Cataract Surgery Vitreous Loss

[Luvtoski]

Dear Doctors,
Just went to a Cataract specialist due to a 3+ cataract that formed from Vitrectomy.  I no longer have my vitreous fluid, but rather the Saline solution they put in after my ERM peel /Vitrectomy 7 months ago.  I know there are additional risks to the cataract surgeon ripping my lens capsular sac due to the factors of less support with the saline fluid, perhaps weekend zonules, etc.

#1) I asked the Surgeon what happens if my fluid leaks thru the capsular sac during surgery and/or a rip and continuous leakage.  Surgeon said it doesn't matter because the eye is enclosed and it won't go anywhere.
Isn't there more to it than that?

#2)  Do you recommend antibiotic injection of Ceftazidime at the end of surgery if I am only 57, healthy, and have the thinner Saline fluid that may allow the Ceftazidime to do potential damage to my Retina (of which is already compromised from the ERM/Vitrectomy) ?

I know asking 2 part questions sometime does not get both answered, but I really REALLY would appreciate your view on them if you have the time.

Thank you !!!

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

No especially in the USA we deal with a large number of "informed consumers' that do research on the internet and come in with a list of questions about many things: anesthesia, IOL type, IOL power and target post op refractive errors, premium IOLs, glaucoma medicines, generic vs brand names vs laser for glaucoma.

Most surgeons would not be offended.

Some patients come in and without discussion demand this type IOL, this type refractive error, refuse this test for glaucoma, state that they know any complication is a sign of malpractice.  That patient I prefer to discharge from my practice.  Medicine is a two way partnership.

JCH MD

[Luvtoski]

Wow, thank you so much Dr. Hagan for your quick response to both my questions!!!

I know you don't have time to keep answering posters questions, but I wanted to ask you if you be offended if you happen to be the Cataract Surgeon who said he uses antibiotic injection Ceftazidime, and I came back for another appointment to discuss it further with you?

Am I likely to risk offending the Surgeon?  Or on the other hand perhaps might he not feel strongly about the injection and this might prompt him to re-think it with my surgery ?

So far I like him the best of 3 Cataract surgeons I met with so don't know if this injection should be the "deal breaker".  

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

1. No not really. Also a thick material called a visco-elastic is used to hold the capsule back and stabilize the eye. Most surgeons have lots of experieince because vitrectomies are so common now.
2. It is controversial but most surgeons, including our practice, does NOT inject antibiotics into the eye at the end of cataract surgery.

JCH MD