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1932338 tn?1349220398

IOL lens Target

Dear Dr. Hagan,

I am trying to understand why it is that when targeting "plano" with an IOL, it is much better to end up in the myopic range than in the hyperopic range.  I know there is about a .5 margin of error with target vs result, so if I use lets say a 24 power Tecnis ZCB100 monofocal lens that the IOL master says gets me to -.25  and then a positive .5 error happens, I then get to a positive .25 / hyperopic position.

1) Would you please tell me the actual "downside" to being +.25 so I can better understand it ?  What would I see at a +.25 that would be worse than say a -.25 ?
2)  With having a previous vitrectomy, and wanting to end up plano...do you recommend me targeting LESS than a -.25...something like a -.60 ???   My other eye (which I will be leaving alone for years to come) is a +1...so I don't want to get too far of a spread between the two, but don't want to end up in the hyperopic range either.  Any ideas on this decision would be soooooo helpful.   ;-)
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233488 tn?1310693103
MEDICAL PROFESSIONAL
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Helpful - 0
Avatar universal
Hello,

I hope you can get relief from those sutures soon!

Last year I had a suture for an IOL because a second vitrectomy to remove an ERM was performed at the same time as the IOL implant. This was in Jan. 2011, and looking back on my calendar, I see that the stitch wasn't removed until early May! I believe it was removed then only because it had broken through the sclera. It was sure visible just under my eyelid.

I think the suture was needed to prevent my lens from slipping out during the vitrectomy, since the lens implant step preceded the vitrectomy and membrane peel.

Best of luck with your situation.
Helpful - 0
233488 tn?1310693103
MEDICAL PROFESSIONAL
That's very unusual. First we rarely use sutures anymore; second if they are put in they are usually removed 3-6 weeks max; third if they are uncomfortable and can't be removed we usually trim the exposed part or fit the eye with a bandage contact lens.

If there is more than one surgeon in the group you might ask your surgeon to have one of his partners look at it and see if they can be removed. No need to put up with that type of pain/discomfort

JCH MD
Helpful - 0
Avatar universal
How long should the corneal wound sutures stay in after IOL surgery? My doctor says that the suture tails are causing my irritation for now, but once he removes the sutures this will improve. Can't wait..this is so uncomfortable. Has been 2 months so far.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
IOL formula are individualized not only for the patient and the IOL but for each individual surgeon. No adjustments are made for post vitrectomy.

JCH MD
Helpful - 0
1932338 tn?1349220398
Dr. Hagan,  Thank you VERY much for your detailed reply to my question.  I actually think that I get it now !

When you decide with your patients on IOL targets, do you normally select a stronger lens than you normally would, if the patient had a previous ERM/Vitrectomy?
(hence, no vitreous support and potential weaker zonules)

I don't know if I am suppose to be allowing for that with my Vitrectomy.
Helpful - 0
233488 tn?1310693103
MEDICAL PROFESSIONAL
1. The reason we never try and leave someone farsighed post cataract/IOL surgery is that there is no distance that is clear without glasses. Most people are ecstatic with 0.00 in the dominant eye and -1.00 in the non dominant eye.
2. There is no problem with +0.25  that is some a tiny amount of farsightedness it won't matter (the smallest amount of lens change is usualy =/- 0.25    
3. Aiming for 'zero' or plano or maybe -0.25 or -0.50 is not bad. It is not exact enough to create problems.

JCH MD
Helpful - 0
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