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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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My 76 year olf Mom just had cataract surgery four days ago.The

Customer Question

My 76 year olf Mom just had cataract surgery four days ago.
The next day she was seeing fairly clearly and went to doc for a follow up visit.
Doc said everything looked good.
She is due back to see him again in a few days.
Unfortunaltely this morning when she woke up and the vision was extremely blurry, all day long.
Could this be just part of the healing process? I have researched this and have not come across anyone that saw clear the day after surgery and a few days later went blurry.
I do not want to panic her, as I know that a number of things could be happening to cause the sudden blurriness. I would just like a professinal opinion right now.
- Can this just be a normal healing process - clear and them exremely blurry?


Her other eye is partially blinded by a retinal occlusion for a few years, so the eye she had the cataract surgery on needs to heal correctly as it is her only sighted eye.
She is also onblood thinners.

UPDATE - Well, yesterday my Moms eye turned completely white.

Her cataract surgeon saw her at midnight and referred her immediatley to her retinal specialist , who saw her at 2 AM

He said she had a very bad infection, drained some of the pus out of her eye, and took a culture, also gave her a shot of antibiotics into her eye.
( Culure why? to see if it was a staph inf aquired during surgery? Or what other reason?)

He said it is a very bad situation, that the prognosis is guarded, , that it could take months for the infection to heal and the damage the infection can/will cause could require a surgey , that my MAY restore some site.
He said they cannot even adrress surgery of other complications taht may have occurred with the cataract surgery until the infection clears up which obviously means that the longer she has to wait for the surgery, the worse the sight outcome will be.

Should she be in a hospital for this right now?? What could they do for her in a eye hospital setting? He is seeing her again
tomorrow AM- What is done all these upcomng months to monitor the infection if it is monitored in an outpatient setting? -
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Rick replied 2 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

It sounds like your mother has endophthalmitis, a very rare but very severe complication that can happen after cataract surgery. As a retina specialist I treat a lot of these infections.


 

Dr. Rick :

Cultures are always done so that if the immediate therapy is not working you will, hopefully, have an organism identified that can help you to modify the treatment. As you already know, treatment starts before the results of the cultures are known.

Dr. Rick :

Actually her final sight outcome does NOT depend on when, or if, the retinal surgeon does any surgery (vitrectomy) but, rather, on what type of bacteria has invaded her eye, how much damage is done to her retina and other structures by the bug, inflammation, and swelling etc.


 

Dr. Rick :

Sometimes patients like your mother are monitored in a hospital setting but, in the majority of cases, therapy consists of the intravitreal injections (inside the eyeball), subconjunctival injections (around the eyeball) and very frequent strong topical antibiotic drops. I would say that 98% of my cases of endophthalmitis are treated as outpatients

Dr. Rick :

The retina specialist is going to watch your mother very closely to make sure that the infection is getting better every day, in some cases I check a patient twice a day....he will then see if she has any complication (high eye pressure, retinal detachement, cornea problems etc) and deal with them if they come up.

Dr. Rick :

I wish I could tell you that everything is going to be OK but, unfortunately, this condition is about as serious as it gets in my field. All that can be done right now is for her to get the best care possible and hope for the best.


 

Dr. Rick :

Now. You might want to ask: "What did the surgeon do wrong?" and the answer is: Nothing.


 


This is just one of the risks of having eye surgery and, rarely, it happens and there is no rhyme or reason why it happened to your mom.


 

Dr. Rick :

Does this make sense to you?

Dr. Rick :

Please remember the top 3 ratings are positives and Excellent service is my goal. Your positive feedback is how we are compensated. If you aren't 100% satisfied, just click "reply." I will be happy to discuss your issue in more depth and do everything I can to provide you with the information you require.


Otherwise, a high positive rating is very much appreciated, bonuses are great, and find me anytime for follow up.



Let me know if you have further questions.

Customer: replied 2 years ago.

Thank you for such detailed information.


I just cant see how he can monitor her every day, sometimes twice a day , as an outpatient..


We would have to have her at their office every day for possibly months. Twice a day?


I would think the only way to do this is a hospital setting.


 


She obviously cannot ge to their offices every day on her own.


I am wondering if I will just need to take a leave of absence from work to get her their every day.


We will do whatever it takes to try to save her sight.


 


Are the injections you are talking about needed daily? Or how frequently?


 

Customer: replied 2 years ago.

Thank you for such detailed information.


 


I just cant see how he can monitor her every day, sometimes twice a day , as an outpatient..


 


We would have to have her at their office every day for possibly months. Twice a day?


 


I would think the only way to do this is a hospital setting.


 


She obviously cannot ge to their offices every day on her own.


 


I am wondering if I will just need to take a leave of absence from work to get her their every day.


 


We will do whatever it takes to try to save her sight.


 


Are the injections you are talking about needed daily? Or how frequently?

