RD after cataract surgery

[Robr929]

A few months ago, I noticed my left eye was acting weird and I couldn’t see. A quick trip to the doctor determined I needed cataract surgery in both eyes; left eye first. 10 days after my cataract surgery I started to notice a couple of floaters and some halos. Dr sent me to a retina specialist, who diagnosed me with PVD.  I asked the doctor if I can play men’s league ice hockey and she said yes! Probably should’ve trusted my gut and not played, but I went for a second opinion and was checked into the hospital for RD surgery… he said I caught it early.  I’m four weeks post-op, and I can see pretty well with some haziness and also have a lot of postsurgical debris/floaters. I am nervous to get my other cataract surgery because I don’t want to go through this again, if it caused the PVD and RD. Are there any tests they can do before I do my other eye to try and not let this repeat? Thanks!

[Ron_AKA]

I have had PVD in both eyes after cataract surgery. I found one study that showed risk of PVD in the first six months after surgery was not elevated for those with cataract surgery compared to those of similar demographics but without surgery. However at 1 year, the risk of PVD was over 7 times higher in the cataract surgery. I have not seen any conclusive evidence of the cause. Some speculate it may be the use of a high intensity light during the surgery.

I have not had any RD as a result of my surgery, but the study below concluded that risk is elevated in those who are younger than 75, male, and more myopic (longer eyes). There is really not much you can do about those risk factors other than age. It may be preferable to defer surgery until after age 75 if that is possible.

You could ask to see your eye measurements of both eyes to evaluate the risk of the first eye compared to the other. Axial lengths of more than 25 mm are associated with higher risk.

https://onlinelibrary.wiley.com/doi/full/10.1111/aos.15142

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

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

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

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[MrPresley]

Did you have a vitrectomy as part of the PVD surgery in your LE? I don’t recall having any post surgical debris/floaters following a ERM surgery/vitrectomy for my LE eight years ago.  Since then I have a OCT scan and full dilated exam performed by an ophthalmologist/retinal specialist for both eyes twice a year. Following cataract surgery in my LE 18 months after the intraocular surgery, I opted to not have cataract surgery performed on my RE. Like you, I wondered if having an IOL in my RE might present any complications should a ERM procedure become necessary in the future. It probably doesn’t (Dr. Hagan would know much better than I), but nonetheless the cataract in my RE hasn’t become bothersome enough to require surgery yet.

[Robr929]

Thanks for your response. Everything happened very quickly. About 10 days postop cataract surgery,  my implant was still working fine however I noticed a couple of floaters. I saw my cataract surgeon 15 days postop and he referred me to the retina specialist who said I have PVD but no retinal tear or detachment.  At that time I decided to get a second opinion and I saw another specialist at approximately three weeks post cataract surgery. That’s when he saw my detachment and I had surgery the next morning. My retina surgeon said I had a small hemorrhage after surgery and that’s why I have floaters/debris. I just find it hard to believe that all this was not related to the cataract surgery and that’s why I’m afraid to schedule the other cataract surgery until I have more info on how to proceed. I just don’t want this to happen again.

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

Robr: You are at very high risk of having a RD in the other eye and when cataract surgery is done it will increase the risk further.  In patients without significant risk factors for RD, they are relatively are, however cataract surgery, even modern small stitch, quick surgery increases the risk.  And things can change quickly with a PVD post cataract surgery. So it is possible that the RD could have developed between when you saw the first retina surgeon and the second.  If and when you need cataract surgery on the other eye, I usually had the patient see a retina specialist and cleared for cataract surgery. sometime there would be thin areas or tiny holes that the retina surgeon felt should be closed with laser if cataract surgery was at hand.  We always apprise the patient that cataract surgery increases risk of RD, expecially if history of RD in the fellow eye. Post uncomplicated cataract surgery the retina surgeon would see 1-2 weeks later. The retina surgeon can see the retina better with the cataract removed.  And of course with any increase of floaters, flashes of light loss of peripheral vision need to see the retina surgeon immediately. Ask your retina surgeon but I can't imagine he/she would want you playing hockey or other contact sports.

[Robr929]

Dr Hagan…thank you so much! My retina surgeon agreed that playing hockey after my PVD diagnosis was not the best idea idea…in the end, I’m glad I went for the 2nd opinion and caught it early.   I’m in no rush to do the other cataract, as I want my left eye to completely heal with hopefully all post-op “debris” absorbed. Only then, will I map out the plan with the surgeon of how to mitigate an RD as much possible.  Thanks again!

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

You are welcome Robr.  One last thought. Your blood relatives should be aware of your RD as that will put them at a slightly higher risk especially if other risk factors such as high myopia.

[MrPresley]

@Robr929 how close is the IOL set in your LE compared to your non-operative RE?

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

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[Robr929]

@Mrpresley not sure but will find out. Can you elaborate as to why it’s important?  Thanks

[MrPresley]

If you have myopia (like me) and had a monofocal IOL placed in your LE that’s 2.0 D or more different from your so far non-operative RE, there might be a period of monovision adaptation.

[Robr929]

@mrPresely I opted for a toric monofocal IOL for distance. My RE is less than 2.0 D from my LE, but my LE astigmatism is worse.  For the short time after surgery, and before the PVD, my vision in my LE was amazing… Hopefully it’ll clear up in the coming months and I’ll get that back!  

[MrPresley]

It took about nine months for my LE to achieve its final visual acuity after ERM surgery. Very gradual process. Since I also have an ERM in my RE, so far asymptomatic, when it came time to address the cataract in my LE that had become problematic 18 months after the ERM surgery I opted for a monofocal IOL in that eye only that was in approximate parity to my RE, -4.5 D (LE) compared to  -6.0 (RE). I considered getting distance correction for the IOL in my LE, and having my RE for close up, but that would have been a monovision approach which I had tried some years prior with contacts and did not like. Also my cataract surgeon dissuaded me from doing so, and I must say this worked well for me, so I hope to never need cataract or ERM surgery for my RE.

[Ron_AKA]

What was your eyeglass prescription for both eyes before cataract surgery?

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

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[Ron_AKA]

What was your eyeglass prescription for each eye before cataract surgery?