Thinking about delaying my 2nd cataract surgery and need advice.

[cazms53]

I had cataract surgery on my right eye one week ago and had a Tecnis toric monofocal lens implanted.  The goal was to do a mini monofocal with my right eye targeted for -1 and my left dominant eye targeted for plano.  My results from my first surgery have been good and I am pleased with my distance vision and my intermediate vision.  At my appointment this morning, my surgeon said my vision in my corrected eye is 20/25 and he is concerned if he targets my left eye for 20/20 that my intermediate vision will not be as good as it is now.  In addition, I have IOP in my surgery eye (33) and he started me on prescription eye drops to treat it.  I am uncomfortable proceeding with the second surgery so soon after the first.  Would it make sense to wait until my eye has fully healed to know what my final vision will be and to correct the issue with the eye pressure before proceeding?  The reason my surgeries were scheduled a week apart is because of my extreme myopia so it will be a bit uncomfortable for me to wait until he has another surgery date available next month but it is doable.  Any input would be very much appreciated.

[JohnHaganMD]

Absolutely. Our practice normally waits at least 3 weeks before doing the second eye so the person can tell us whether they want distance or near adjusted on second eye. SECOND your IOP is way too high especially after a week. you don't want to deal with high pressure in both eyes.  This forum is full of people that rushed into second eye surgery when not happy or having problems with first eye and very much regretted. it.   Need to find out why your IOP is so high so that something can be done on second eye to prevent the rise (inflammation? Steroid responder? Vitreous problem? ) etc.

[cazms53]

Thank you so much for your response!  My gut is telling me to wait so I appreciate you confirming my concerns.

[JohnHaganMD]

Best of luck. If things get dicey don't forget you can always get an independent 2nd opinion. This is definitely abnormal.

[cazms53]

I did cancel my surgery for today and rescheduled for April, giving me a full month since my first surgery.  Hopefully, my eye will have healed enough to know my final results, making it easier to decide on how to move forward with the left eye.  I was prescribed Combigan drops to use for the IOP and was told that the increase in pressure is probably due to a response to the steroid in my other drops. On Friday, my IOP was 16 and jumped to 33 by Monday.  How soon after starting the Combigan drops would I know if it is working to alleviate the pressure?

[JohnHaganMD]

48 hrs to know the effect.  Steroid eye drops can raise the pressure in about 8% of people but it usually takes being on the drops several weeks before the pressure goes up UNLESS you have been on steroid drops before.

[xltjim]

I appear to be a steroid responder as well.  I had a situation similar after my first vitrectomy.  Pressure went to 38 and had pain in the eye.  Was put on Alphagan P (I believe) and it went down in a couple days.  I had to come in each day to check the pressure.  On subsequent surgeries where I had to have steroid drops, they have prescribed the Alphagan to take as part of the drop regimen and has kept pressure low.  You made a good decision to hold off on the second surgery until this can be stabilized.

[cazms53]

Yes, I am very happy I made the decision to delay.  Even though I have such a large difference in the vision between the corrected and uncorrected eye, I will gladly take the discomfort over rushing into something and being unhappy with the results.  After reading Dr. Hagen's  response I am questioning whether or not the steroids are responsible for the pressure, as it occurred during the first week and I have never been on steroid drops before.  I think I will take the initiative to make an appointment for later this week to have my pressure checked again since they didn't request that I come in.  

[JohnHaganMD]

Good idea.  Odds are good your IOP will come down and that you eventually can go off the drops.