Expert:  Dr. Rick replied 2 years ago.
Those are all excellent questions and, after things are noted to be getting better, your mother will not need to be seen as often.

I manage cases like your mothers on an outpatient basis all the time and I am sure she will get excellent care that way.

You may have to take some time off of work to help her through this. Check with your employer....there may be some family leave program in place to help you out during these difficult times.

Usually just the initial injections, then very frequent drops. More injections will only be needed if indicated, but not every day etc.

Let me know if there is anything else I can help you to better understand as you and your mother continues to deal with this infection.

As a person who has given positive feedback 65 times in the past you know what to do next :-)
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.

I forgot to mention that two weeks prior to the cataeact surgery the doc did a 'minor" laser on the eye to relieve her eye pressure as it was elevated to i belive 27? ( She takes lumigan to keep her pressure down)


they siad it could take wekks for the lasrer to be effective, but wanted it dne defore the cataract to avoid a pressure spike after the cataract surgery.


Could this laser treatmetn have caused this infectionor posssibly cause the infection to tear her retina?

Expert:  Dr. Rick replied 2 years ago.
No. The laser treatment did not cause her eye infection since the laser does not expose the inside of her eyeball to the outside world like cataract surgery does.

It should also not have affected her retina in any way.

How is your Mom doing today?
Customer: replied 2 years ago.
She is at the retinal surgeons office right now with my sister in law , waiting to hear from them. If you don't mind i will
let you know how it went.
Expert:  Dr. Rick replied 2 years ago.
Sounds like a good plan. I look forward to hearing from you.
Customer: replied 2 years ago.
can the eye infection, Possibly I guess a staph inf, spread to the rest of her body? Same as if you get a staph inf in your body (usually from a hospital setting) that it can? is the eye infection that kind that can spread into her head? etc?
She has a naval cavity fluid problem from a fall three years ago where she broke her nise .has a frequent fluid drip. Do we need to get another doc involved , ENT , neuro?
why wouldn't she need antIbiotics for the rest of her body. , why just the eye?
Expert:  Dr. Rick replied 2 years ago.
There is almost no chance of the eye infection spreading to her head or any other part of her body.

No need for antibiotics for the rest of her body...all that needs to be treated is her eye....also doesn't sound like an ENT or nero doctor is necessary at this point. Everything is in the eyeball.

Don't forget to mash the excellent feedback button :-)
Customer: replied 2 years ago.


How about IV or oral antibiotics? Not necessary?

Expert:  Dr. Rick replied 2 years ago.
That is correct. Not necessary from what you have posted.
Customer: replied 2 years ago.


Ok, they said they found that the bacteria is dead from the injections and the drops and the inital culture says the bacteria is not growing - but they still need to wait a few more days to see if it grows. but the pus is still there -


Normally they would wait a few weeks to drain the pus but they want to do it now - Drain the pus with an incision? and add saline .And do more anitbiotic injections _this they woudl be done as an outpatient in the hospital - i thought they extracted the pus the other night , but they just extracted some fluid for culture.


They also said doing this procedure probablywill not improve the vision - but i guess they want the pus out to see the retina more clearly?


 


 


They said the retina is inflammed but no holes in the retina.

Expert:  Dr. Rick replied 2 years ago.
The main reason to do a vitrectomy now is to remove the inflammatory "gunk", give more antibiotics and steroids inside the eye and remove any traction on the retina.

It sounds like your mom is getting excellent care. I would do the same thing.

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you at no additional charge :-)
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.

Yes, they said the eye was very inflammaed but didnt want to wait.

They said doing this now may increase her chances of slight vision coming back (only seeing lght ) may will give her a 20 percent chance , but she will be basically blind for months, this surgery will not help that.

Said if she waits to do it the chances of any sight are virtually 0 -

Aslo said she is msot likely permanently blind at this point - that nothing they are doing will help that , the infection was too aggressive Looksl ike her chances of being able to see again are very grave.

can the Virectomy cause an occlusion? Does it matter?

 

Is the virectomy still a plus? It is good to remove retinal traction?

They need to give her a Vitamin K injection before the surgery because she takes blood thinners. This is sucha sad, sad day for my Mom .

She is now only able to see out of her right eye with the retinal occlusion that blocks her visions about 75 percent.

 

Should i ask her surgeon to psotpone this and refer her to teh NY Institute for a hopital stay. Do you know of this place, perhaps they can do something different for her? Or perhaps they have better qualified surgeons?

 

The retinal sepcialsits she sees were not able to repair any sight in her occluded eye a few years ago, have her steroid injections and laser with no improvemnt. My confidnence level in waning.

 

Also, the risks of this surgery are infection or loss of eye???

If she got a terrible infection from jsut cataract surgerym, why wouldnt the risk of an infection from the Virectomy be enough reason ot to do it? Or the risk of losing an eye?? Obviously her eyes are not the type that take surgery well...

