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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7959
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I had cataract surgery in my left eye in October of 2012 and

Customer Question

I had cataract surgery in my left eye in October of 2012 and have normal vision corrected to 20/30 with glasses. I have taken pred forte since the operation but have persistent redness in the eye once the pred wears off. The pred clears the eye but I find that I need a morning drop and an early evening drop to clear the eye. Overnight it becomes red again. My doctor has recommended that I get an opinion on an IOL exchange. I don't have any other symptoms and can function normally through the day. The feeling in the eye varies during the day and I do get some mild pain in the bone area surrounding the eye and some mild pain surrounding the socket if I do not use the pred. I was cleared earlier of the problem of the cortical material that could not be removed from anterior chamber during surgery. The IOL, a tradiitional one used for many years (and not the one planned for anterior chamber) is in the Posterior chamber. My doctor said I have a cat's pupil as it was stretched during the surgery. Another said that it may be an imbalance in vitreous and acqueous impinging on the iris. I am seeing two big specialists soon..a retina specialist and a cornea specialist who should help. Sometimes the eye feels watery but I have no major pain in the eye but it always feels like I have something in my eye. Any advice appreciated.
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.
Hi. I'm online and happy to answer your question today. I am a retinal surgeon.

That is a long time to be using a steroid eye drop that is a powerful as pred forte. Who has been supplying this medication for you?

Is there any pain in the eye?

Is your eye sensitive to light, especially when you try and stop using the pred forte, or is it just red?

How is your vision in that eye?

Was it your eye surgeon who suggested an IOL exchange?

The doctor who told you that you have a cat's pupil from stretching or possibly a vitreous strand....was he an optometrist or an ophthalmologist?

This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.
Customer: replied 1 year ago.

That is a long time to be using a steroid eye drop that is a powerful as pred forte. Who has been supplying this medication for you? THE OPTHALMOLOGIST WHO DID THE SURGERY. HE DID EXTENSIVE FOLLOW UP ( I PASSED A VISUAL FIELD AND MY PRESSURES ARE 14-20) AND WE LEFT OFF WITH ONCE A DAY WITH PRED. I AM NOW REFERRED TO A SPECIALIST

Is there any pain in the eye?I AM NOT REALLY SURE AS IT IS MORE JUST IRRITATED BUT WHEN I DO NOT USE PRED THE WHOLE EYE FEELS OUT OF SORTS AND PAINFUL BUT MOSTLY IN THE REAR AREA? PAIN DOES NOT KEEP ME UP AT NIGHT AND I AM FUNCTIONING WELL.

Is your eye sensitive to light, especially when you try and stop using the pred forte, or is it just red? I HAVEN'T STOPPED THE PRED EXCEPT FOR ONE DAY BUT NO EXTRA SENSITIVITY TO LIGHT OR FLASHES EVER. I CAN DRIVE IN BRIGHT SUNSHINE AND AT NIGHT NO PROBLEM. EYE IS RED WITH THIN STRANDS MOSTLY BUT SOMETIMES WHOLE EYE IS RED WITH NO LINES BUT WHOLE WHITE AREA IS RED LIKE A RED BALL.

How is your vision in that eye? MY VISION IN THE EYE IS EXCELLENT AS PER EYE EXAMS AND ABILITY TO FUNCTION AT WORK OR DRIVE

Was it your eye surgeon who suggested an IOL exchange? MY SURGEON SUGGESTED I GET AN OPINION ABOUT A POSSIBLE IOL EXCHANGE FROM A SPECIALIST.

The doctor who told you that you have a cat's pupil from stretching or possibly a vitreous strand....was he an optometrist or an ophthalmologist? HE WAS A YOUNG OPTHALMOLOGIST

This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.

Expert:  Dr. Rick replied 1 year ago.
.
Expert:  Dr. Rick replied 1 year ago.
Louis,

Thank you for that extra information.

It is possible that your pupil is not round due to stretching that was necessary during the surgery but, if this were the case, your surgeon would know it and it would be obvious on slit lamp exam. I do not understand why there is confusion on this issue.

As a retina specialist myself, I don't know what a retina doc is going to have to offer on this topic.

Of course, you can not continue to use pred forte forever....the risks are just way too high. Perhaps you could stop the drops for a month and see if the redness goes away over time?

From what you have posted, it seems that your PCIOL is in the capsular bag where it belongs. With that being said, I'm not sure that an IOL exchange will change anything and, since your vision is currently very good, it very well may make things worse in the long run.

Consulting with a corneal specialist won't hurt but, in my opinion, there is no surgical intervention that will address the redness in your eyes or the mild pain you are experiencing.

Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS


Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7959
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 1 year ago.

Dr. Rick: Just a few more comments. There is no confusion on stretching of pupil. It resulted from the surgery.


 


Also during the surgery they could not locate the IOL in the capsular bag which is I think in the anterior chamber. It is in front as they could not remove all cortical material. I surmise that you feel I need to stop the pred to see if the eye heals. If you could clear up the last few questions I would appreciate....Thanks Lou

Expert:  Dr. Rick replied 1 year ago.
Lou,

Ok. That makes sense about the pupil then....

That means that the lens is probably in the ciliary sulcus.

Yes, that was why I thought stopping the pred forte would be a good idea. But now, with this extra data your redness could be do to persistent, mild uveitis secondary to the continued presence of small retained cortical particles that the (young) surgeon had to leave behind when the posterior capsule ripped.

If your slit lamp exam still shows cells (flair is not so important at this point) then continuing the pred forte, or a more mild steroid such as FML, is appropriate.

Does this make sense to you?
Expert:  Dr. Rick replied 1 year ago.
One other thought.

If nuclear material, or a significant chunk of cortical material, fell out of the bag and sunk back into the vitreous cavity then, I agree, a consultation with a retina surgeon would be needed.

Let me know if you have any more questions or concerns.

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