IOL exchange

[GeoffM]

Nine months ago I had a cataract surgery which in itself went ok. In the first couple of weeks after the op everything was ok, albeit with middle distance focus, not far as intended (monofocal lens). However, I then developed a macular edema which went after about 5 months of eye drops. At some point while having the CME my lens tilted and decentered nasally and I now have diplopia (well, multiplopia really) and astigmatism among other things.

The surgeon was quite reluctant to perform surgery until all other non-surgical options have been concluded, which was yesterday. I've yet to see him again for his opinion on what level of risk IOL exchange is.

However, my question is actually about the decentration and tilt, with astigmatism. Is it because of surgery-induced scars that the astigmatism has occurred, which has resulted in decentration and tilt, or has the decentration/tilt caused the astigmatism? I appreciate you don't have my eyes in front of you, but is it usually one rather than the other?

Thanks.

[GeoffM]

I'm on my second opinion already! Right up until March both the surgeon and his senior colleague said the lens was central; they referred me to my current consultant and when I first saw him just a couple of weeks later he declared the lens decentered and tilted. Even the optometrist I later saw for glasses said she could see it. So I don't know when it happened!

If the shifting did cause the CME then that's almost reassuring that, if I had another op, it might not re-occur. It's still possible of course.

Many thanks.

[GeoffM]

Forgot to mention that the multiplopia is monocular, ie can close my other eye and it's still there. I'm 35 and do have a history of eye problems (coloboma being one, but the multiplopia is after surgery and after the CME). The multiplopia manifests itself as mostly two copies of the main image at 8 o'clock and 2 o'clock (roughly corresponding to astigmatism angle) but other lighter images too, and they're all oriented the same as the original image (no mirroring or rotation). I had a contact lens assessment to see whether an opaque lens with clear pupil would block off reflections but no luck.