Scarring of cornea post--cataract surgery

[Carole60]

Dear Dr.:

I had surgery done on one eye for a cataract, and that worked out very well. However, two weeks later, the same surgeon did the other eye and there was severe pain immediately following the second surgery. This pain was not at all present with the first surgery. In the follow-up visit for the second surgery, the doctor told me that I had severe abrasions of the cornea, and that I had to have rubbed the eye over and over again for that to have happened. What I know that I did was when I had trouble opening the good eye because of the pain of the most recently operated eye, I held the post-surgical patch somewhat firmly over my eye to allow the good eye to open with the least amount of effort. This kept the eye that most recently had surgery from hurting and allowed me to open the good eye. I have continuous pain, which I manage with pain killer, such as Tylenol. Her words were, "it is HUGE!" Now I don't know if she means the abrasions are deep or spread all over, but superficial.

The question is: now that I have this abrasion, what are the chances of recovery?


This discussion is related to Cornea Scar treatment.

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

Keith,  So far your friend the ophthalmologist has done a spectacular job, indeed to arrive at the point you are in would do credit to a University Ophthalmology Trauma Team.  Some of the brightest ophthalmologists I know practice in smaller communities.

Right now best advice: Do what your ophthalmologist tells you to do. Your job now is to heal.  Maybe 4-6 months from now when everything is quieted down you can discuss a referral to a corneal specialist to see if anything might be done to get rid of the irregular astigmatism and scarring, for example PRK.

Don't forget to protect your GOOD eye from injury and disease. It sounds to me like you are in very good hands.

JCH MD

[dchamberss]

Dear Dr. Hagen,

Thank you for your service to our country, your scientific contributions and for the help you provide to people here - you are a great American Sir.

I am a 36 yr old male in good general health.  No medications, no allergies or chronic disease, normal BP.  I received a strike in my right eye the first sunday in Oct.  

This was a penetrating globe injury with a full thickness corneal laceration and traumatic cataract.  The laceration required 20 interrupted sutures which were placed under general anesthesia approx 2 1/2 hours after the injury.  These are just slightly off the visual axis.

The following morning (Mon) post op visit revealed the formation of a traumatic cataract, which was scheduled for removal the following PM (Tuesday).  The left eye was measured as a proxy for sizing a monofocal AcrySof (acrylic from Alcon Labs) lens replacement.  

The cataract removal was done by phaecoemulsification and, as the capsule integrity looked good, the new lens was placed.  There does not appear to be any RAPD, but I noticed some efferent dialation defect (confirmed by my opth, but he thinks it is not a lot considering the injury).  

My pressure has been good post op.  I was on vigamox (qid) and omnipred (every 2 hrs), w/eurythremiacine (sp? sorry) gel at night.  That was for the first 2 weeks post op.  Now I am only on the omnipred (every 2 hrs) and euryth gel at night.

My vision used to be 20/13 left eye, 20/10 right eye, uncorrected, with excellent focal ability, night vision, and all around superior vision.  My vision at this point is 20/300 uncorrected, 20/80 (pinhole).  My Dr. is OK w/my progress and expects an improvement to 20/50 corrected potential posts removal of the corneal sutures.  Most of which will be due to corneal astigmatism and scarring.

What can I do to have the best possible outcome.  Of course I will listen to my local Opthamologist (who's a friend as well), but this is a very rural community and most of his patients are cataract and the like.  He is an excellent Dr., but you can't be in general practice and an expert on everything.  Can you give me any additional information on what I can expect, what my options are, what I can do to improve my outcome and what I can expect for a prognosis.  My left eye vision is still excellent (with no presbyopia or other defect).  Can I overcome the binocular rivalry that forces my to keep my right eye closed much of the time?  Will stem cell research or other technology likely offer improvement in my corneal performance or lens?  Is it possible to remove the current IOL and replace with a better one in the future.  Sorry for so many questions.

I have been reading journal articles on penetrating globe injuries, but that doesn't make up for the experise you have in this area.  I am intensely interested in your opinion. Thank you so much for your time.  

Sincerely,
Keith Chambers

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

Quite good. Ask about getting a bandage contact lens.

JCH MD