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Ask Dr. A.S. Desai Your Own Question
Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2434
Experience:  MS Ophthalmology with 13 years of surgical expereince
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My mom has monovision cataract implants from several years

Customer Question

My mom has monovision cataract implants from several years ago. The implants were not perfect, so she still needed glasses for many things. She later developed glaucoma which was not well-controlled by meds or laser surgery in her distance eye, her right eye. She was told she had tiny retinal occlusions in all four quadrants and was encouraged to have a trabeculectomy. She could see 20/20 in her right eye with glasses. The day after the surgery she could see 20/50 with glasses with her right eye. The pressure in her right eye was still high, although we were not told the number. The doctor released a stitch with the laser, and we were told to see him in nine days. When we returned, my mother's vision in that eye with glasses is now 20/200, the pressure is 6, and she has a central retinal vein occlusion. All the doctor said was that the surgery had gone well and that the pressure will get to normal range with natural healing. We were told to see a retina specialist. We cannot understand how this happened and have no idea if she will have a return of vision. It seems to us the glaucoma surgery must have caused this. We hope to see a retina specialist this week and then are scheduled to return to the glaucoma specialist one week later. Please tell us what happened and what you think her prognosis is. She was a healthy, independent 75 year-old. She has no common risk factors for CVO. No high BP, cholesterol, diabetes, smoking, etc.
Submitted: 4 years ago.
Category: Eye
Expert:  Dr. A.S. Desai replied 4 years ago.

Thank you for the question.I am Dr.A.S.Desai and I look forward to assisting you .

It is indeed very unfortunate that your mother had to go through these visual problems. It is true that intraocular pressure takes time to settel down after trabeculectomy surgery. Though the IOP is low after the release of suture, it is likely to become normal with time ( 4-6 weeks with regular use of steroid eye drops). However the CRVO is not due to the surgery itself though its timing was with it. Since she has had primary open angle glaucoma, it is a known risk factor for CRVO. A chronic rise in the IOP can cause occlusion of the central retinal vein. CRVO has two sub-types ie : ischemic and non-ischemic. I am sure the retina specialist would do a detailed eye exam and detect the sub-type. The latter type has a better prognosis with better visual recovery than the former type. As the IOP has been kept lowered with surgery, the risk factor has been treated. However visual recovery would depend on the sub-type and whether there have been retinal complications such as macular edema. I guess these details and further prognosis would be known only after a visit to the retina specialist.

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Thank you and best wishes.

It was a pleasure to have answered this question.

Views expressed are for information purpose only and cannot substitute a visit to an ophthalmologist

Customer: replied 4 years ago.

Thank you. XXXXX was not present prior to the surgery. It was not present the day following. It was detected after the surgery, when the pressure was lower. Why would it present with lower pressure when it was not present with higher pressure?