Expert:  Dr. Rick replied 2 years ago.
I am sorry to hear about your mothers prognosis but, I have had to tell family the same exact thing myself too many times :(

I would consul you to proceed with the vitrectomy...it is what needs to be done at this moment.

I would not postpone therapy for any reason whatsoever. There is no one who can give your mother any better care then she is getting right now.

Expert:  Dr. Rick replied 2 years ago.
Any risks of the surgery at this point are much, much smaller then doing nothing.

Those are risks of any eye surgery, even eye surgery to control an eye infection.

If you do not do anything she will loose the eye.

It sounds like your mother is in excellent hands. I would, at this point, just follow whatever the retina surgeon suggests and hope for the best. Try not to over think things at this critical junction....

Does this make sense to you?
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.


Yes it does. And thank you

Expert:  Dr. Rick replied 2 years ago.
My pleasure.

I will send positive vibes your mothers way.....please let me know how her surgery goes and, remember, I'm here if you have any more questions or concerns.

Hang in there :)
Customer: replied 2 years ago.
ok, surgery went well, did not see alit if retina damage. follow up today she had a lot if gooey gunk in her eye, normal?
took another culture, waitng for results. last culture came back staph , they said that was the easiest too treat?
continuing all drops and seeing Docagain tomorriw.
they said it was safe for her to restart blood thinners tonight, but I am very apprehensive. Isn't there a possibility of post op retinal bleed. why take this chance as post op bleed at this point can be devastating to her site.
Docs in her office ate not in agreement on when she should restart it.
surgeon yesterday said restart today.
doc in office today said restart today.
their doc on call said it would be safe to stay off for a few
off for a few more days since she is only on the Coumadin for AFIB.
Is that because the bleed risk lasts a few days after surgery?
their associate said the bleed risk occurs within the first 12 to 24 hours after surgery. Who is right?
Expert:  Dr. Rick replied 2 years ago.
There is no need to worry about a post op bleed from restarting her blood thinners.

As a retina surgeon, I agree with the doctor who said it is OK to restart the blood thinners now.....

The new cultures will most likely be negative but it is good to check.

do not worry about the gook in her eyes; that is normal.

Let me know if there if there are any other questions you have. I'm glad to hear that the vitrectomy went well.
Customer: replied 2 years ago.
well, I already told her not to
take it tonight, so she missed tues dose, wed dose and took vit
k for surgery that day and missed the dose tonight.
ok to start tomorrow? One of her docs said there was like a one in 500 chance she coyjd get a post op bleed. didn't want to risk it.
I know have to pray that she doesn't have a stroke from missing her pills.
I guess i should have listened to her doc today and had her start it tonight.
I thought there was a chance of a retinal bleed .
Expert:  Dr. Rick replied 2 years ago.
The blood thinner really will not increase her risk of a post op intraocular bleed.....Ok to start right now if she wants

There is a chance of a retinal bleed from the surgery....but it is small and the blood thinners have very little to do with it.

Make sense?
Customer: replied 2 years ago.
she is already asleep, was in a lot of pain fr surgery. took a pain med and is finally resting SI can give thencoumadin to her now. I hope starting tomorrow is ok
Expert:  Dr. Rick replied 2 years ago.
The sooner you can start back on the coumadin the better as far as decreasing her risk of blood clots....I would try to start it today if at all possible.

I am glad to hear that she is getting some rest. I hope things continue to improve.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.
she has to continue three diff eye drops every two hours for at least another week.
an antiinflam, an antibiotic and I think a dialater?
plus the doc wants to see her three days next week to check the eye . is this much medication something you have done? and these many visits?

Expert:  Dr. Rick replied 2 years ago.
The number and frequency of drops sounds right to me, as do the number of visits.

Sounds like she is in good hands.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.
Bad news. on sept tenth her retina detached, she had retinal attachment surgery on the eleventh, had a band put around her retina and a gas bubble put in place.
she is trying to heal from that right now, the pain is intense.
Does the new retina surgery make her eye more prone to post op bleeding - and if so what will that bmeeding do to her eye? pool up behind her retina?
what is the probability of an eye bleed right now?
we took her off her blood thinners indefinitely. Doc wanted to put her back on after 5 days bit we are keeping her off . is a retinal detachment surgery such as she had have a high probability of a bleed for persons not on blood thinners?
Customer: replied 2 years ago.

Bad news. on sept tenth her retina detached, she had retinal attachment surgery on the eleventh, had a band put around her retina and a gas bubble put in place.
she is trying to heal from that right now, the pain is intense.
Does the new retina surgery make her eye more prone to post op bleeding - and if so what will that bmeeding do to her eye? pool up behind her retina?
what is the probability of an eye bleed right now?
we took her off her blood thinners indefinitely. Doc wanted to put her back on after 5 days bit we are keeping her off . is a retinal detachment surgery such as she had have a high probability of a bleed for persons not on blood thinners?

