IOL options with impaired acuity after ERM peel

[chazas]

My eyes were both very myopic, around -9 each.  I’ve been happily wearing multifocal contact lenses for years.

Last April, I had a retinal detachment and an emergency vitrectomy – I got a scleral buckle and had a gas bubble. I almost immediately got a cataract.  I wanted to go with a multifocal IOL to correct the cataract, but then I developed a significant epiretinal membrane, which made hat inadvisable.  

A couple of weeks ago I had a combined second vitrectomy/membrane peel and monofocal IOL implantation.  They were aiming for -1 to -1.5 so that either I could decide to either use the eye for mini-monovision (get the other eye done plano later) or just have a consistent near/intermediate focus. Recovery from the membrane peel seems to be going ok – the surgeon says I’ve gone from 20/400 best corrected to about 20/80, though so far it’s not clear to me whether this eye will ever have sufficient acuity for easy reading.  The other problem is that we had a big refractive error – if I remember the numbers right, I’ve ended up about -4.5, but (at least with the stitch still in) wit about +2.25 of astigmatism.  The surgeon said that effectively leaves me around -3.5, an unhappy result.

She’s ruled out explantation of the IOL as too invasive because of the multiple surgeries, says that when things settle down I could do either a piggyback lens or have Lasik.

So here are the questions.

Has anyone had either a piggyback lens implant or Lasik to correct an IOL refractive error?  How did you choose the approach?

Any input on abandoning the mini-monovision plan and having both eyes done about the same, whether plano or about -1.5?  As a non-expert I would think that if I continue to have significant acuity problems with one eye, having both of them at about the refraction is probably going to give me better results.

As an alternative, has anyone ever heard of a strategy using one eye for everything and the lesser quality eye just for periphery/stereopsis?  I.e., not worry too much about where the “bad” eye ends up, and get a multifocal IOL (or just wear a multifocal contact) on the other.

Thanks for any thoughts.

[chazas]

It was a collaboration between a retinal surgeon and an anterior segment surgeon - I was living in another city, both were at the university teaching hospital's eye clinic and were on faculty at the medical school.

[JohnHaganMD]

There are no studies to date that demonstrate the superiority of the femtosecond laser over standard phacemulsification and some show worse results during the first 100 cases (learning curve).

JCHMD

[teller4]

chazaz,
Glad that your procedures have gone well!  I was reading your first post about the combined IOL and second peel and was wondering if one surgeon did that or was it a collaboration between a retinal surgeon and a cataract surgeon?

[chazas]

At a little over 2 months since PRK, I'm around 20/25 in the "bad" left eye.  They can refract me to close to 20/20.  I'm currently wearing daily wear contacts in my right eye, which is at -9.  My retinal and anterior doctors have both cleared me for cataract surgery and iol implantation, which is scheduled for late May. I'm going to keep it simple, with a monofocal iol set for distance, and plan on wearing light progressive with readers as a backup. I'm wondering if anyone has any thoughts as to whether traditional or femtosecond surgery is preferable to minimize the risk of retinal detachment.  The literature I've read doesn't seem to say much.  The ability to check the iol power right away sounds great, given that I had such a large refractive error in my left eye. But the use of the pressure ring sounds like a bad idea.

[JohnHaganMD]

Best of luck

[chazas]

I had PRK on the bad eye yesterday.  Man, that hurts!  I'm at work today, but with the lights off in my office and the computer monitor brightness all the way down...

The good news is that before it got so painful last night I had to sit alone in a dark room with my pain meds, I was watching TV and reading closed captions from 10 feet away. At this morning's follow up appointment, I read a little better than 20/40 and they said my epithelial cells were already about 40% healed.  

[JohnHaganMD]

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