Iris removal?

[ellieg72]

My mom originally went in for cataract surgery, which was unsuccessful, and the clean-up surgery that followed poked holes in her retina, causing it to detach.  She subsequently underwent two retinal re-attachment surgeries and now has poor, very limited vision in her eye.  Two questions:  The first is that she cannot fully open her eyelid and hasn't been able to since her first re-attachment surgery.  Possible causes?  Second, she just received the billing statement for her second re-attachment surgery in which the surgeon replaced the vitreous with the silicone oil and upon reviewing the statement, found billed charges for "Removal of Iris".  Is this common practice?  Her doctor has NEVER mentioned this.  My dad says (because my mom's vision is such that she cannot see well enough) her eye looks different - the part that was blue (the iris) is now more "clear".  Why would the iris need to be removed?

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

At this point I would just be speculating and that's something I try to avoid. If your surgeon is unavailable you have several options. 1. Write him/her with a list of questions.  2. See another vitreo-retinal surgeon for a second opinion. Take your bill in and ask about the iris removal procedure and have them explain what was done.

JCH III MD  Eye Physician and Surgeon

[ellieg72]

Thanks so very much for your response.  In reference to my second question, none of the exceptions that you listed for removing the iris are present in my mom's case.  Are there any other possible exceptions that you know of?  Unfortunately, her surgeon is highly unavailable and his office staff is not very helpful, to put it mildly, so she won't be able to get any kind of "answer" from him until her follow up appt. at the end of Sept.  Regarding the iridectomy you mentioned, her surgeon did indicate that he made a "pinhole" in her pupil (not the surrounding iris) - what purpose would this serve and how would this affect pupillary function?

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

Hello ellieg72. Sorry to learn of all your mom's complications.

1. The drooping upper eyelid is called ptosis and is not an uncommon complications of many types of surgery including cataract and retinal detachment surgery. It also often develops spontaneously without surgery as we age as the eye lid muscles stretch, grow weak and sometimes detach from the eyelid. It usually requires surgery to fix and often perfect match with the other eye and perfect open/shut movement cannot be restored.

2. The second question I cannot answer. Normally one does not want to remove the iris as it is important to visual functioning. There are exceptions such as when a tumor is on the iris and iris has to be removed to get the tumor out. Also in some cases of glaucoma, implant insertion, pupillary block a very small piece of iris is removed to provide a pathway for fluid to get out of the eye. This is called an iridectomy.

You would have to ask the surgeon for more clarification. Why don't you just take in a copy of the bill and ask them to explain that particuliar item.

JCH III MD   Eye MD