Expert:  Dr. Rick replied 2 years ago.
I'm very sorry to hear about this complication.

The retina surgery does not make her eye more prone to bleeding, nor do I think if she had been on coumadin would her risk of this problem been increased. Detached retina is a common complication of serious eye infections like your mom had.

Bleeding in the eye usually fills up the back of the eye (vitreous cavity) although, yes, it can get behind the retina.

If she needs to be on the blood thinners for her health and safety I believe it is OK, from an ocular point of view, to do so. Of course you should confirm this with your mothers surgeon.

Let me know how things go for her. Take care.
Customer: replied 2 years ago.

Heawr doc is in agreement that she can stay off of coumadin for an exteneded time since she was only taking it for an AFIB that she no longer has.


He said if there is any risk of bleed in her eye it is more important to keep her off the thinners and also the 81 mg aspiring she takes for a heart stent .


 


The retinal surgeon said the was some bleeding, i think right after the surgery. We just dont want to do anything that can make her bleed in eye.


How bad would a bleed in her eye be now , what can it effect?


 


 

Expert:  Dr. Rick replied 2 years ago.
I'm glad the A fib has resolved.

That being said, in my opinion, neither the aspirin or the coumadin would significantly increase her risk of an intraocular bleed at his point. But if she doesn't need them, then no problem.

I do not think that she will bleed now but a bleed could be no problem at all or could be a disaster...just depends.

Does that make sense?
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.

Hello


 


Just a thought, as i obvioulsy cannot learn enough about this!


 


Why wasnt the gas put in during her vitrectomy? Isnt that sometimes done?


is it because the vitrectomy was only done to clean out the eye?


I know the doctor said he couldnt tell if the retina was damaged during


the operation because of the inflammation. So I am thinking he couldnt do any retinal repair or gas because of this? I am thinking the tear was already there or got worse from the vitrectomy? It that why a few days after the vitrectomy the tear came about? Could the vitrectomy have caused the tear? The doc that did the vitrectomy was "shocked" about the tear . His partner was the one who did the office follow up and spotted the tear and did the retinal attachment surgery and gas insertion.


 


 

Expert:  Dr. Rick replied 2 years ago.
Gas bubble is not always done during surgery to repair a detached retina. Every case is different.

The tear and detachment was most likely present before the vitrectomy, but, yes, just the vitrectomy could have caused the tear.

That being said you mom had such a terrible infection in her eye that if the surgery was not done she would have lost the entire eyeball.

I have to admit that, over the course of two decades of practice I have experienced retinal tears after vitrectomy surgery for severe endophthalmitis.... it is a risk we have to be willing to accept and be able to quickly address and fix.

It sounds like you mother continues to get excellent care.

I hope things are improving.

Take care and let me know if I can be of any further assistance.
Customer: replied 2 years ago.


Well, the doctor who did the vitrectomey said that the infection was gone .


But that she had inflammation that made it hard to see retinal damage.


 


Why was my mom not able to notice a retinal detachement occurring the days after her vitrectomy>


She was told on her follow up visit by another doc that she had a detached retina and needed retinal surgery.

Expert:  Dr. Rick replied 2 years ago.
Because her vision is really bad and the amount of "extra" vision that was lost from the detaching retina was not enough for her to notice. Also, it may have only involved her peripheral vision at first, which is hard for some perfectly normal patients to notice.

That is why follow-up visits are so important: To catch problems before they get out of hand.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.


Hello, I am finding out today from her cataract surgeon which type of cataract surgery she had so that I have a full idea of all the surgeries that have been done on her.


I am asking wihich or these three she had -


Phacoemulsification (Phaco)


extracapsular


or


Intracapsular


 


i would assume it was the Phaco as she did not have stitches and did not come home with a patch -


 


Are the first two, Phaco and Extra , the more modern ones that are done and the ones that preserve the vitreous gel? Would either of those two types of surgery have given her a better chance of not getting a retinal tear and or infection?


 


thanks


 

Expert:  Dr. Rick replied 2 years ago.
Both of those cataract surgeries stay away from the vitreous gel and, as such, preserve it.

In some cases the posterior capsule can break during cataract surgery and then the vitreous gel is involved. This is not very common,however.

From what you posted your mother had phaco.

Here is an article, from a very, very reliable source, that discusses both phaco and extra (ecce) cataract surgery:

http://www.aao.org/publications/eyenet/200904/feature.cfm

How is your Mom doing?

Customer: replied 2 years ago.


Thanks -


Well, she is still in some pain, still on three or four drops of meds every two hours or so, Still off the aspirin and blood thinners - Docs are down to seeing her once a wekk right now.


