Dislocated lens material after Cataract surgery, now Vitrectomy - some questions

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Hi,

I had my cataract surgery 3 days ago, but part of the cataract fell into the vitreous humour. After this happened, my surgeon called a retina specialist for Vitrectomy. He, however, covered my face entirely, and after I felt suffocated, I asked them to stop the procedure.

They told me I was claustrophobic, and my oxygen level was fine, so I could not have suffocated. Given I am claustrophobic, they now want me to be under general anesthesia and be operated on for removing the remaining cataract.

Q1. Was the cataract surgeon incompetent in not operating successfully? Or, can such mishaps happen due to the patient's eye health?

Q2. Is it a standard practice to have patient's face completely covered and taped for Vitrectomy?

Q3. What general advice/warnings would you give me in regards to ensuring that my eye is being looked after well prior to and post Vitrectomy?

Q4. Given I have hypertension, what are the possible risks pertaining to my eye, if I am given an anesthetic?

I ask this since I have been unable to get second opinions in my case, so will be very thankful for your response.

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11 Replies

  • Posted

    I am an eye surgeon with over 20 years experience.

    1.Mishaps happen, no surgeon gurantees 100% success but we usually get close at 98% so you are unlucky.  Surgery can be more difficult if the pupil is small, the patient anxious and breatholding or moving.  Some eyes are more risky because of problems like exfoliation which makes the lens abnormally loose.  

    If the posterior capsule breaks then vitreous can come forward and get trapped in the incisions and around the implant. This has to be cleared by anterior vitrectomy done in the same operation -occurs in perhaps 2% of all cataract ops.  Sometimes a chunk of the lens or even the whole lens can drop towards the retina. Then another operation "vitrectomy" is required - less than 1% of all cataract operations.  The good news is the eventual visual outcome is still expected to be good in most cases.

    2.  Yes it is normal to completely cover the face in both cataract surgery and in vitrectomy procedures (I use a tranparent plastic drape). These days most eye operations are done under local anaesthetic with the patient awake.  Patients who are anxious or claustrophobic need special care.  Don't worry there are lots of ways you can be helped.  If the dropped lens is very small it might be left alone but that may delay your recovery as the chunk can cause inflammation and glaucoma, hence the need for surgery. I would explain that your drape will be loose and lifted off your face. Underneath you could have a tube with oxygen.  I would recommend sedation with an oral tablet 2 hours earlier or else intravenous seadation  by an  anaesthetist.  With severe anxiety a general anaesthetic is probably the best option.

    3. The second vitrectomy operation will entail removal of all the vitreous gel and the remaining lens material. Then if the artifical lens implant is not yet inserted then that will be placed as well.  The surgery may need to be delayed if your cornea is cloudy. You will need preopertative steroid and antibiotic drops and the pressure may require acetazolamide tablets.  After surgery you will need similar care to standard cataract surgery.  Most likley you will have nylon sutures. These do not dissolve and are often removed around 4 weeks after surgery (easily done in the consuting room).

    4. Many patients are hypertensive.  That does increase the risk of haemorrhage but the risk remains slight. The main thing is your eye really does require more surgery.  Ideally have your blood pressure controlled medically prior to the procedure.  If the high BP is secondary to anxiety it will drop with sedation or general anaethesia at the time of the op.  You will worry until the procedue is done so the sooner it is over the better. There is a risk of retinal detachment so the opertion will include a search for any retinal breaks that can be sealed before you get a retinal detachment.   Your doctors will have seen many anxious patients and successfully treated them  I suggest you explain your feelings and let them explain what they can do for you.  Always remember that most complications of cataract surgery can be rectified resulting in a good visual outcome.

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    • Posted

      Hi I had a macular hole and cataract done at the same time 9 weeks ago. It I have like a very tiny transparent square on the edge of the brown and White of my eye plus it's a little red around it. When I went to opticians after 6 weeks he said I still had a stitch in, is this the stitch as it's still irritating me eye.
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    • Posted

      Seems you do have a nylon suture.

      If you can see a red mark and feel discomfort it needs to come out because the suture is probably loose and on the surface. Removal is easy but generally done by an eye surgeon (not optometrist).

      You may need referral if there is no appointment coming up soon.

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    • Posted

      Thank you for your reply I don't go back until end of May. Is it easy to do. I thought it would dissolve on its own.
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    • Posted

      Nylon does not dissolve.

      We don't use soluble sutures in the cornea because they cause more inflammation than nylon. Nylon is strong even though much thinner than a normal hair.  

      After 4 weeks the wound should be well healed. Removal is easy for a doctor - all you feel is nothing or sometimes a slight tug when the knot comes out.

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    • Posted

      Hello, I hope you still read these problems. I had cataract surgery on both eyes. I am 70 years old fit and healthy. First op. on left eye worked very well. A short sight lens fitted- now can read and sew without glasses.

      ​Right eye -had good vision and have never worn glasses. Cataract not severe. A number 22 fitted. Left me unable to see in that eye. Had another op. last week by consultant to rectify the problem. It appears that lens was too far forward which made me short-sighted in my long-sighted eye. Can you please tell me the cause of this? I have read many papers and it seems that the lens being implanted upside-down could be a cause or a tear/puncture of

      the posterior capsule. My pupils are not unduly small  as that seemed to be another reason for the problem. What in your opinion is the most likely cause. I had 2 different registrars for the ops. but the Consultant for the last op. 

