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quattrocchi
medicine forum beginner
Joined: 14 May 2005
Posts: 37
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 Posted: Sat May 14, 2005 2:25 am Post subject:
Cataract Surgery yesterday
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What is fogginess after a cataract operation? And how come we're photo-sensitive
afterwards?
Yesterday I had cataract surgery at my local public hospital. It was performed
under the New Zealand free public health service, and was rather an excellent
experience. The most discomfort I felt was in the anaesthetic room prior to
surgery where they fitted the block at the side of the eye, somehow seemed like
they were manhandling the eye sideways a lot, and that felt awful.
I wasn't sedated, and found it very interesting to be awake and having my
occasional questions answered as they operated on me. (I wished they'd've hooked
up a video feed from the surgeon's eyepiece to a VCR recorder and provided me
with a tape like the one I got from my retinal re-attachment op 5 years ago.)
They gave me a piece of the IOC packaging:
AcrylSof by Alcon, Texas.
Model SA60AT
Power: 13.5 D.
My other eye is -3.50. The aim is to give me an IOC that will result into some
myopia, -1.25 or thereabouts. I'm very pleased with that.
After the op the eye was covered with full eye covering and shield. That same
day I was in slight dull pain after the meds wore off, but nothing much.
Day 1 after. I woke up pain free, but very photo-sensitive to light coming in
through the (white) eyepatch.
I went into the hospital this first morning and they removed the eye covering.
However I was greeted by very cloudy vision - like a heavy mist - and extremely
sensitive to light. Fairly sharp pain on looking at daylight, say, out the
window.
Eye pressure was normal (15), and they said the mistiness is also one of the
usual responses. Perhaps overnight pressure build up and caused some reaction of
the cornea to fog up.
Day 1 late afternoon and the mist is clearing. Just a hazy halo effect from any
brightly lit parts.
What might this fogginess have been? and how come we're photo-sensitive after a
cataract operation?
Thanks
--
Auckland NEW ZEALAND |
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William Stacy
medicine forum Guru
Joined: 01 May 2005
Posts: 1177
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| Posted: Sat May 14, 2005 11:18 am Post subject:
Re: Cataract Surgery yesterday
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quattrocchi wrote:
| Quote: | What is fogginess after a cataract operation? And how come we're photo-sensitive
afterwards?
|
There is some corneal edema (swelling) and your eyes are widely dilated
on the day of the surgery. This should be pretty much gone by the next day.
| Quote: | Yesterday I had cataract surgery at my local public hospital. It was performed
under the New Zealand free public health service, and was rather an excellent
experience. The most discomfort I felt was in the anaesthetic room prior to
surgery where they fitted the block at the side of the eye, somehow seemed like
they were manhandling the eye sideways a lot, and that felt awful.
|
It does. When I had mine done, I found a surgeon who used anesthetic
drops alone.
| Quote: | My other eye is -3.50. The aim is to give me an IOC that will result into some
myopia, -1.25 or thereabouts. I'm very pleased with that.
|
Good choice.
| Quote: |
After the op the eye was covered with full eye covering and shield. That same
day I was in slight dull pain after the meds wore off, but nothing much.
Day 1 after. I woke up pain free, but very photo-sensitive to light coming in
through the (white) eyepatch.
I went into the hospital this first morning and they removed the eye covering.
However I was greeted by very cloudy vision - like a heavy mist - and extremely
sensitive to light. Fairly sharp pain on looking at daylight, say, out the
window.
|
This needs to be checked carefully. You may have had some corneal
damage. Probably will clear up, but I'd stay on top of it.
| Quote: |
Eye pressure was normal (15), and they said the mistiness is also one of the
usual responses. Perhaps overnight pressure build up and caused some reaction of
the cornea to fog up.
|
Not if the pressures are 15, which is normal and would NOT cause foginess.
| Quote: | Day 1 late afternoon and the mist is clearing. Just a hazy halo effect from any
brightly lit parts.
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So it's probably just the dilation taking longer to wear off.
| Quote: |
What might this fogginess have been? and how come we're photo-sensitive after a
cataract operation?
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See above, but still not certain. I'd guess a combo of the dilation and
maybe a corneal abrasion. My vision was crystal clear the next morning
after both surgeries. But then I had no anesthetic injections and no
patching or suturing was required. Did you have any stitches?
w.stacy, o.d. |
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quattrocchi
medicine forum beginner
Joined: 14 May 2005
Posts: 37
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| Posted: Sat May 14, 2005 7:50 pm Post subject:
Re: Cataract Surgery yesterday
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In article <gUmhe.16715$J12.2184@newssvr14.news.prodigy.com>,
William Stacy <wstacy@obase.net> wrote:
| Quote: | quattrocchi wrote:
What is fogginess after a cataract operation? And how come we're
photo-sensitive afterwards?