Can see a little line across her eye, doc said it was the gas bubble she was seeing - Other than that , no sight improvement - just some shadows and light. Interestingly enough, her other eye, the one she had a retinal occlusion in a few years ago, where she can only see the bottom half of things, she is using more - She said it feels like her sight in that eye got brighter, i think it is because she cant see out of the other she is just utilizing the other eye more .


 


I did have a thought -


Have you heard of eyes getting weaker, losing gel, getting retinal detachments from patients using SSRI meds or even anti anxiety meds.


i wonder if my Moms eyes are just weaker as she has been on Zoloft for many years and some studies that kind of med can effect eye pressure, eye gel, etc.


I find it interseting as my brother had some sort of burst of eye floaters in one of his eyes a few years ago where he had to have some sort of laser repair.( he had also had laser surgery a year prior to that to improve his nearsightedness.) He also at the time was on some sort of SSRI anti depressant and possibly an anti anxiety med. I wonder if these meds can damage your vitreous, cause floaters and flashes, as I know my Mom had several floaters in her eyes as well.


Any thoughts or medical experience with that at all?

Expert:  Dr. Rick replied 2 years ago.
No. The use of SSRI's, Zoloft etc would have no effect on her eyes in any way whatsoever.

It sounds like your brother had a retinal tear with vitreous bleeding...once again his use of SSRI's and anxiety medicine is just a coincidence.

After practicing retina for over two decades, and studying Ophthalmology for most of my adult life I have never seen nor heard about any relationship like you are talking about.

At this point I am glad to hear that your mom can see light...This we can work with. Lights out blindness we can't......
Customer: replied 2 years ago.


Thanks - Just found out she had the Phaco .

Your advice and knowledge has been more than I could have ever asked for . I will be sure to keep you posted on her progress.

My mom has a film over her eye , making it look like her eye is blue as opposed to brown. I think it has been like that since the vitrectomy or since they retinal surgery. Hard t tell as her eye was swollen so shut for a while, It is now pretty much open so i can see it better. The docs have obvioulsy seen it. Do you know what that would be from? the gas bubble? The infection? I am going to her follow up appt with her end of week, so I would like to have as much knowledge as possible so that I can better understand what her doc is telling me about her eye.

 

On a seperate note -

do you think my brothers tear was a result of the laser surgery?

 

Also, why do some just have laser repair for a retinal tear and vitreous bleeding, like my brother , and some has to have a full retinal detachement surgery, such as my mom?

 

As an FYI - i i even developed a rolling eye flash and floaters when I was on an SSRI a few years ago - (lexapro) - they never went away .

perhaps it is something genetic to my family or will become listed as a more common side effect if the years to come. It is becoming a more common side comment on websites lately.

 

Customer: replied 2 years ago.


Thanks - Just found out she had the Phaco .


Your advice and knowledge has been more than I could have ever asked for . I will be sure to keep you posted on her progress.


My mom has a film over her eye , making it look like her eye is blue as opposed to brown. I think it has been like that since the vitrectomy or since they retinal surgery. Hard t tell as her eye was swollen so shut for a while, It is now pretty much open so i can see it better. The docs have obvioulsy seen it. Do you know what that would be from? the gas bubble? The infection? I am going to her follow up appt with her end of week, so I would like to have as much knowledge as possible so that I can better understand what her doc is telling me about her eye.


 


On a seperate note -


do you think my brothers tear was a result of the laser surgery?


 


Also, why do some just have laser repair for a retinal tear and vitreous bleeding, like my brother , and some has to have a full retinal detachement surgery, such as my mom?


 


As an FYI - i i even developed a rolling eye flash and floaters when I was on an SSRI a few years ago - (lexapro) - they never went away .


perhaps it is something genetic to my family or will become listed as a more common side effect if the years to come. It is becoming a more common side comment on websites lately.

Expert:  Dr. Rick replied 2 years ago.
The change in her eye color is most likely due to swelling of her cornea. It might also be from a film of inflammatory tissue stuck to her iris (the colored part of her eye).

No. I don't think your brothers tear was from the laser surgery. These things just happen....

That depends on the extent of the tear and how much, if any retinal detachment is present. If there is a tear but no detachment then laser can be done to "weld down" the tear so that the retina has less of a chance to detach.

I will look for you and your family in the medical literature ;-)
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.
I just got your joke! we may well be in the literature one day!
thanks again
Expert:  Dr. Rick replied 2 years ago.
My pleasure. Give my best to your Mom.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.


Hi

 

Correction -

Her cataract surgery was extracapsular without stitches and he used a facial emulsion? instrument to remove the cataract.

 

Does this sound right?

 

Also, how would we know if the posterior capsule broke during cataract surgery and if the the vitreous gel was involved?

 

yesterday she saw a wobbly in the eye, hopefully it is the gas dissipating?

 

Aslo , as for the blue film on her eye, , will it eventaully dissipate or will it need a surgery? Does it inpede her vison?

