Now need Laser Posterior Capsulotomy After Cataract Surgery & 2 RD'S, what next?

[Greenbaypat]

So after seeing my eye doctor, It was scheduled for me by the eye doctors office to schedule with my cataract surgeon for further evaluation on eye issues.  My eye sight in my left eye was worsening after only a few months since my last visit plus,  I have also been experiencing a great amount of glare in bright lights and the sun which continue to be hard to bear.  The eye doctor said I have swelling in both eyes, some scarring, and The left eye has some bleeding.  I had cataract surgery in March of 2014.  I had retinal detachments in July and October of 2013.  

My cataract surgeon suggested I schedule for a YAG Laser Posterior Capsulotomy, which is quick and will clear up the distortion and glare, one eye at a time.  I am not thrilled about having another surgery obviously, but feel confident in the doctors I am seeing for this, yet am concerned just the same!

Any surgery has risks, obviously...!  Further RD'S?  Is the surgery making that more possible, or if I don't do this procedure would my eyes continue to have increased glare and scarring and loss of vision?  

I have to admit that my concerns come from having one thing after the next, and possibly causing more future issues because of another intervention or surgery of sorts?  How much can the eye take, and at what point is more surgery making it worse, or not worth the added risks?
What is the recovery time from this procedure?  At what point, if I go ahead with this surgery as scheduled, do I know that this has been successful?

Thank you for any insight you may have

[pinhole]

Hi Greenbaypat,

That is good news about the results of your visual field test! I have lost some peripheral vision because of extensive laser and possibly because of some degeneration of fibers of the optic nerve.

I certainly relate to the burden of all the eye drops, maintaining the schedule of administering them, and all the handwashing! I take the two anti-inflammatory prescription eye drops four times a day and the timolol just once a day.

I think the deeper eye pain you described should perhaps be reported again to your doctor. At each appt. I am always asked whether I have eye pain, so I conclude the answer must matter. In my case my eye feels uncomfortable but not painful. It feels swollen even though it's the retina that is swollen, not the whole globe (at least I think that's the situation!). Maybe it's dryness I am feeling. It can be hard to put how the eye feels into words.

Are you getting retina scans each time? That is, the test where you see the red line slowly descending as it maps the retina. That's the test that showed my swelling had improved. The retina had flattened and several of the cysts had disappeared.

As for the eye sensitivity that apparently we both are experiencing, I put on those over-the-frame sunglasses as soon as I step outside. Things look bleached out otherwise. You know the kind of sunglasses--available OTC at a drugstore. I received a pair in the cataract kit.

Do you know what type of IOL you have? Mine are Technis with no added features, but I discovered that one is a one-piece and the other is a three-piece. I found this out by googling the model number that was on the little card given to me at each surgery.

I continue to wish you the best and appreciate your posting updates.

[flossy93]

Wow, I'm so sorry about the regimen you are having to deal with.  The pressures do sound somewhat elevated so it's good the dr is bringing out the mega artillery of drops to try to bring them down.  

In terms of the pain in your eyes, if you had a chance to mention it on Thursday at least the dr knows about it and can give you some advice.  That's something for which I don't have an idea about what could cause it, although it certainly sounds unpleasant.  

In terms of the 'traction problem', I've seen that term used when describing the vitreous of the eye pulling on the surface of the retina.  As people age and the vitreous jelly inside the eye becomes more fluid-like and shrinks a bit, sometimes it tugs on the surface of the retina.  From what I've read it sounds like many patients have the vitreous separate from the retina without any problems, except that sometimes it gives transient 'flashing' or 'barber pole' visual illusions.  For some other patients the tugging or traction is stronger and can lead to a surface problem on the retina like a tear or layer separation in a small area of the retina.  The retina specialist can order an OCT to get a 'side view' of the retina layers, if such a thing is suspected.

Thanks again for the update, and please keep us posted on how your vision evolves in the coming weeks.  Hopefully with the full strength attack on the swelling and elevated pressure you will be seeing better soon. Sending you positive thoughts!

[Greenbaypat]

I posted my results to pinhole last night, but also wanted to add that I feel pressure or a type of deeper eye pain, especially in my left eye.  I had this when I was checked on Thursday, and still have it.  I have put warm washcloths on my eyes, which gives temporary relief.  Plus 8 prescription drops throughout the day...then the artificial tears....in between, so as to not wash out the meds....  

I feel like I. Am drowning in drops, always cleaning up my face, and basically feel like a mess!  Lots of hand washing...

I guess both you and pinhole know this routine!  

[Greenbaypat]

The  summary of my visit  now to my cataract surgeon, to check on my progress or lack of it.  I have been experiencing blurry vision, swelling in my eyes, and sensitivity to light.  

On my visit they ran a visual acuity test and found I hadn't lost seeing the white lights in range.  So, that was good.  My overall vision, has decreased.  He said I have a Hemorrhage on left side of the optic nerve, with probably some  bleeding and fluid.   I have swelling in both eyes, elevated eye pressure in both eyes, and he said I may have some sort of traction problem-(which I have no idea what that means). They  are watching for glaucoma, though currently don't see that.  Plus, watching pressure and so on.   I go back to him in a week and the retina surgeon a week or so after unless something else presents itself.

The technician measured my pressures from 24-28.  The doctor said it was 24-and that the new drops prescribed should help lower the pressure from the steroids.  So, another appointment  to check on all of that in one week. I was prescribed Timolol Maleate .5% 2x per day.  I am  Still on brimfenac 2x and prednisolone 4x per day.  Also, to use the eye drops for the dryness in them.

He said it would still be a benefit to have the YAG in my right eye, but not until all levels back to normal....or the new normal.

[flossy93]

Hi Greenbaypat, so sorry to hear about the ongoing visual acuity problems after your YAG procedure.  I was really hoping the YAG treatment would be the last stop on the treatment train for you.  The good news is that it sounds like you have a great team of doctors who are cautiously advancing you through the steps of treatment and carefully monitoring you along the way.

I hope that, similar to pinhole, you have an improvement in your vision after the anti-inflammatory drops have a chance to give you some benefit.  It's good to hear you are also being checked for elevated IOP since you have had so much done to your eyes, there could be a recent increase in pressure you would want to have monitored and if elevated, treated.  BTW my mom has normal tension glaucoma, and has been given several different types of drops to treat it (all of which have been eyedrops used once or twice per day).  I don't know if there is an oral drug for lowering IOP.  

Just wanted to send you some positive thoughts your way.  If you did end up needing an injection of an anti-inflammatory drug to help any swelling to reduce, it wouldn't be as bad as it sounds.  I have talked with a few patients who get anti-VEGF injections in their eyes for retinal bleeding and, while not pleasant, said it wasn't too bad, and certainly 'worth it' for helping preserve their vision.

Please keep us posted on how the drops change your vision - hopefully things will be clearing up soon.  Good luck!

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