cataract surgery post scleral buckle with vitrectomy

[llymphs]

hi, 46 yo male pharmacist w/ hypertension, kinda type A (more like B+) ...5/28/08 had almost 360 degree Giant Retinal Tear OS, "fixed" with scleral buckle/vitrectomy, had a small cataract prior to surgery, but rapidly developed to an operable cataract in 5 months. now 12 days post cat surgery (implanted w/ AcrySof IQ model SN60WF pwr 8.0 D). md had to put in an extra stitch, which has induced astigmatism, so i still can't see very well. i wear a "pirate" patch most waking hrs to decrease headaches (with minimal success). i have new floaters, as well as yellow-orange hue to what vision i have...1) is this color change "normal"? stitch removal in 2 days and hopefully vision will improve...it has to!
also, post vitrectomy, all my floaters were removed, and as i stated, have new floaters (usually black dots, not like my old friends they removed). 2) could the fluid become "dirty" post cataract surg? if so, can it be replaced?
3) also had retinopexy OD in june for almost 100% lattice, which has induced a more severe presbyopia, a long lag time in light accommodation (from light to dark and visa versa), poorer night vision, light sensitivity, and a generally bad disposition! aside from my disposition, 4) are these changes normal? 5) will they perhaps improve? 6) anything i can do to help? oh yeah, fyi, CSR (central serous retinopathy) OU...due to age/sex/htn/type A... so clear vision doesn't mean readable type... letters/#'s look like those things one has to retype on certain websites. you know?
sorry so long winded, but off of work and going stir crazy....2 kids and a non-bread-winning, visually impaired pharmacist dad make me anxious as h-e-double toothpicks!! Also,  Dr. Hagan you were very kind to me in a previous post...thanks.

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

CSR would not cause all those problems.
JCH MD

[dukey]

Was this all because of CSR? Seems extraordinary if so.

[llymphs]

was just fitted with a new contact lens last week  on my operated eye (360 detatchment, etc) and, Dr. Hagan, the contact lens strength is -2.00!! my right eye is -11 and forming a cataract (which will work in my favor in a couple of years). thought i'd let you know how it all turned out.
all my retinal md could say was, "uh...uh...uh...amazing." i think that says it all.
thanks again,
john

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

Fantastic.  Your problem was untreatable when I started in private practice and would have ended in a totally blind painful eye.

JCH MD

[llymphs]

WOW!
Just returned from 6 wk f/u visit and refracted at......20/20!!!
after retinal evaluation next week, if CME has resolved, will taper pred and will be fitted with a -2.5 to 3.5 contact lens!! i've been -11 for years (as is OD)...i really can't believe it and neither can my opthamologist...her smile was wider than mine and this normally reserved woman actually high-fived me!
i did shed a few tears of joy and thanks when i got to my car, for there are no such things as small miracles.
whodathunkit?! especially after 360 detatchment and the myriad complications.

thank you so much for "listening" to my incessant ramblings...it was therapeutic for me.

i value the time you gave me, sir.

john (make that smilin' 20/20 john)

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

-

[llymphs]

thanks! i'll keep you posted. yeah, vision at all after 360 giant tear is remarkable. i am quite lucky and don't take it for granted.

john

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

Generally steroids make CSR better not worse. Having CME and CSR decreases liklihood of edema resolving: RX is topical steroid drops and topical Non steroidal antiinflammatories like Acular wait and see what happens then periocular steroids then intra ocular steroids.

You have a very complex problem and if you are seeing 20/20 ish after to 360 giant tear you're ahead of the curve.

Good luck
JCH MD

[llymphs]

i'm back. 6 wks post cataract surg...now have CME od and am on acular ls qid and pred 1% bid for approx 5 weeks. have 20/20'ish from 8 to 12 inches, but worse than 20/400 beyond that. surgery was almost 2 hrs due to a "mushy" cataract and my having to be put all the way under due to my "excited and charming" behavior due to the fentanyl! (5mg of hydrocodone is like 10 mg amphetamine! paradoxical rxn). appt tomorrow w/  cataract surgeon (who is head of opth dept at med school here)..said my eye was in a "mell of a hess". regarding the CME...what is possibility of resolution? what i've researched...it's a +/- situation. the pred is now in my system after 6 weeks and am Johnny Insomnia and on edge, (can you tell?), yet back at work...fun.  if the flourescein scan on the 13th is neg, said i.v. steriod, if no resolution, then intraocular? inj of same. what then? i just need an outside opinon of this, 'cause you know i'll bombard them with questions. md said i was unique in many ways! i'm always the youngest pt there (46 yo)... and not to swell my head, but i am much more edumacated than most and with much insight. i've also found that THANKING God for this is the best medicine , as it has opened many more doors from which i can  help others in their pain. strength in weakness, ya' know. paul was right on target. any info is so greatly appreciated and i value your opinion.
oh yeah, i also have CSR and the steriods have definately exacerbated this condition...will it subside after steroid therapy? tired of looking at kidney-shaped faces.
thanks, john

(retinal guy is excellent...met rn who assisted in surg and she said my retina was 360 detached and my eye "looked terrible", (and i told jokes during reattachment, duh.) but i can see! i am in johnson city, tn and he is from Duke...looks just like a young Groucho Marx!) so i AM in good hands.

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

1. Color vision does change after catract surgery. Usually for the better. You may have some swelling in your retina. Look at white and see if it looks white or is off color. Ask your surgeon about it.
2. When cataracts are removed patients often see floaters that they couldn't before because the cataract masks them (like not seeing furniture in a dark room, when you turn up the lights you can then see the furniture that was not visible in the dark). When you had a vitrectomy your vitreous was removed and replaced with a watery saline like solution.  


You have some very very serious eye problems and its not possible to generalize about what will happen. I don't want to mislead you one way or the other. You ask good questions but only the surgeon looking in your eye can tell you the best answers.

I wish you good luck. If you feel at any time you want a second opinion don't hesitate to ask for one.

JCH MD