Michael J Kutryb, MD  

Specialties: Ophthalmology, Cataract Surgery, glaucoma

Interests: Ophthalmology
Kutryb Eye Institute - Titusville
Titusville, FL
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Things You Can Do to Increase Your Cataract Surgery Success

Oct 14, 2009 - 6 comments

    Usually after I finish cataract surgery on a patient, the first thing I tell them is "You did great!."  I'm often heard saying to patients, "I'm proud of you!"  Successful cataract surgery requires not only excellent surgical technique but also a partnership with an interested motivated patient.

    Here are some things YOU can do to help make YOUR cataract surgery experience more successful.

1.  Make sure your surgeon had addressed any co-existing eye conditions and how they will affect your outcome.  Macular degeneration, macular pucker, diabetic retinopathy, glaucoma and dry eye keratopathy are the main co-existing conditions we see.

2.  Make sure you let the surgeon and anesthesiologist know if you have had trouble with surgery or anesthesia before and if you are extremely nervous or have clostrophobia.

3.  If you are feeling ill and having trouble with fevers or a cough or shortness of breath please let the surgeon know and be ready to possible delay the surgery.

4.  If you have blepharitis or granulated eyelids follow instructions on using baby shampoo or lid cleaning pads like Ocusoft in addition to an antibiotic ointment for the prescribed time before surgery.

5.  Make sure you are able to actually put in your eyedrops properly and follow the drop schedule exactly.  If you can't do it yourself you will need to have someone do it for you.  This is one of the main areas where I run into trouble is when patients forget to use the drops or think that they are doing so well that they don't need to use them.

6.  After surgery report any problems right away to the surgeon's office.  All ophthalmologists will have a 24 hour call service that will relay your call to the doctor on call that day.  Don't be shy or afraid or embarrased to call your doctor.  He or she needs to know right away if you're having a problem.

7.  Keep aware of your medical allergies and make sure that none of the drops or medications you are given are not on your allergy list.  I know that is mainly the job of the doctors and nurses but mistakes can still happen and if you're paying attention you could help to prevent a problem.

8.  Stay clean, wear clean clothes, take a good shower the night before and wash well especially around your face.  Wash your hands a lot and try to keep them away from your eyes if possible.  These are just common sense things to help reduce the risk of infection.

Good Luck, and God Bless.

Cataract Surgery Complications Linked to Flomax

Jun 27, 2009 - 0 comments

A new landmark study has shown that men taking Flomax (tamsulosin) have twice the risk of serious complications after cataract surgery.  The study out of Canada collected data on over 96,000 men who had cataract surgery.  The higher risk of complications was found in the men taking Flomax within14 days of the surgery, but not in men taking other medications for BPH (benign prostatic hyperplasia.)  The complications noted included retinal detachment, lost lens fragment, infection and inflammation.

How does Flomax affect cataract surgery.  It's called Intraoperative Floppy Iris Syndrome (IFIS) and in basic terms it can make the iris very loose and floppy so that it doesn't dilate well for the cataract surgery and often causes the pupil to un-dilate during the surgery. The floppy iris can billow about like a sheet in the wind, can get sucked up in the phaco-emulsification tip or squirt out of the surgical incision.  I've even seen the iris try to go out of the tiny 1 mm side port incision.  The effect can be so great at times that tiny flexible iris retractors are sometimes needs to physically hold the iris out of the way for the cataract surgery.

My personal estimate in my practice is that about one in 12 men getting ready for cataract surgery are currently taking or have taken Flomax.  It is a very, very popular drug, and to be honest does an incredible job for those with serious BPH and urinary issues.  Even if patients have been off of Flomax for a several years, I still include them in my Flomax protocol group since the iris effects of Flomax do not necessarily go away when the drug is stopped.

For my patients getting ready for cataract surgery, I ask them to stop Flomax for 2 weeks prior to surgery.  In the operating room, we often utilize intraocular epinephrine solution to dilate and stiffen the iris, and alway use a thicker viscoelastic agent to hold the iris in its place.  Also, careful consideration is given to make sure the incision dives well over the peripheral iris and a very tight incision is essential to reduce iris prolapse through the incision during the case.  I very rarely need to use iris retractors anymore (none in the last 18 months) despite operating on about 2 Flomax cases each week.  I haven't personally seen a greater incidence of major complications, but I have seen a few cases with minor damage to the iris, especially near the incision.  Some of  these cases can be much more difficult at times, however, and they have contributed to some extra gray hairs.  I attribute my low complication rate to the great contributions by surgeons like David Chang, who have popularized protocols using stronger dilating drops, thicker visco-elastics, low flow infusions, and epinephrine mixtures.  I will tell you it makes all the difference in the world.

