A complex eye issue

[Crslack]

A relative now 30, had a cataract removed 25 years ago from his right eye. The entire lens capsule was removed which we understand was common practice at the time. His vision is +12 diopters in that eye.

His left eye is -7 diopters. The doctor says that his lens is off center. Marfans would be an answer but he is otherwise asymptomatic.

The recommended solution is an IOL in the right eye, an ICL in the left eye with the potential that ICL may not be satisfactory for the left eye in which case a standard single vision IOL would be inserted.

I am interested in professional opinions and patient experience. Particularly around the IOL with no lens capsule and ICL

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

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[Crslack]

Thank you. He is headed towards second and third opinions.

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

This is an extremely complex situation and not every eye surgeon has experience with this dilemma.  The RE is pretty straight forward. His cornea would need to be checked by pachymetry and cornea endothelial cell count to see if it will tolerate an IOL. If so he would need either an anterior chamber IOL or a posterior chamber sutured IOL. The latter is much more difficult and requires a surgeon used to working on post-operative complicated cases.

The LE is more tricky. In some cases it is possible to do a modified phaco removal and insertion of capsular fixation ring and put the IOL in the usual position. At other times the entire lens needs to be removed list the RE and either AC IOL or sutured PC IOL put in.  I don't think an ICL will work very well.

I would get at least 2 and better 3 opinions from the medical schools department of ophthalmology and specialists that do complicated post operative complications.

JCH MD