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I have had my final postop visit today with my

ophthalmologist regarding my light sensitivity...
I have had my final postop visit today with my ophthalmologist regarding my light sensitivity since cataract surgery, which has not improved. She informed me weeks ago that I had a friable and thin iris which she sutured with 1 suture at the time of surgery. Today, my exam revealed 20/20 vision, IOP of 13, and no inflammation. However, I again described to her the problem with glare/haze-like vision when I am in any bright light, either indoors or outside. She then told me that this is permanent and the only solution would be a tinted contact lens. I had been looking at this option for the past few weeks as I had the feeling that this was not going to improve. I wore contacts for years, so I am not concerned about this, but have to admit that I am very disappointed with this outcome as the eye (left eye) that is affected is my dominant eye and also my distant vision eye. My right eye is set at -1 for a mini monovision so I can continue working as a medical transcriptionist; however, I did have to decrease the brightness on my computer screen to avoid headaches since the surgery. What caused this? I have had good healthy eyes all my life and take no medications. I was not asleep for this and remember an extreme amount of irrigation being done, so much so that my hair was soaked when I took off my surgical cap in my room. The surgery also took over 30 minutes, yet the doctor and her surgical nurse insists that there was no problem with this eye. The right one took 11 minutes and I have had no problems with that eye from the time I rolled out of the OR to this very day 7 weeks later. I have to accept this outcome, but cannot get any real explanation about how this happened. Can you please help me understand this? Also, do you think that a tinted contact lens is the best option, as I really do not like the sounds of the surgery performed to repair an iris and I have no cosmetic issue with this. Thanks very much!
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Answered in 2 hours by:
3/15/2018
Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 12,247
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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Hi. I'm Dr. Rick and I have two decades of ophthalmology and retina surgery experience. I'm online and happy to answer your question today.

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How long ago was the surgery?

can you upload a picture that shows your pupil well?

How old are you?

M/F?

What lens is in the affected eye (look at the card you were given)

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.

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can you upload a copy of the surgical report? This will tell us exactly what went on during your surgery

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Customer reply replied 5 months ago
My surgery on the L eye was Feb 6. I am a 65-year-old female. The lens that is in the affected eye is Acrysof IQ Power 20.0 D, Length 13.0 mm, Optic 6.0 mm. I have pasted the surgical report below and have uploaded a picture of my pupil, which hopefully is clear enough for you to see. Thanks very much for your help with this.Discharge Date: Not specified
OPERATIVE REPORT
Date of Service: 02/06/2018
PREOPERATIVE DIAGNOSIS: Nuclear sclerotic cataract left eye.
POSTOPERATIVE DIAGNOSIS: Nuclear sclerotic cataract left eye.
PROCEDURE: Phacoemulsification of the left lens with posterior
chamber lens implant.
PROCEDURE PERFORMED BY: Durriya S. Esaa, M.D.
The patient was identified in the recovery room and topical
anesthesia was administered using 2 percent unpreserved
lidocaine drops and jelly. The patient was transferred to the
operating room. The eye was prepped and draped in the usual
manner using Betadine scrub and Betadine solution.
A lid speculum was placed. A paracentesis incision was made at
the limbus with a diamond blade at 11 o'clock and 5 o'clock, 0.5
cubic centimeter of 1 percent unpreserved lidocaine was placed
into the anterior chamber; DisCoVisc was placed into anterior
chamber. A corneal valve incision was created in the following
manner. A 2.4 mm length groove of 0.2 mm depth was made between
2 and 3 o'clock with a diamond blade in the anterior limbus.
This was dissected into clear cornea for a length of 2 mm with a
2.4 mm clear cut slit knife and the eye was entered creating a
valve incision. A continuous tear anterior capsulotomy was
performed using a disposable 25-gauge irrigating cystotome
needle. The nucleus was hydrodissected and hydrodelineated with
BSS. The nucleus was phacoemulsified without complication using
cumulative dissipated energy of 12.4. Irrigation and aspiration
of the cortex was performed. The posterior capsule was
polished. A Monarch II lens inserter was used to insert the
AcrySof lens model #SN60WF, 20 diopters. DisCoVisc was removed
with irrigation and aspiration at the minimum setting.
The wound was hydrated and tested. There was some iris
prolapse. Therefore, Miochol was instilled and one interrupted
10-0 nylon suture was used to close the eye. The suture was
buried. Topical Omni drops were placed and she was taken to the
recovery room in good condition.
______________________________
Durriya S. Esaa, M.D. Date Time

Thank you for that additional data

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sorry...all I can tell from the photo is that you have blue eyes -- I can not see the shape of you pupil....

In reviewing the operative note I can tell you that you do not have "a friable and thin iris which she sutured"

The wound was leaking during the surgery (this is why your hair was soaked and so much irrigation was used), and your iris prolapsed (poked through) the leaking wound.

This prolapse may have caused your iris to be rubbed on during the surgery and macerated. This is most likely the cause of your glare/haze issues.

And, your surgeon is correct, there is no real fix for this problem...although, depending on the type and amount of tissue damage to your iris, additional surgery (iridoplasty) might help some. Of course, an opaque contact lens is an easier, quicker and safer alternative to additional surgery.

As far as the surgeon and surgical nurse insisting that there "was no problem" during surgery....that is not -- totally -- correct....

There was no major problem; everything went well.

But. Iris prolapse, while not a big deal, is still something that does not happen all the time and is not a desirable thing. In your case, the surgeon dealt with the prolapse correctly by re-positing the iris and putting a stitch in the entry wound so that everything was watertight.

So. What to do now?

I would go with the opaque contact lens. It is safe. It is easy. It is reversable (just take out the contact lens) and it will probably resolve your symptoms. You can always do iridoplasty later if necessary.

Does this make sense to you?

I am happy to be able to help you today. If you would be so kind, please help me get credit for my efforts in answering your questions and press the excellent feedback button for this encounter. And, don’t forget, I work for tips. I would also be happy to continue to answer any more questions you have until we have resolved your concern.

Dr. Rick MD FACS

I wish you the very best.

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 12,247
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Verified
Dr. Rick and 87 other Eye Specialists are ready to help you
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Customer reply replied 5 months ago
Thanks very much for the information. I did feel that this was not a common occurrence with cataract surgery, but as they say you cannot unring a bell. What is done, is done and I have to be thankful that I have 20/20 vision now, in spite of the problem I now experience. I have contacted my optometrist, who has fit me for contacts over the years and is a very good doctor. I am sure he will resolve this with a contact lens and I will be happy with it. I really fear more surgery for this, and would rather stay conservative with this issue. Again, thank you so much for your professionalism and advice. I now feel very reassured.

Glad I could help.

Have a good day.

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