I want men to know that if they are considering taking Flomax, they should carefully consider how it will affect their cataract surgery in the future.  I very strongly urge you to at least look carefully into other options for treatment of BPH symptoms.  As a cataract surgeon, I know that I would want to avoid this drug if I knew that I might need cataract surgery someday down the road.  If you are already taking Flomax, you should know that you can still have safe cataract surgery and should not stop the drug unless under the direction of your doctor.  Your cataract surgeon will most likely ask you to discontinue it for a while (if possible) around the time of your cataract surgery.  You don't want your iris to be "floppy" do you.

Michael Kutryb, MD

Can LATISSE Really Make Eyelashes Longer, Fuller, and Darker?  Absolutely, Yes.

May 10, 2009 - 35 comments

    At first I was a little skeptical about how prescription eyelash growing solution LATISSE would be received out in the general population.  I have been using the exact same solution, as an eyedrop called LUMIGAN, to treat glaucoma for about 10 years.  You see, it has this unusual side effect of making eyelashes longer and darker.  It was only recently that the ophthalmic drug company Allergan, decided to use this long known side effect of bimatoprost 0.03% solution (known as the glaucoma drug LUMIGAN) to create LATISSE to be marketed to our increasingly appearance driven society.  LATISSE is applied to the upper eyelashes once a day with a special brush and after several weeks when the effect begins, the dose is usally tapered down quite a bit.  Now for those on the cutting edge of beauty, they have one more weapon in their arsenal.  It's a lot work to stay beautiful, especially for those in the television and entertainment industries where your face and figure can have a big effect on your paycheck.  And, hey if you're not a movie star but want to look like one - more power to you.
     Anyway, I wanted to let you know that this product really does work.  Early results with LATISSE with my patients and from other doctors I know, confirms my belief.  It works very well and this stuff is the real deal - but understand that it will not work on everyone.  I estimate that about 20% of people might not get much response and about 5% may have to stop the product due to irritation, itching or redness of the lids or eyes.  Please read the package labeling carefully, since this product has the potential to cause redness of the eyelids and eyes and may have to potential to change iris color to a darker, more brownish shade.  I have seen all of the above side effects with the glaucoma drop version, but LATISSE is applied only to the upper lashes (not the eye) and the dose is much, much lower and is tapered off significantly after a few months.  The incidence of LATISSE side effects is actually rather low but be on the lookout especially for eyelid and eye redness.

Good Luck with your eyelashes.  If you get a chance look at Brooke Shields' eyelashes on the LATISSE web site (really awesome photos -  truly remarkable.)  By the way, I have no financial interest in Allergan and I am not a paid consultant.

MIchael Kutryb, MD
Kutryb Eye Institute
Titusville, Edgewater, FL

Cataract Surgery May Not Increase Risk of AMD Progression According to Recent Study

Feb 08, 2009 - 4 comments

A recent study published in the journal Ophthalmology, revealed that cataract surgery may not increase the risk of progression of advanced age-related macular degeneration (AMD.).  The authors used data from the well known Age-Related Eye Disease Study (AREDS.)  For many years, cataract surgeons like myself, have cautioned our patients, that we have seem patients that have had worsening of their AMD after cataract surgery but there has never been a direct link.  Previous studies have suggested, that the AMD has a propensity to get worse over time with or without cataract surgery.  This recent study appears to confirm the general concensus that the AMD needs to followed closely, regardless of whether or not cataract surgery is performed and while some patients may show worsening of the AMD down the road, it statistically not related to cataract surgery as far as we know.

For my part, I always have this discussion with cataract surgery patients who have AMD.  I also make sure they are on the appropriate anti-oxidant vitamins, omega 3 fish oil, lutein, and a diet rich in green leafy vegetables like spinach  and brocolli.  For patients with advanced AMD, I usually use the Acrysof IQ lens which filters UV light and some of the harmful blue light at the very, very end of the visible light spectrum.  It is the only IOL that does that and it might have a slightly better protective effect than other IOL's (although no proof yet, long term.)  If possible, I also use the very lowest light power on the operation microscope, try to limit the surgery to less than 8-10 minutes.  Simple little things with no proven benefit but worth the effort I think.

I have one patient that I think of often who was already at 20/400 vision due to end stage AMD in the right eye and moderate AMD in the left eye with a very cloudy, mature cataract.  I have him on AREDS formula vitamins, Lutein and Omega 3 fish oil and a proper diet.  It has been about 5 years since we removed the cataract in the left eye and used the Acrysof lens (with the extra chromophore filter) and he maintains 20/20 vision in that eye and often brings in the very heartfelt poetry that he writes and publishes.  You see he is a WWII veteran and is a strong patriot.  His works of poetry get to me every time and I think the world of him.

Michael Kutryb, MD