After Cataract Surgery

[wdt2613]

I had cataract surgery on 10/17/07.  Mono lens.   Very well respected surgeon in downtown Chicago at well respected Chicago hospital.  Surgery took 1.5 hours because the doctor told me that he wanted to take extra time to remove the posterior subcapsular cataract because the removal became a little complicated and he was practicing defensive medicine to ensure no problems. It is now 10/22/2007, my eye is somewhat swollen in the back.  
The vision is very colorful.  Vision seems to be somewhat clear at distance but there still is some blurriness.  I could read to the second bottom line at the surgeon's office.  However, I am having light flickering sometimes in corner of the eye.  Further, I am having some half crescent halos that appear in the normal field of vision sometimes depending on the light condition. I went to a concert last nite and the swelling and unbalanced vision was bothersome.  
My doctor looked into my eye the day after surgery and told me it was fine.  I have another appt. with him tomorrow.  Is there anything I should be concerned about?

[Engineer123456]

I still have the same symptoms you have described.  My cataract surgery was on June 18, 2007 and included the Eyeonics Crystalens accommodating IOL implant.  I have been for a second opinion which doctor also gave no encouragement for improvement.  I am now scheduled to see a retinal surgeon.  According to the original surgeon and second opinion, the retinal surgeon will likely say that an attempt at correction would be too dangerous.  The half halos you describe are there, plus a glare both day and night from light sources, plus a concentric ring in the middle of the field of vision from lights off to the side, plus that same flickering you see.  My main problem is the flickering which covers half the perimeter of the surgical eye.  It is VERY distracting and occurs with the slightest movement of the eye, e.g., as the eye moves across this line of text it actually halts many times.  Each of those halts produces a flicker.  The original surgeon said he had rarely seen this and it only lasted a couple of weeks.  The second opinion said the same.  Both say that the implant is solidly in the correct position, and that the cause of the flicker is that the vitreous gel increased it's liquification as a result of the surgery.  The second opinion said he more often encountered the flickering in non-surgical aging patients whose vitreous gel liquification was an aging process which was advanced.  My paraphrase of what they said was that the gel in the eye was moving with each eye movement creating the flicker.  I already had some liquification of the gel, with associated floaters, prior to surgery.  I do not want to divert this thread off your case, so I will open my own thread.  Just wanted you to know my experience.

[wdt2613]

Thank you doctor for your kind words of encouragement.  I just got back from my neuro-opthomologist and I registered on my scale of looking far distance at 20/20.  The arcs/crescents/flickering are still there but he said they will go away.   This forum is very helpful and your time is appreciated!

[Michael J Kutryb, MD]

Sounds like you're doing fine.  I'm happy for you!
MJK MD

[wdt2613]

I thank you for the quick response.  

I went to two surgeons before I chose this neuro-opthomologist.  My case is very interesting sayeth the two previous surgeons and my current doctor.  I am only thirty years old with a posterior subcapsular cataract in my right eye.  My left eye is clear and healthy.  I waited almost four years for this surgery because I wanted to lose complete vision in the cataract eye before the surgery.   All the doctors told me that I could wait until I was ready.  I am a little high strung about these things because I read A LOT for a living.

I was going to go to Jules Stein in LA but decided to stay here in Chicago.
  
I was implanted with a diopter 16.0 D 13 mm 6mm Advanced Medical Optics Intraocular Lens.  They did an immersion technique to measure the implant.

The surgery did take an hour and a half.  He did tell me afterwards that the cataract was a little difficult to remove but that he was being extra careful so that if any problems happened, he would be ready.  He stated that is why it took so long.

I was knocked out at first but then came to and watched about an hour of the surgery.  He told me he wanted me knocked out because I was young, this was my first surgery and to avoid any other problems.  However, I was awake during most of it and it was very unique to see a doctor working on your eye.  One time, I felt pain/pressure during the surgery and told him so.  They put in more sedatives to my eye via drop.

I was bandaged up until that afternoon and now am on Vigamox and Prednisolone Acetate Opthalmic drops.

Today is five days post surgery.  The vision is bright and I can see pretty well.  As I said, I can read down to the second bottom line on the chart with the post-cataract eye.  There is still a lot of red above the eye when I lift my eyelid.  There is still a visual bruise on my face.  There is some blurriness in the vision.  Further, there are still these arcs/halos/half crescents that pop up in my field of vision.  Further, I have a little flickering of light in the corner of my eye.

Any pertinent questions, comments, that I need to do on my visit tomorrow and my subsequent visit next week.
Thanks.

[Michael J Kutryb, MD]

I'm really not sure whether your surgery went well or not.  I just can't make much comment on the info you gave us.  Your questions should all be addressed to your surgeon and he SHOULD take the extra time to answer all your questions and address your concerns.  It may take a few days for some corneal swelling to go down.  You might need a new glasses prescription to see your best.  Also, with posterior subcapsular cataracts - there can sometimes be a little bit of haze left on the posterior capsule which would require a yag  laser in 3 months or so.  That could be the situation here.  In my experience with posterior subcapsular cataracts, I don't try to polish the capsule too much because you can tear the capsule in the operating room.  If there is a little haze that can't be polished off - I can laser if off 3 months later with a 99.5% chance of success.  That's just the best way to do it, in my opinion.

I'm just a little curious about your case.  Did it really take 1.5 hours???  Usually most surgeons should be able to finish in 10 -15- 25 minutes.  Ask your doctor if there where complications??  

MJK MD