cruystalens problems?

[sossells]

Results are disappointing for my recent cataract surgery, with crystalens implant. After 4 months I have double and triple vision in the operated eye with complex astigmatism of 3+ diopeters. There were 2 YAG laser procedures to remove interfering tissue to better seat the lens and one procedure to remove the cloudy residue. Still the vision is severely impaired by multiple images. The cornea has now been mapped for its irregular shape. However, the surgeon is now concerned that there may not be enough cornea to withstand lasic correction. Alternatives are keratomy or corrective glasses, which seems a shame, considering the expensive crystalens. I think there is too much risk and judgmental lattitude in the keratotomy, but I need this eye to be corected before doing the other eye --- unequal magnification between the crystalens and the other unoperated eye is a source of another nuisance image.
Has anyone else had these problems? Can a crystalens be removed and replaced? Has anyone had more than 3 diopter irregular astigmatism corrected by lasic? Has anyone corrected this much astigmatism by the keratomy procedures?


This discussion is related to Crystalens HD 4th Generation Lens.

[DallasCPA]

who was your surgeon?  I'm in the DFW area & gave consulted with one of the "top" crystalens surgeons here, but am now quite concerned & wondering if I should go down to Austin...

[sossells]

This was  HD500 crystalens. sossells

[DallasCPA]

yikes! Was this crystalens HD, or can this happen no matter what IOL is used?

[sossells]

Well, this is to close the chapter on my crystalens problem and it may be of interest to someone who is contemplating cataract surgery. I am about a year after initial surgery and healing is complete. My eye surgeon assured me that I did not have z-syndrome, but could not explain why the crystalens resulted in so much extreme astigmatism. He had performed 2 small incisions during the cataract surgery, intending to reduce the beginning astigmatism. The incisions are reportedly made according to some nomograph and are supposed to be pretty accurate, since the nomograph is based on years of experience. For any statistical process, there are some "out-lyers" that fall far from the mean or average. Unfortunately for me, my results fell in the "far from norm" region,.
The surgeon later performed PRK surgery to try and correct the astigmatism and I now have about 20/70 uncorrected vision in that eye. Hopefully, this may be further corrected to about 20/40 with glasses. I apparently do not enjoy any benefit of flexure of the crystalens for good focus at near and far objects. Needless to say, this is a disappointment compared to the high expectations for a crystalens. Naturally, if I had it to do over again, I would opt for a conventional lower cost IOL, especially because I have to wear glasses anyway - near or far. Bad things can happen, but maybe you will have better results.

[sossells]

Thanks. I now have an article by Yuen and associates, where he reports 2 cases of z-syndrome. It is exactly as you described. The problem, solution, and photographs are very well presented. I have complained about a pressure sensation in one side of the IOL ever since surgery, but was told that I was probably feeling the dryness of a surface scar from one of the incisions. I replied that I couldn't believe that everyone that had IOL's would put up with that discomfort - but I have tried to accept it. Now I believe that the pressure bump sensation that i feel is perhaps real (not normal) and may be due to the z-syndrome warping of the IOL.
I will approach my surgeon with this and see if I can be helped. My surgeon is one of the top crystalens centers in the DFW Metroplex. Please accept my tribute to your skill and willingness to help. I will let you know of the outcome.
Gratefully, Sossells

[Ray T Oyakawa, MD]

Z-syndrome is when the capsule contracts making the Crystalens is to a "Z."  One haptic moves forward and the other backwards.  You had mentioned that they lasered the tissue to allow seat the lens.  This results in an increase of astigmatism which does not correspond to the corneal astigmatism. Symptoms would be some of the things you described.

If you had increase in corneal astigmatism due to the two incisions made, it is possible it was done on the wrong axis thus increasing the astigmatism.  This can be fixed at times by suturing  these cuts.  It would hard to fix 3 diopters of astigmatism buy additional cornea cuts.


A simple test would be to do a hard contact lens over refraction.  The hard contact lens would eliminate the irregular and regular  corneal astigmatism and mainly show the residual astigmatism from inside the eye (the IOL). If only the cornea is the problem you should get good vision with the hard contact lens over-refraction using just sphere.

Dr. O.

[sossells]

My preop astigmatism was minor.
The surgeon voluntarily made 2 incisions (that I had not expected) to correct my slight astigmatism. The result is much worse than brfore surgery. With that eye I get now 3 distinct images for a traffic signal light from a distance of about 300 ft.
Can that be corrected by keratomy?
I have not read of z-syndrome. What is z-syndrome and symptoms?
Appreciate your reply.
Sossells

[Ray T Oyakawa, MD]

Is sounds like you had a z-syndrome. I do not think you have three diopters of corneal astigmatism.  Most of this would have been present preop.   The Crystalens or any IOL is very difficult to remove and replace after a yag.  

I would recommend you see another crystalens doctor for a second opinion.  Look on the Crystalens website and look for a Center of Excellence in your area.

Dr. O.