 

Expert:  Dr. Rick replied 2 years ago.
That is Phaco surgery....the most modern type of cataract surgery available. The terms can be confusing because phaco is a form of extracapsular cataract surgery, just like laparoscopic gallbladder removal is a form of gallbladder surgery. Does this make sense?

The surgeon would know right away if the posterior capsule broke and the vitreous moved forward into the anterior segment. You would only know that this happened if the surgeon told you.

She has a lot of reasons at this point to see a wobbly in her eye at this point. I'd not worry about to much right now.

It is hard to tell if she will need additional surgery from the blue film over her eye. I think, in the scheme of things, the primary issue limiting your mothers vision at this point is the damage to her retina from the terrible infection she had in her eye (endophthalmitis)

I do want to say, however, that from what you have told me so far your mother is getting excellent care. I don't see anything that I would do different at this point.

Have a good day and let me know if there is anything else I can do to help.
Customer: replied 2 years ago.


Correct. I spoke with their office and they confrimed it was Phaco -

No stiches, unremarkable, broke up lens and took it out, left capsule partially intact and inserted new lens.

 

 

Not sure if I asked you this -

the day after her cataract surgery she was seeing pretty well. she started to develop a blurry.film on her her eye the next day which got progressivley worse by the next day, that was the day they did the antibiotic injections in office and took a culture. the vitrectomy was done several days later.

 

The third day after the cataract surgery, before the infection was discovered, she cried alot, was in an emotional state -

could the crying have caused the bacterial staph infection?

Expert:  Dr. Rick replied 2 years ago.
No. Crying had nothing to do with her eye infection. No need to worry there.

The bacteria most likely got into her eye during the surgery. Every precaution is taken to make sure this doesn't happen but, even then, sometimes it does....
Customer: replied 2 years ago.


She had seen a line across her eye a few days ago - doctor said it was the gas bubble disispapting,


Today the feels like she is seeing a protrusion out of her eye , like two inches and that it looks larger than her eye. And that she can feel it and it is uncomfortable - Driving her crazy - in her words -


We cannot see it from looking at her eye, she is just explaining to us what it looks like to her from the iside looking out,


Can this still be the gas bubble or something more serious?


 


 

Expert:  Dr. Rick replied 2 years ago.
It sounds like the bubble.....nothing to be concerned about at this point.

It is not unusual for patients to have see all sorts of things as the eye heals.
Customer: replied 2 years ago.

Actually, she said she cant feel it , she can just see it.


As long as you dont think it is something detaching or pushing from the back of her eye, I am going to just take her to her regular check up tomorrow. Would she feel pain if it was something more serious?


I know she wouldnt feel a retinal detachment.


 

Expert:  Dr. Rick replied 2 years ago.
From what you have posted I do not think it is anything serious. She should be fine waiting until her regular checkup tomorrow.

Pain at this point would be something that I'd have checked out right away, but serious things can go wrong even without pain.....but try not to worry :)

I hope the checkup goes well tomorrow.
Customer: replied 2 years ago.
thanks.she says it looks like a coffee cup sized saucer plate is protruding out of her eye, looks like it is hanging out of her eye and looks like it us moving alo aeound. was afraid that the bubble was too big and had no place to go but out.Do you think the doc tomorrow is going to try to remove some of the bubble ? he removed some a while back to try to bring down her eye pressure, which it didn't. he had to numb her eye and stick a needle in it. I hope he doesn't do that again . Isnt the gas bubble supposed to gradually move to the top of her eye. she says she sees the line moving down and sees the protrusion at the bottom of her eye. Can this mean the bubble moved to the front of her eye? could it be from her not positioning her head correctly . He has her keeping her head at a 45 degree angle, no laying flat...
Expert:  Dr. Rick replied 2 years ago.
No. I do not think that he is going to remove some of the bubble. What she is seeing is most likely the bubble...and the good thing about that? She can see :-)

What she sees at the bottom of her eye is consistent with the bubble. As it gets smaller if forms a mass at the top of her eye. What she is seeing is the bottom of the bubble. It looks like it is in the bottom of her eye since the eye is like an old fashioned box camera -- the image is upside down.

I doubt that the bubble has moved to the front of her eye since her posterior capsule was intact after the cataract surgery per your prior posts.

She has done nothing wrong with her head position.....it really is harder to mess things up as a patient then you think it is.

