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]

Hello,
If I am understanding you correctly, your main question is whether to proceed with the YAG to clear up opacity that developed after cataract surgery. I am not a doctor, and I cannot advise you what to do.
I have had a retinal detachment in both eyes, repaired by scleral buckle and vitrectomy,  then had cataract surgery in both eyes. Last week I had the YAG procedure in the eye with the densest opacity. It did clear up a lot of the blurriness by letting more light reach the retina. It was a super quick procedure. No pain. No floaters. Nothing. Pretty much as soon as the dilation drop wears off you can tell the benefit.
You can use the search feature (the magnifying glass icon) to read what others have said about the YAG procedure.
I hope you will get your questions answered by your surgeon to your satisfaction.
I wish you the very best.

[Greenbaypat]

Thank you!  Happy to hear of your success!  I guess my main concern is that I fear the more the eye is operated on, so to speak, the more prone to risk it becomes.  Certainly there isn't a specific connection to multiple surgeries making the eye weaker, but the concern is still present for me.  

[flossy93]

Hi GreenBayPat, so so sorry to hear that you are having an issue with PCO after everything you have been through with your RDs and the cataract surgery!  I'm sure you have already read that PCO is the most common complication of cataract surgery, though, and that it's more common in women than men.  So, not unanticipated, but still a pain.

The good news is that YAG procedures are typically very successful in removing the clouded material at the rear of the eye capsule.  The impairment to your vision from the clouded capsule sounds very typical.  The clouding of the posterior capsule due to cataract surgery is sometimes even called a 'secondary cataract.'

Because cells have proliferated/accumulated behind your IOL implant, there isn't an alternative to improve your vision other than removing them.  Although the YAG procedure does have risks, from what I have read it is the least invasive option for removing the clouded tissue that is blocking your vision.  Doctors used to try to remove this tissue surgically, but I would think that additional physical eye manipulation by poking instruments into your eyeball might pose a greater risk than the laser process.  It's worth asking your doctor if there is a lower-risk alternative to get rid of the PCO, but my guess is that it is being recommended because it IS the lowest risk option even for prior RD patients.

There is a risk of elevated intraocular pressure and swelling from the YAG procedure, so you may be given drops or other meds for both.  There is a small risk of a RD too, as you are aware.  Talk with the doctor who will perform the procedure ahead of the day of surgery about your concern regarding a repeat RD.  Discuss with him/her the doctor's ability to reduce the laser beam intensity and number of pulses that are planned to cut the clouded material away.  I've read in a few placed that less total energy imparted by the YAG laser can reduce the risk of RD.  

The prognosis is good for you that the YAG procedure will immediately improve your vision, with a small risk of complication.  I agree with the surgeon's idea of doing the YAG procedures on different days, separated by some number of weeks.   That way if you do have an immediate complication from the YAG process, you will have one 'good' eye to get around with while you deal with any complications.  

Thank you for taking time to share your experiences here.  Wishing you the best of luck and good vision!

[Greenbaypat]

Thank you for your insight, it is well taken!  I appreciate the suggestions of less pressure as stated,  concerns of RD and or any further damage, scarring, or other possible complication are all real and also scary!  I did check back with my regular eye doctor who checked in with my surgeon to verify details I shared and concerns I had.  She  said if there was any question or concern, or something else I should investigate she would let me know!  So far I haven't heard anything from her, so assuming she is in agreement with the choices and schedule made.  I Know she would call me if there was anything, as I know her and also she has communicated with me in the past.  I am SO Lucky to have her!  

Only 8 days for the first and worst of the two to be done...I think I am ready!

[flossy93]

It's good to hear that your doctors concur about the best approach to fixing this issue for you.  

I will be thinking of you on the 16th and sending you positive thoughts and good wishes for a successful surgery.  Really hope that you notice an immediate improvement in your vision, and that you do not have any complications.  Please let us know how it goes.   Fingers crossed!

[Greenbaypat]

I feel the YAG procedure went well, as all went quick and nothing else was done at the appointment.  Also, no additional instructions, restrictions, or drops were required.  The procedure wasn't painful, but mainly uncomfortable.  The remainder of the day my eye felt irritated, but that was about it.  Today, I feel my vision is the same as it was before the YAG procedure.  I feel as if I have less clarity when trying to read only with the YAG eye.  Letters seem less clear, going from a fuzzy word or string of letters, to some being clear...nearly as if the letters have had water spilled on them and lose clarity in spots and don't sit straight on the page.  Perhaps more astigmatism?  I don't know and don't feel thrilled with this blur occurring.