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  • Posted

    Hi

    I've just put in a reply to another post from someone called Sian, I noted your post and I thought I would let you know of my very recent experiences.

    18 months ago I was absolutely terrified, and very, very angry. I needed a cataract operation and my father who had to have two when slightly older than I am now, was left in all sorts of trouble. His poor experience tainted my expectations and make me a complete wreck.

    I had the cataract operation, it went like a dream. None of the complications my father had. I could see for miles with perfect clarity. As one who was born with very short sight, this was nothing short of miraculous.

    Then it all went wrong.

    Lying in bed I noticed in low light I had almost what looked to be a lazy eyelid, I would open my eye, and the eyelid would take ages to roll up.

    It wasnlt the eyelid. There was a bubble of fluid between the vascular layer and the retina, threatening to peel the retina off like bubblewrap.

    I went to the optician to discuss the wierd thing i was seeing, she referred me backto the consultant who did the cataract, he sent me to a specialist in Cardiff, who took one look and told me I was going tohave surgery that afternoon.

    The procedure was about twice as long as the cataract surgery and used three ports.

    I have high blood pressure (well I HAD it) treated by Losartan and a beta blocker. On a good day it motors 155/85 on the medication

    The anaesthetist ran a mix of lignocaine and immobiliser plus something else intot he eye, not through a tube as they did for the cataract but by a needle straight in - i did not feel a thing thankls to a topical applicationof drops beforehand. They gave me IV sedation too as the procedure was going to be longer than the cataract op

    They sucked the stuff out of the back of the eye and filled it with gas.  It all went very well. But here's the thing. for a cataract op you cant see what is going on. When the lines go intot he backof the eye to suck your eyeball bits out .. they are in sharp, clear focus. Seeing your eyeball contents sucked up a tube is ... eyewatering.

    The procedure for me was very similar to the cataract op except they put three ports in not one and of course they are going round the lens capsule. yes they put a face covering on me that meant my other eye could see nothing much but it did let light through - considtency of a j cloth - and they ran an oxygen mask in and that propped it off my face to reduce the claustrophobia.

    By now you can see I had this as a local. The surgeon offered me the cjhoice, but said it was a lot less complicated if I was awake and cooperative, there was a "full and frank exchange of views" and I agreed to have it under a local.

    POST op the biggest, biggest problem is not keeping your head positioned as they say. I was lucky, I had to adopt the sort of position evety bloke my age adopts in the pub, head down pondering the head of his pint....  FAILURE to adhere to the positioning instructions WILL reduce of negate the tamponade affect of the vitrectomy gas and that means the op will fail.

    18 months ago I might have blamed my cataract surgeon if the machine ruptured the lens capsule. Today I am far more accepting of the fact that there are few certainties in life and sometines, to lay it bluntly, sh*t happens.

    I found a research paper from the Hong Komg School of Opthalmic Surgery detailing the vitrectomy procedure and post op problems I found it invaluable for understanding what was done - my vitrectomy surgeon was a man opf few words and even fewer explanations, probably because the procedure is not as stunning a success as most cataract ops, and if it fails well you probably become eligible for a white stick and a labrador.

    It took almost two weeks before I was allowed to lift my head for more than ten minutes an hour and three months for my vision to return to normal, during the whole time after the two sweks I was able to drive - and carry out my work as an IT consultant, off the back of my "good" eye exceeding the UK driving standards.

    Well almost. The man at the DVLA let me drive a car or a van. They took away my full entitlement to drive a vehicle steered by its tracks. (I gained that on a bulldozer) and only recently gave it back now everything is OK !!

    Hope this helps and your procedure goes as well as mine did

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  • Posted

    SCAC has a different surgical problem from John.  Both are complications of cataract surgery but SCAC has a dropped fragment of lens and SCAC had a retinal detachment.  Surgery for the latter is more complex and the visual outcomes are much more variable.  

    John is lucky his macula did not detach as the vision would not recover nearly so well.  

    When SCAC has her vitrectomy she is unlikely to need gas or air bubbles and so no need for prolonged positioning in strange orientations.

    If any retinal breaks are seen they will be lasered during the procedure but still her convalesce will be similar to routine cataract surgery.

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    • Posted

      People report very different recovery times and outcomes what would you expect if you were the patient. I found the procedure very easy and pain free but some evidently experience severe pain during it. My only problem was dryness after the first procedure due to the preservative in the eye drops. 
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  • Posted

    Glad to help SCAC. It must be confusing but I believe you are just between 2 operations and it should all work out OK in the end.

    Furthermore at some stage you may need second eye surgery and usually the second eye goes well. 

    If you are claustrophobic explain to your surgeon & don't simply clam up with fear. And don't do what one of my patients did a few years ago which was to sit up in the middle of the op - I had to abandon the half completed procedure and reschdule under general anaesthetic at a later date (she was not starved so could not safely have a GA that day)!

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