing lens implanted during cataract surgery

[LeeAnnBu]

My doctor used a toric lens to correct astigmatism and a cataract.  My vision is worse than it was and can not be corrected by glasses.  He says he used the wrong lens; now my astigmatism is horizontal instead of vertical (? or vice versa) and he needs to remove that lens and use a spherical lens.  Is this done frequently?  What are the dangers?  Any suggestions?

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

1. Use the search feature and archives to read about retinal detachment surgery and macular disease.
2. Unfortunately with the type of problem you have retinal detachment probably with macula off the vision often does not return to normal even if the retina is reattched.
3. It sounds like you have macular edema now sometimes called CME.
4. I recommend a second opinion with a different retinal group.

Again return of normal vision after a retinal detachment especially if the macula was pulled off is very very common.

JCH MD

[Chele830]

I am new to this so forum so please bear with me. I am a 54 year old female. I had a torn and detached retina in my right eye repaired in October.  Tear was repaired with laser and gas bubble and positioning for a week so the retina surgeon could perform a sclera buckle(sp) successfully.  The buckle procedure was performed and several more weeks of eye drops and face down positioning.  As expected a cataract formed and my eye Dr./Surgeon recommended removal and a Toric IOL 11.0D implant due to my high nearsigntedness.  Had the Toric implanted December 16.  I was so I was excited about the possibility of seeing out of this eye without contact lenses (as previously worn) and returning to a normal life.  After the lense implant my D. followed up the next day with an exam and I told her that my vision seemed the same--it was blurry and foggy somewhat the way it was prior to the lense implant.  I was told to up my eye drops from 2x daily (Acular and PreForte) to 3x and to return in two days.  No change in vision but upon examination by the Dr. was told that there was a membrane that sometimes forms behind the implant that would be polished off and that I had formed one.  A YAG laser procedure was done on January 5 and the Dr. commented how thick the membrane had gotten but said that the membrane had been lasered and that I would probably notice a floater later in the day and not to be alarmed that it was the remainder of the membrane falling away.  Again, I was so hopeful that after a good nights sleep I would wake up the next day and see.  It as been 3 1/2 months of anxiety and disappointment.  Well the next day I awoke to the same blurry vision.  I called the Dr., and saw her again the next day.  She said that the lense was completely clear and said that my eyes were incredibly dry and had a hard time refracting my vision.  I stayed for several minutes and tried both a gas perm. and soft contact lense on that eye to see if that would help.  It did not.  She wanted me to see the retina doc and come back to see her this coming Tues Jan. 12.  Saw the retina doc Jan. 7 who checked the retina (which was still in place thank God!) . He saw nothing remarkable except that the retina was a tiny bit thicker and a little fluid which he attributed to normal healing after all the procedures but did change my eye drops to Durezol .005% and Xibrom .09%.  So my question is why can I still not see clearly out of this eye. I don't feel comfortable to drive which is a huge part of my work.  I have read as many of these posts as I can and I don't seem to find anyone that has experienced this.  I don't know what to do.  Both Doctors have excellent reputations and come highly recommended and have been very accessable, but that doens't help me to see any clearer.  I would appreciate any advice, direction or suggestions.  

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

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[JodieJ]

I'm not an eye care professional, but I've read that a toric IOL with too much astigmatism correction can cause irregular astigmatism (and some unpleasant side effects).  I've also read that Alcon's toric IOL contains something sticky to prevent rotation in the eye, which may make it more difficult to remove.  I think that Dr. Hagan's suggestion about getting additional opinions is very wise.  If you do decide to explant the IOL, it would probably be best to have a very experienced surgeon do it.  

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

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[JohnO123]

LeeAnn -- I had Toric lens in to correct astigmatism and cataracts and my distance vision in that eye is awesome. Then I stupidly went and got ReZoom from another doc thinking I wouldn't need glasses at all but they put the wrong strength and I am all blurry and miserable (see last week's post). I'm going back to the doctor that did the Toric and he is going to take out the ReZoom and put in the second Toric in 4 weeks. I think you'll find a lot of people on this board that have had good luck with Totic. I hope they can fix it for you.

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

I strongly recommend you get a second even third opinion from two other eye surgeons. If the problem was that the IOL was the wrong poser then glasses should correct you to normal vision.  Find other Eye MDs at www.aao.org

Removing an IOL can be more difficult that the first operation. Risks include infection, bleeding, retina swelling, vitreous loss, and IOL power problems or dislocation.

JCH MD