I do intend to now call the surgeons office, to inquire, as I don't know if this is to be expected or if it is a problem.  If you have other thoughts Flossy or any other readers, please offer them.
After I hear more and discuss this with the surgeon, I will update this string.

Thank you for the positive thoughts and assistance!

[Greenbaypat]

So, I called the doctors office about the blurriness(see message to flossy above) and they said so long as no flashes or curtains that my eye may have some swelling causing this and to give it another 48 hours... So, if not better, call Friday and they will take a look at it.  Or if other situations arise, call them.

[Greenbaypat]

So, I ended up going in to have the first YAG checked, as I had some discomfort along with fuzzy vision....so, he basically said I need to use these (refresh optics advanced) drops like 8 times a day.  Every two hours. When I calked in, and the technicians were asking questions, is when they said, Yes! Come in.  I woke up in the middle of the night with that side of my head aching-which was odd!  I took ibuprofen, as my head was splitting!  

So,  On the next one he said, begin them right away.  He said my eyes have been through a lot and need the extra moisture.  He gave me a bunch of samples to use.  

[pinhole]

Hello Greenbaypat:
I read your post from 2/20. I am sorry you are having ongoing problems.
Might you consult a retinal specialist at this point?
I am not proceeding with a YAG in my other eye because unlike the first one that I recently had done, the opacity is not very dense and does not bother me, plus I have edema in the first eye (a cyst or something was evident before the YAG).
I hope your vision is improving. Have the lubricating drops helped?
Best wishes to you.

[Greenbaypat]

Hi pinhole, gosh you read my mind on this one!  I had a difficult time sleeping last night, as this was also on my mind!  I can say the eye drops have helped some, but.....   Overnight, I came to a similar conclusion as you, in that I feel I should wait on my GOOD Eye!   I still have blurriness and fail to see much improvement over prior YAG!   Seeing the RD surgeon, or at least checking back with my trusted eye doctor, is a minimum.  

I guess I need some answers first, clarity both in the YAG "ed" eye, or at least a vision check of that eye to compare back to before considering the next eye.  

Thanks for the reply and good wishes.  Keep me posted on your status as well, and good luck too!

[pinhole]

As I reread your original post, I see that you were told you had swelling in both eyes. Is that swelling of the retina? Was any treatment proposed?

The reason I perceived improvement after my YAG is that the center of the PCO was so dense it was blocking out light to the retina. I immediately experienced light getting through. But lines of text are now smeared--the water-drop effect that you described seems similar.

Were your two RDs in the same eye, or one in each?

I am glad you are staying on top of your symptoms and gathering as much information as you can.

[Greenbaypat]

You asked----As I reread your original post, I see that you were told you had swelling in both eyes. Is that swelling of the retina? Was any treatment proposed?
Thanks for rereading all of this!  I was told the swelling was likely from all of the procedures on my eyes, scarring from cataract surgery.  Not sure if it is on the retina...seems odd to even say, but I am unsure!?  


The reason I perceived improvement after my YAG is that the center of the PCO was so dense it was blocking out light to the retina. I immediately experienced light getting through. But lines of text are now smeared--the water-drop effect that you described seems similar.

SAME here!  Apparently, the light blocking is somewhat common, and it was told the YAG would improve that.

Were your two RDs in the same eye, or one in each?  
One in left first, July 30th and second in right in October  2nd of the same year.

So, I spoke with my eye doctor and she feels I should go back to my retinal specialist and surgeon who did my RD'S, and have his evaluation and assessment of the current situation and what my next step should be.

I did cancel my second YAG, as I want to get some answers and see also if my vision improves in the first one.

I hope to get in ASAP, and get clear on what it is that I am dealing with, and the road forward.  Also, the water droplets answer, which is troubling to hear that you are experiencing it as well!   How long ago did you have the YAG?

[pinhole]

I hope you have gotten an appt. with the retina surgeon. If your general ophthalmologist makes the call to the specialist you might get in faster if by calling yourself you don't get in as soon as you'd like. My YAG was nearly a month ago.