Now. Take the rest of the night off and relax. Dexter (the series) starts again on Sunday so that is wonderful news and, while I'm sure you were very upset about the Green Bay Packers Unjust loss on Monday -- as were we all here in Wisconsin -- there is nothing we can do about it but move on. ;-)

And the other good news? You mother is seeing well enough to complain about seeing things.......
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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Customer: replied 2 years ago.
hi, went for check up yesterday. this time instead of the doctor checking her eye pressure in his office, the tech did it in the screening room with the long probe struck that touched her eye.I told her to be very careful I hope she got an accurate reading I shooukd have asked that the doc do it during her exam. dint feel that her reading could be asaccurate as the doctor checking it and shouldn't have let anyone touch her eye except hm.the pressure in her surgery eye came back a seven ore nine.the pressure in her non surgery eye came back a 17so, doc examined her. he said retina still looked good, but she had or still has cornea edema . hehe said she has it from the surgeries and trauma. he said the vigamox may be contributing to the edema not healing . He took her off the viahamux and also lowered her cylopetalate from four drops a day to one. kept her on the durazol four times a day but TOOK HER OFF HER LUMIGAN DROP IN THE SURGERY EYE. and dies not want to see her again for two weeks.what if her pressure in her surgery eye escalates ? she hasn't been off lumigan for many years.Why DI yiu feel he would make all these medication changes? cultural fr vitrectomy came back showing staph Epi and hemolytic strep. the report also said contaminated. doc said the culture is not accurate , contaminate,also , the blue film over her eye has dissipated, it now just looks like a clear coating over her eye colors part with rough edges. What is that ????
Expert:  Dr. Rick replied 2 years ago.
That was a tonopen and it is very accurate and safe. Nothing to worry about there.

Those eye pressure readings are fine.

I agree with the drop changes. No need for the lumigan since her pressure is so nice and low.

The trauma of what her eye has gone through will make her eye pressure lower. She may not ever need the lumigan again, or she might. In any event I doubt her eye pressure is going to shoot up at this point.

Many times the culture reports on cases of endophthalmitis comes back labeled as contaminated. This is because for "normal" cultures that the lab deals with those bacteria are considered a contaminate not a pathogen -- in the eyeball they are pathogens, not contaminates.

The bacteriology lab I use knows that eye cultures with these bugs are usually not contaminated but rather represent the bug I am interested in....I would not worry that the lab doesn't know this.

I very much doubt that the culture represents a contaminate. In any event, the culture is only done in case therapy is not working -- treatment in eye infections is not delayed pending culture results.....

If the doctor who examined your mother today and make that statement about the culture results was her retina surgeon I'm not sure why he doesn't know this fact about the culture label.....but, once again, you should not worry about this at all as it really doesn't matter.

The part about the blue film was cut off, but I'm glad to hear that is getting better.

Sounds like your mother is continuing to get excellent care.

Take care and have a good day.
Customer: replied 2 years ago.

The blue film has changed so her brown eye color can now be seen, however what she has over her iris ( part of eye that shows the color?) is now a clear glassy film, almost looks like a contact lens with jagged edges a little outside the iris? What is this?


 


Is the corneal edema normal? Coudl she have has it since the surgery?


Why adress it now with stoppong hte vigamox and not in prior weeks?


 


SHe had a very high pressure in her surgery eye two weeks ago and they put her on combigan, they took her off that last week once the pressure went down again.


so she has has fluctutatng high and low , why? What is the danger if in this next two weeks while off of any presusue lowering drops the pressure skyrockets? It has to be dmamging in some way.


 


Why not just keep her on the lumigan? Danger in pressure going too low?


 


And you agree with the stoppign of the antibiotic drop and also the reduction in cyclopenate? Deisnt the cyclo keep ther eye dialted for maximum healing? The durazol is the anti inflammatiory right? This is the one she is staying on steadily -


 

Expert:  Dr. Rick replied 2 years ago.
Let me address your questions in order:

1. That is most likely an inflammatory membrane. It will resolve in time.

2. The corneal edema is from all the trauma her eye has had. She will have it for quite some time longer and, yes, it has been there since the surgery.

3. Her pressure going up and down is to be expected with all she has gone through. The pressure spikes are not what is/has done the most damage to here eye -- brief pressure spikes will not be what, in the end, limits her final vision. I would not worry about this at all. In the scheme of things this is a minor issue and, from what you have posted, is being well managed.

4. Yes. You do not want the pressure too low...this is bad too. Pressure of 7 or 9 is not "too" low, but it points to the fact that you no longer require a powerful drop like lumigan.

5. I agree with all the drop changes. Remember, I've been a retina surgeon for over 20 years and have dealt with problems like your mother is experiencing so often that I couldn't give you a number if I tried. The antibiotic drop is no longer necessary and it is time to let her pupil start moving some. Dilation isn't what allows the eye to heal.

6. Yes. That is a steroid and will be used for quite some time to come.

From everything you have posted your mom's eye doc is doing everything correctly. I'll let you know if they start to mess up :-)
Customer: replied 2 years ago.


tahnks.


Do you agree with the doc that the edema may clear up a little faster once she is off the vigamox? Why?


 


Do you thibnk he is taking her off the vig anddaialtaion med to heal the edema?


 


Do you agree that she can finally lay flat? I feel that she only had the retinal surgery on two weeks ago, feel like she is being taken off everything too soon,.