There is some corneal edema (swelling) and your eyes are widely dilated on
the day of the surgery. This should be pretty much gone by the next day.
|
The dilation was certainly gone by the next day, when I first had the covering
removed.
| Quote: | I went into the hospital this first morning and they removed the eye
covering.
However I was greeted by very cloudy vision - like a heavy mist - and
extremely sensitive to light. Fairly sharp pain on looking at daylight, say,
out the window.
This needs to be checked carefully. You may have had some corneal
damage. Probably will clear up, but I'd stay on top of it.
|
Thanks.
| Quote: | Eye pressure was normal (15), and they said the mistiness is also one of the
usual responses. Perhaps overnight pressure build up and caused some reaction
of the cornea to fog up.
Not if the pressures are 15, which is normal and would NOT cause foginess.
|
Might the pressure have been higher o/night?
| Quote: | Day 1 late afternoon and the mist is clearing. Just a hazy halo effect from
any brightly lit parts.
So it's probably just the dilation taking longer to wear off.
|
I noticed that my pupil was not dilated the day after.
In fact ATM the eye is less dilated than the normal eye. A smaller black dot.
Now it's Sunday, the 2nd day after the Friday operation, and the haziness has
diminished somewhat to about 15% of what it was. But it's still hazy or foggy.
And brightly-lit things seems to spread into the adjacent dark areas. AS IF the
pupils were dilated.
| Quote: | What might this fogginess have been? and how come we're photo-sensitive after
a cataract operation?
See above, but still not certain. I'd guess a combo of the dilation and
maybe a corneal abrasion. My vision was crystal clear the next morning
after both surgeries. But then I had no anesthetic injections and no
patching or suturing was required. Did you have any stitches?
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No stitches, I believe, though I didn't actually check afterwards. I asked
before the op and the surgeon said stitches were not usually used. Only in
difficult circumstances. I believe mine was not a difficult circumstance.
Brian
--
Auckland NEW ZEALAND |
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quattrocchi
medicine forum beginner
Joined: 14 May 2005
Posts: 37
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| Posted: Sat May 14, 2005 11:49 pm Post subject:
Posterior Capsular Opacity (Was: Cataract Surgery yesterday)
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In article <1116107452.4cf902178b88b30a79631018c723c4f3@teranews>,
quattrocchi <quattrocchi@ww.co.nz> wrote:
| Quote: | In article <gUmhe.16715$J12.2184@newssvr14.news.prodigy.com>,
William Stacy <wstacy@obase.net> wrote:
quattrocchi wrote:
What is fogginess after a cataract operation?
[...]
Now it's Sunday, the 2nd day after the Friday operation, and the haziness has
diminished somewhat to about 15% of what it was. But it's still hazy or foggy.
|
After a little googling, I'm now wondering if I have posterior capsular
opacification' <www.eyemdlink.com/Condition.asp?ConditionID=354>.
Brian |
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David Robins, MD
medicine forum Guru Wannabe
Joined: 02 May 2005
Posts: 135
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| Posted: Sun May 15, 2005 1:08 am Post subject:
Re: Posterior Capsular Opacity (Was: Cataract Surgery yesterday)
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Since they mentioned the corneal edema as being visible the first day, it is
most likely that, and takes a few days to a couple weeks to clear up,
usually,
Way too soon for posterior capsular opacification at this point. Usually
occurs months later.
On 5/14/05 6:49 PM, in article
1116122037.5957d73585f5395554d93963578b32c2@teranews, "quattrocchi"
<quattrocchi@ww.co.nz> wrote:
| Quote: | In article <1116107452.4cf902178b88b30a79631018c723c4f3@teranews>,
quattrocchi <quattrocchi@ww.co.nz> wrote:
In article <gUmhe.16715$J12.2184@newssvr14.news.prodigy.com>,
William Stacy <wstacy@obase.net> wrote:
quattrocchi wrote:
What is fogginess after a cataract operation?
[...]
Now it's Sunday, the 2nd day after the Friday operation, and the haziness has
diminished somewhat to about 15% of what it was. But it's still hazy or
foggy.
After a little googling, I'm now wondering if I have posterior capsular
opacification' <www.eyemdlink.com/Condition.asp?ConditionID=354>.
Brian
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William Stacy
medicine forum Guru
Joined: 01 May 2005
Posts: 1177
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| Posted: Sun May 15, 2005 9:48 pm Post subject:
Re: Cataract Surgery yesterday
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quattrocchi wrote:
| Quote: |
Might the pressure have been higher o/night?
|
It *could* have been, but if it measured 15 the next day, any fogginess
from pressures would already subside. The cornea swells from high
pressure, but clears as soon as the pressure drops, unless something
else is causing it.
| Quote: |
I noticed that my pupil was not dilated the day after.