[Greenbaypat]

Thanks!  Yes, I got an appointment for a week from this Thursday with my retinal surgeon.

Thinking back, my eye doctor wanted the retinal doctor to check the health of the macula and overall eye health.  She said my cornea had some swelling.  Also, she mentioned that she had seen one pin point hemorrhage in my left eye, prior to the YAG.  She commented that she wasn't sure if the cataract surgeon was just addressing one issue, to be able to see more clearly if there is something else that needs to be addressed.

I do have a headache again today, and am unsure if it is related to the eyes, or just a coincidence?  I don't know about you, but each change that occurs it is sometimes challenging to know when to be concerned and when not to.  

[pinhole]

Hi Greenbaypat:

I hope you got reassuring news about your eye health from the retinal surgeon today!

Best wishes.

[Greenbaypat]

Thank you!  I guess only someone who knows the struggles, or fear of it all involved...anyhow, I actually was able to get in late yesterday afternoon & the surgeon actually had an emergency come up as I was there!?!  ...ugh, and I know what that is like, FULL Well!  My appointment was basically completed, but I with it all wasn't able to get prescriptions until today.

So...After seeing my eye doctor, (as you know, or is in this string of postings...). and now seeing my retinal surgeon, at a minimum I have swelling in both eyes.
The retinal surgeon started me on two prescriptions with a follow up in about 4 weeks.  Prednisolone 4 times a day
and   -- Bromfonac 2 times a day.(spelling?)
In the meantime, my cataract surgeon proceeded to call me this afternoon as well!!!  He called to check in and see what was going on.  He then said he wanted me to schedule another appointment and come in one week to see him(he did both eyes with the cataract surgeries a year ago, and the one YAG in my left eye).   The cataract doctor said I should have my eye pressure checked again, be dilated, and a glacoma test and not sure if/what else.  Also, to hold off and evaluate and treat the situation at hand before going further.  My eyes have been through a great deal in just under two years.
He said if the drops don't level things out, I might get the SHOTS!!?!   Yikes, I don't like the sounds of shots in my Eyes!

My vision has decreased, with some blurriness, some discomfort, along with swelling.
But, even though it appears I am experiencing ongoing problems,
I do feel very lucky to have such a great team of doctors who apparently are working together quite well!  I do credit my eye doctor with making this happen, she has been the engine behind it all, for sure!

Where are you at with your eyes?  Your prognosis &/or next procedure?  
Have you had the shots?

[pinhole]

I am sorry for all you are coping with--it's a lot. I have been taking two drops for the swelling, including Prednisolone. I created a chart to keep track, and have followed all instructions to the letter (waiting the recommended time between the two types of drops, shaking the bottle if that's in the directions, etc.).
My first appointment after being on this regimen for several weeks was this week, and the scan showed a big improvement! So I will be continuing with the drops for now, in hopes of further gain. The shot was mentioned to me, too, at an earlier appt.
I started a glaucoma drug last year to control pressure. It is working well.
Sounds like you do have a great team working on your behalf. Keep up the positive energy!    

[Greenbaypat]

Wow!  Sounds like a similar story and treatment plan!  You have no idea how good it is to hear that your appointment has shown a big improvement!!!  I needed to hear that, as you know how the doubts and fear seem to creep into your thought process....   Ugh!?!

I do get checked next week, so am hoping they can see more clearly that there isn't anything else and things are staying in some control...

I also am going to check and see if what I feel in my eyes now, is dryness, and if I should still be using the preservative free drops in between or not?

Do you have glaucoma?  Or is it just pressure issues?  How high is your pressure, if I can ask?  What is high?  Mine have been 18-21.... Varying in those ranges, at least lately anyhow.  What is the drug?  Is it preventative or like a blood pressure type thing?  Is it drops or oral?  

I apologize for all the questions, but am curious as it appears I may have the same needs...also, my dad has had a number of eye issues, as of late...

Thank you, and keep me updated on your progress.  

[pinhole]

Timolol drops for the pressure once a day. My pressures were often in the low 20s but sometimes in the high teens. I'm not sure what the normal range is--should be available online. I have heard that different people can tolerate different pressures, though.
I use preservative free lubricant drops as needed for eye comfort.
Yes, I do think we have similar challenges!

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[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!

[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.

[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!  

[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!