Removal if IOL

[ellard]

I was wondering if someone could offer me some advice.

I’m 30 years old and have severe myopia. I had clear lens extraction in my right eye approximately 13 years ago, and towards the end of last year I suffered an in the bag dislocation of the lens. I then underwent an operation to have a new IOL sutured into the eye wall. Since the operation, I’m suffering from severe ghosting images below lights in all lights conditions except sunny days outside. This week the consultant told me that he believes it is due to the an “edging” effect of the IOL as the ghosting got worse when he dilated my pupil.

An option now is to remove the lens and become aphakic. If I did go ahead with this I was told my uncorrected vision would be around -3D.

What are the risks of becoming aphakic and what can I expect? Will I see as I do today or will there be considerable differences? I could do with as much information as possible as I have a big decision to make that I’m going to have to live with for the rest of my life.

[JohnHaganMD]

The most important thing I'm going to tell you up front: Get a minimum of one and ideally 2 independent consults from  different cornea/refractive/cataract surgeons who do IOL exchange/removal as part of their practice. Most cataract surgeons do not do this type of surgery since its rare complication.

No you will not see anywhere near as well without the IOL as you do now. Moreover you have all the risks of infection, bleeding, double vision, droopy eyelid and most important increased risk of retinal detachment. You are at high risk anyway due to your high myopia, and higher still because of your decision to have your lens removed and an IOL put in. Research has shown that an eye with no natural lens or IOL   which you would be its called aphakic have the highest risk of RD and it could be as high as 5-10%   Then you will have all kinds of problems with getting your eyes to work together. You don't list what your other eye is, whether its had surgery and what the glasses RX for it is. This is a big decision and multiple opinions should be sought, it is high risk surgery.

[ellard]

Thank you for your response.
The vision in my other eye is good, I have just under 20/20 correct and have had a lens replacement in this eye also.
My right eye which I am having the problems with has always been my weak eye and the original lens extraction was due to a cataracts and was not by choice.
What other options are there other than having the lens removed?

[JohnHaganMD]

So your post was in error, you did not have a clear lens extraction but a cataract extraction. That takes some of the sting out of the problems.  Your symptoms are worse when your pupil is big and better when small. You could ask your surgeon to prescribe Alphagan P and use it for a couple of weeks to see if it helps. It keeps the pupil small especially in dark without putting stress on the retina. You would also try a dilute pilocarpine eyedrop such as 0.5%  However pilocarpine puts stress on the retina and the stronger solutions such as >2% increase the risk of retinal detachment. You could try a color contact lens with a central pupil and in a color that matches your iris color.  Finally you can just put up with in in order not to have to take the risks of more surgery.

[ellard]

Hi. I went for a second opinion and the consultant confirmed what the first consultant said regarding the "edging" effect and that the lens is positioned too high. He also said that he does not suture IOL’s into the eye wall anymore due to the difficulties of centering the lens. His method is to use an Artisan iris clip lens which he said he would clip to the back of the iris and not the front so it would still be behind the pupil. Other than the risks associated with the surgery is there any other problems that this could lead to or is it a good solution?

[JohnHaganMD]

I've never had any reluctance in this forum on in my practice to say I don't have experience with something.  Your situation is one of them. If you are comfortable with the surgeon and the suggestions you may want to proceed. Or you can that that proposal to another surgeon that deals with IOL complications.