Cataract surgery only one eye? Is that good?

[anntab]

I am 15 months post ERM surgery in left eye at which time they replaced the cataract with implant lens.  My right eye has a mild 2+ cataract.  Since the surgery they don't seem to work together.  The implant eye sees bigger and also distorted.  The cataract eye has floaters, but is my good eye.  Will it help to remove the cataract (with vitrectomy in this eye.

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

No reason your RE would need vitrectomy unless it has a significant ERM also.  To best answer your question you would need to send me your post operative glasses RX and your vision with those glasses

[anntab]

vitrectomy is for floaters, large black one and white film like
OD Sphere -0.50  Add.+2.50    Dist PD
OS +0.50  Cylinder -0.50   Axis 030  Add 2.50   Near PD

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

Not much difference in the glasses RX so the problem must be due to the macula in the ERM eye that is called metamorphopsia  if the image is larger   macropsia.   Don't do surgery on LE till it needs it. Discuss with your surgeon.

[MrPresley]

I had ERM surgery for my LE and if anything had some minor micropsia afterward, but nothing extremely significant. It seems to have resolved itself (or my brain adapted to it) especially following subsequent cataract surgery in that eye. There is no way that I would consider a floater-only vitrectomy (FOV) for my so far non-operative RE.

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

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[anntab]

thank you Dr. Hagan and Mr. Presley:  I have residual distortion in the left eye post ERM surgery 15 months.  cataract surgery was done at the same time as the peel.    My retinal surgeon says that my issues, (difficulty reading, driving at night, closing the ERM eye when reading my phone) are due to the combination of the residual distortion (e.g.. buildings are convex) from the ERM surgery and the floaters and 2+ cataract in my right eye.   He wants to do an anterior vitrectomy and remove the cataract in the good eye, hoping it will take over better for the other eye which is probably not going to improve.  He says the vitrectomy will be no more risky than the cataract surgery.   What do you think?

[anntab]

I have both metamorphosis and micropsia in the post ERM eye. LE.  Will that resolve eventually.   The RE is the one with the mild cataract and the floaters.   My retinal surgeon wants to remove cataract and the floaters with an anterior vitrectomy as he says that removing the cataract will make the floaters more evident in my vision.

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

Not true. A simple cataract removal/insertion of IOL is much less riskier than doing a vitrectomy at the same time.  In my mine it is lunacy to do a vitrectomy just to get rid of floaters. The vitrectomy will increase the risk of ERM in your RE.

[anntab]

Would you then wait to to do new IOL until cataract is worse?  I am understanding you do not advise vitrectomy for floaters.  Will they be more evident with the new lens?  Does the new lens help the other eye with the distortion?  Is it common to have distortion after ERM surgery?  Does the distortion ever go away after this long?  I do not see it when looking with both eyes usually.   Do you correct this with glasses prescription?

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

I can't give you all the answers on the internet. I would suggest you get a second and third opinion from different ophthalmologists.  Distortion is ultra common after ERM surgery.

[anntab]

My prescription after erm surgery post 18 months has changed to OD Sph Plano, cyl - 0.25, Axis 125.  Add 2.75.   OS  sph -0.25 cyl  -0.75, axis 015.  add 2.75.  What does that tell you?
Still have ERM eye seeing about 1/3 bigger, and wavy lines on the amsler grid

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

Your glasses RX in RE (OD) is almost 99% window glass   The LE (OS) has a small amount of astigmatism. It tells me nothing about your vision, the health of your eye or the amount of distortion you have.

[anntab]

Thank you Dr. Hagen:  A recent OCT scan says I have hyper reflectivity in the EZ layer.  What does that mean?  

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

It describes what the OCT shows but is not specific for any diagnosis.

[anntab]

I forgot to mention that I have already had PVD with Weiss ring in my right eye.  This is the eye with the 2+ cataract, that my retinal surgeon who can do both cataract and vitrectomy would like to do.  I have a large black floater in that eye that I have had for 6 years.  Since the vitreous is already detached, would that make a difference in your advise regarding the vitrectomy for this floater, along with the cataract surgery?  My retinal surgeon says I will see the floater more after he does the cataract, so suggests taking it out.

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

Adding a vitrectomy to a cataract/IOL operation greatly increases the risk and expense of the surgery. I have never been a fan of laser or vitreous surgery for floaters.   Most Eye MDs would not think this a very appropriate course of action.  You might want to get a second opinion from just a cataract/IOL surgeon.

[anntab]

how is the risk increased?  I was told by the retinal surgeon it is the same risk as just the cataract surgery alone in his opinion.

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

He's wrong.  A vitrectomy is a major operation, much larger than a cataract operation, it adds time and complexity, increases the risk of retinal detachment, macular edema, plus you may still see floaters.  Most people see more floaters after cataract surgery because the eye sees better, they also see wrinkles, gray hair, dust on the furniture and other things they could not see before.   As I said you may want to see a cataract/IOL surgeon and get a second opinion.  But no honest surgeon will say a straight forward cataract/IOL by phaco is same risk as cataract/IOL/vitrectomy.

[MrPresley]

Dr. Hagan, in your opinion do you believe that having cataract surgery prior to having a vitrectomy presents a significant complication potential for the retinal surgeon. Reason I ask is that I have a baby cataract in my right eye along with so far asymptomatic macular pucker. My intention is to do nothing for that eye as long as things remain that way, but it's always possible that the cataract could advance to the point of needing to be addressed in the future.  

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

Mr. P: Generally no and over the years I was asked many time by retina surgeons to remove cataracts so they could see the posterior part of the eye better and help them doing the vitrectomy. Sometimes the retina surgeon will remove the cataract prior to doing the vitrectomy and of course we have said many time vitrectomy causes cataracts so sooner or sooner even eyes without cataracts that have vitrectomies develop them and need surgery.     Either this poster has misunderstood what the surgeon said or the retina surgeon is being dishonest by saying that elective cataract/IOL surgery PLUS elective floater removal vitrectomy is no more complicated than standars cat/IOL phacoemulsification.