Suppressing keloid formation in eye surgery

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I had nothing but outstanding results after cataract surgery with my Crystalens implantation.  I am severely myopic; my vision could no longer even be measured.  I wore glasses contacts for 53 years before surgery and had perfect vision afterward, No correction required and I was free of glasses for the first time in a hal-century.  You can imagine how I enjoyed the freedom and I praised my surgeon and my Crystalens implants far and wide!    One eye was corrected for near, the other for distance.  Now, 4 1/2 years later, I have broken zonules and require surgery to remove my implant from my worst eye.  It happened suddenly while at the computer.  It is not related to my implant, but aging, I was told.  I will have to have the new implant placed outside the capsule and part of the vitreous removed.  I am the only Crystalens patient in a huge practice to have this problem.   What can I expect after this next surgery?  Being a keloid former, I am becoming more worried about a second surgery of this magnitude causing excessive scar tissue to give me unfavorable results.  Is there a way to suppress keloid formation?

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I spoke to my surgeon about using a CTR (capsular tension ring) and was told that he used them 20 years ago and discarded the idea of ever using them again.  He told me that keloids don't form in eyes and that I don't have an abnormal amount of scar tissue from the original surgery.  He also told me I was getting into extremely technical areas and should stay off the internet.  He plans to go ahead with the lens and capsule removal and an anterior vitrectormy, Then he will place the standard IOL in the anterior chamber.  I'm disappointed and would really like to try to save the capsule and lens.  The latter does shift a bit, and cloudiness is better or worse depending on its location at any given time.  He said that I am seeing a portion of the bag which has fallen down over the lens, causing the visual anomolies, i.e., reflections and occasional halos. I'm thinking of getting a second opinion.  Are many surgeons using CTRs now?

[Ray T Oyakawa, MD]

This is very unusual.  This may have happen in you had psuedoexfoliation or some other problem with the zonules, such as congenital problem or trauma.

One consideration is to see if a Ahmed capsular tension segment can save the lens.  this depends on the size of the zonular dialysis.

http://www.fci-ophthalmics.com/cataract#CTS

I had one crystalens patient who was a keloider.  A Z syndrome occurred early and I had to yag it.  For the second eye I used Durezol (strong topical steriod) for two months and avoid the problems. This is only one case.  Who knows if it helped.

Dr. O.

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I couldn't help but notice several complaints about the Crystalens IOLs and little praise.  Unless one has a problem, there is no reason for them to even seek a site such as this.  I believe the overwhelming majority of patients are thrilled with accomodative lens implants; I certainly am!  I don't believe anyone should be terribly concerned about the lens itself.  Be more concerned about the skill and care you receive from your ophthalmic surgeon!  As a pretty judgmental R.N., I have never received better care before, during, or after any surgery as I have with my ophthalmologist and his entire staff, and I cannot praise my Crystalens implants nearly enough.  I had 4 1/2 years of perfect vision for which I am extremely grateful and owe to them and my surgeon's skill.  My current problem is not connected in any way, I don't believe because it happened so long after implantation.  We patients have to understand that all our bodies heal differently, react to surgical trauma differently, and accept that no treatment or procedure will be as effective for everyone uniformly.  

I could, like so many do, try to blame some external factor, but I don't.  I only blame my own genetic code when it comes to the things that are breaking down in a 66 year old woman.  People need to give their docs a break, as well as those who have given us so much through research and development of things like lens implants.  I am so grateful for all that medical science gives us every day, and the dedicated physicians who do their utmost to make us whole and healthly.  I'll take this opportunity to say thank you!  I thank you also, for providing this forum.