 


 


And, lastly, i hope, do you have your techs check the eye pressue with a probe in cases like my moms or do you feel it is more accurate to check it wuth your less invasice eye equioemt during your exam

Expert:  Dr. Rick replied 2 years ago.
I really don't think the vigamox has much to do with her edema in the big picture. But she doesn't need it anymore at, at the very least, it is just beating up the skin on her cornea.....

Taking her off the vigamox and decreasing the use of the cyclogel really do not have much, if anything, to do with healing her corneal edema.

You will have to ask her surgeon if she can lay flat now. An answer to that question is complex and requires a hands-on exam.

No. She is not being taken off everything too soon.


The tonopen has been shown to be just as accurate as the Goldman Tonometer (the thing with blue light that the doctor uses). Actually, in cases of corneal edema, the tonopen is more accurate.

I see no problem at all with having the techs check your mom's pressure. In my practice my techs check eye pressure frequently.

Whew! My fingers need a nap from all that typing lol!

Let me know if you have any more questions. I'm happy to help in anyway I can.
Customer: replied 2 years ago.


Thankls for your compassion and understanding as I am just trying so hard to help her in any way I can.

So they teriod ( durazol ) is obvlasuiley still important

Expert:  Dr. Rick replied 2 years ago.
And it will be important for some time to come.....



It was a pleasure to assist you with your question. Please let me know if I can do anything else to help you in the future. Positive Feedback and/or Bonus is welcomed and appreciated.
Customer: replied 2 years ago.

 




I dont know if it was a tonepen that they used.


 


\I think it was attached to a a wire? It had a long meatal like thin bar attached to it about two or three inches long with a while plastic looking tip that they say they clean with alcohol after each patient and replace it once a week. they number her eye and tocuh her eyeball with it.


 


They had one other choice they had looked like the size or a larger magic marker cap ( white )


it looked like a tube about an inch


or so long and wide that was individually wrapped and for one time use. I dont know how they would use that one. They didnt use that one,

Expert:  Dr. Rick replied 2 years ago.
That was a pneumatic tonometer.....used to check eye pressure when there are corneal problems like your mom is having.

The white magic marker thing is a tonopen....it has a little "condom" that goes on the end.

Sounds like excellent care....both of those instruments are sitting here in my office and get frequent use.
Customer: replied 2 years ago.

 

I am understandng that the corneal edema is only seen by the doctors insteunments, not by us, that we cant see it ,

and the inflamamtuiory membrane on her iris that we can see is a seperate issue from orm that corneal edeam issue?right?.

 

Doctor was concerened about the edema issue,made it sound like that was why he was changing her meds.

Maybe he meant that the vigamox was irriting the cornea and that he would rather it not be irritated whlle we are wating for the swelling to go down?

 

And the pneumatic tonometer can pass an inferctio to her form the last patient?

 

The white hting was just a cap taht was individually wrapped. it wasnt shaped like a magic marker,jsut a cap for something.

I dont know that the heck they used on her -

 

Wasnt an eye puff, it was definitely an eye toouch instrument

Expert:  Dr. Rick replied 2 years ago.
If corneal edema is bad enough it can be seen with the naked eye, but in essence, you are correct in this statement

I'd not put too much on what the doctor is rambling on about in the exam room....the care he is giving is exactly what I would do from what you have posted.

No. It will not pass on infections from the last patient

I'd not worry about what they used on her. Next visit, point to it and ask 'em what it is.

A pneumatic tonometer touches the eye....this is not an optometrists office you are in ;-)

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you at no additional charge :-)
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.


Ok, so the film I see on her eye is not the conreal edema, the film that i see, It is just a inflammatry membrane, right?


 


Plus the instrument that was held by her eye for about 10 seconds, i think actaully touching her eye is the better one to use for people with corneral issues, a pneumatic tonometer.

Expert:  Dr. Rick replied 2 years ago.
That is an excellent question and.....I'm not sure.

Depending on how much corneal edema she has, you might be able to see that. And,depending on how closely you look, and how much inflammation she has and/or how large the membrane is you might be able to see it.
Customer: replied 2 years ago.


So the clear membrance we see might be the edema?


 


And, why does the instruement that touches her eye better to use for people with cornea issues?


 


 

Expert:  Dr. Rick replied 2 years ago.
Yes. It could be.

The one the doctor uses with the blue light will not give accurate results in patients with bad corneas. The one they used is the correct one to get a good pressure reading.
Customer: replied 2 years ago.


i wish i could reach out an shake your hand. I have never been able to get so much experienced, accurate information. thanks so much

Expert:  Dr. Rick replied 2 years ago.
This "quality" that you find so positive in me is, I must admit, the bane of my nurses existence. You see, I am always behind in Clinic and, if you were to ask them, it is "Because he talks to much!" ;-)

Take care.

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