Would having a hyphema decades ago affect cataract surgery for that eye?

[NightHawkGuy]

When I was in my early 20s (about 40 year ago) someone tossed a small metal alligator clip to me when I wasn't prepared and when I looked up it hit me in my right eye.  I believed it cause a hyphema and I was immediately taken to a nearby hospital ER. They just covered the eye with gauze pads and I stayed there for a few days until the dark blood in the eye cleared.  No problems with the eye after that, except many years later the eye pressure was a little above normal in the low 20s, so my eye doctor kept monitoring that and eventually had me do the standard glaucoma suspect tests (visual field, optic nerve imaging) just before he retired.  When I went to a new eye doctor about 4 years ago, the tests showed the right eye now had some visual field loss in the extreme peripheral vision in one quadrant.  I was put on eye pressure lowering eye drops in that eye then and continued since then and regular eye tests (3times/year now with a glaucoma specialist) and the eye has been stable (not gotten any worse) since.  The left eye is perfectly fine, no glaucoma, they just monitor its pressure too.  My eye pressures controlled are now 14-16.

Now my right eye has a cataract that is nearing the point where cataract surgery would be recommended, its made that eye a little nearsighted (-2.5D) and best corrected vision is now about 20/40.  I have moderate astigmatism in both eyes.  Prior to the cataract effecting the eyeglasses prescription about 3 years ago they eyes were: L= -0.75S -2.00C x178, R= -0.75S -2.75C x170.

Is there any way effects from the 40 year old injury (and now controlled glaucoma) in the right eye would affect cataract surgery in that eye?  Could it make the tissues holding the IOL in place unstable causing possible later dislocation or rotation (for a toric IOL)?  Could it limit the type of IOL, use of astigmatism reduction techniques (LRI,AK), etc.?

Is there anything I can request a prospective cataract eye surgeon during their consulation & eye exam check for to tell if this would affect the long term prospects for cataract surgery and the IOL choices?  Obviously I would like to have my vision corrected as well as possible so that I am interested in a toric IOL and/or LRI/AK via femtolaser assisted surgery.

[NightHawkGuy]

I'm compiling a list of top eye surgeons in my area (San Diego, CA) and many referrals I've gotten so far from friends/coworkers of friends are for  Shiley Eye Institute.  

One of the top eye surgeons there with top reviews is Chris W. Heichel, M.D. and his listed special interests include:
Challenging cataract and IOL surgeries LASIK, Intacs, & Visian ICL Advanced techniques in laser & refractive surgery Keratoconus Ocular Surface Tumors Limbal Stem Cell Transplantation.

The "challenging" cataract and IOL surgeries is especially interesting to me...

[NightHawkGuy]

At the time (40 years ago)  when I got that right eye injury from the metal clip being lightly tossed to me, I used the old hard contact lenses.  Would such a contact lens have helped to protect the eye from such trauma in any way?

[JohnHaganMD]

Probably not and water under the bridge.

[NightHawkGuy]

Yep and eyeglasses probably would have protected my eye in that incident much better! :)

[JohnHaganMD]

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[JohnHaganMD]

Yes the possible delayed effects of the hyphema are: traumatic-  cataract (which you have), glaucoma (which you have), retinal detachment, dislocated lens.  You can ask your surgeon to do gonioscopy and look for angle damage, and especially unstable lens (wobbly iris called iridonesis or jiggling cataract (called phacodensis).  Your safest bet would be to go with a monofocal, aspherical IOL of high quality e.g. tecnis  and then post surgery femtosecond laser to correct residual astigmatism and make power changes.  I have seen patients have delayed IOL dislocation due to childhood hyphemas.

[NightHawkGuy]

Can femtosecond laser LRI/AK be used to eliminate that much astigmatism reliably (2.75D cylinder in the spectacle plane) if a toric IOL is not used?

If the eye surgeon can't detect weak zonules would a good monofocal asperic toric IOL (Tecnis) be OK for my right eye?

FYI, the trauma to my right eye 40 years ago wasn't a lot of force -  it was just from a small metal clip that was lightly tossed from 10feet away. Not like getting hit with a high velocity baseball or similar...

[JohnHaganMD]

How much astigmatism can be treated depends on skill and experience of surgeon, laser being used, thickness and shape of cornea.  Generally the answer is yes.  Tecnis toric is good IOL.  You likely are okay. The loose lens I've seen were more of tennis balls and fists to eyes.

[NightHawkGuy]

Thanks, I am hoping that since my incident 40 years ago was much lighter force than typical, that I have a good chance that I won't have a "loose lens" situation. Glaucoma is bad enough.

Since Tecnis now has some newer higher cylinder toric IOLs, I'm hoping one of them can compensate for my right eye's 2.75D cylinder.

Is there any complications the glaucoma of the right eye can cause for cataract surgery?  For example I've read that steroid eye drops used in the post-op phase could raise the eye pressure.  Can my existing eye drops (Lumigan + dorzolamide) continue to be   used along with the post-op cataract surgery healing eye drops?

[NightHawkGuy]

I'm compiling a list of top eye surgeons in my area (San Diego, CA) and many referrals I've gotten so far from friends/coworkers of friends are for  Shiley Eye Institute.  

One of the top eye surgeons there with top reviews is Chris W. Heichel, M.D. and his listed special interests include:
Challenging cataract and IOL surgeries LASIK, Intacs, & Visian ICL Advanced techniques in laser & refractive surgery Keratoconus Ocular Surface Tumors Limbal Stem Cell Transplantation.

The "challenging" cataract and IOL surgeries is especially interesting to me...

[JohnHaganMD]

Since you have traumatic glaucoma you are not more susceptable to "steroid glaucoma" about 8% of the population has elevated IOP when on the drops longer than 6-8 weeks. Your glaucoma meds would keep the IOP down. Most doctors do not stop the drops. Some stop lumigan.   Most surgeons don't want anything to do with post op complications so that's good that the surgeon likes them in his/her practice.