In fact ATM the eye is less dilated than the normal eye. A smaller black dot.
Now it's Sunday, the 2nd day after the Friday operation, and the haziness has
diminished somewhat to about 15% of what it was. But it's still hazy or foggy.
And brightly-lit things seems to spread into the adjacent dark areas. AS IF the
pupils were dilated.
|
Could be an inflammatory response. You are taking steroid drops, right?
And SHAKING the bottle well EVERY TIME YOU USE IT, right?
w.stacy, o.d. |
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quattrocchi
medicine forum beginner
Joined: 14 May 2005
Posts: 37
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| Posted: Mon May 16, 2005 12:30 am Post subject:
Re: Cataract Surgery yesterday
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In article <edRhe.256$Uv2.32@newssvr13.news.prodigy.com>,
William Stacy <wstacy@obase.net> wrote:
| Quote: | quattrocchi wrote:
Might the pressure have been higher o/night?
It *could* have been, but if it measured 15 the next day, any fogginess
from pressures would already subside. The cornea swells from high
pressure, but clears as soon as the pressure drops, unless something
else is causing it.
I noticed that my pupil was not dilated the day after.
In fact ATM the eye is less dilated than the normal eye. A smaller black dot.
Now it's Sunday, the 2nd day after the Friday operation, and the haziness has
diminished somewhat to about 15% of what it was. But it's still hazy or foggy.
And brightly-lit things seems to spread into the adjacent dark areas. AS IF the
pupils were dilated.
Could be an inflammatory response. You are taking steroid drops, right?
|
Yes.
| Quote: | And SHAKING the bottle well EVERY TIME YOU USE IT, right?
|
<ulp> I'll start doing that right away!
Thanks. |
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David Robins, MD
medicine forum Guru Wannabe
Joined: 02 May 2005
Posts: 135
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| Posted: Mon May 16, 2005 4:24 am Post subject:
Re: Cataract Surgery yesterday
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Corneal edema can occur from reasons other than high pressure. A common
cause is just from the shock of surgery and the irrigation inside the eye
affecting the endothelial cells on the back of the cornea.
When they (the endothelial cells) are not working up to speed, fluid passed
though them and gets into the cornea. If they recover, the edema goes away
in a few days to as much as a few weeks in severe cases.
If they were borderline to begin with, and are further damaged, the edema
could potentially stay. Those are the very few patients who end up needing
corneal transplants for pseudophakic bullous keratopathy.
PS: Shake well means about 20 shakes every time the steroid drops are used.
On 5/15/05 7:30 PM, in article
1116210734.690da66a47e23bd162cf3fdea4677474@teranews, "quattrocchi"
<quattrocchi@ww.co.nz> wrote:
| Quote: | In article <edRhe.256$Uv2.32@newssvr13.news.prodigy.com>,
William Stacy <wstacy@obase.net> wrote:
quattrocchi wrote:
Might the pressure have been higher o/night?
It *could* have been, but if it measured 15 the next day, any fogginess
from pressures would already subside. The cornea swells from high
pressure, but clears as soon as the pressure drops, unless something
else is causing it.
I noticed that my pupil was not dilated the day after.
In fact ATM the eye is less dilated than the normal eye. A smaller black
dot.
Now it's Sunday, the 2nd day after the Friday operation, and the haziness
has
diminished somewhat to about 15% of what it was. But it's still hazy or
foggy.
And brightly-lit things seems to spread into the adjacent dark areas. AS IF
the
pupils were dilated.
Could be an inflammatory response. You are taking steroid drops, right?
Yes.
And SHAKING the bottle well EVERY TIME YOU USE IT, right?
ulp> I'll start doing that right away!
Thanks.
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quattrocchi
medicine forum beginner
Joined: 14 May 2005
Posts: 37
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| Posted: Thu May 19, 2005 12:22 am Post subject:
Re: Cataract Surgery yesterday
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In article <BEAD8A9C.4A90A%trashadd@bigfoot.com>,
"David Robins, MD" <trashadd@bigfoot.com> wrote:
| Quote: | Corneal edema can occur from reasons other than high pressure. A common
cause is just from the shock of surgery and the irrigation inside the eye
affecting the endothelial cells on the back of the cornea.
When they (the endothelial cells) are not working up to speed, fluid passed
though them and gets into the cornea. If they recover, the edema goes away
in a few days to as much as a few weeks in severe cases.
|
Thanks for that explanation.
I can now report that today (day 6) I woke up to very litle haze and was also
experiencing, understandably, clearer focus. Wonderful. Last night (day 5) I'd
noticed with some anxiety that the haziness was still at about the 10%-15% level
of day 1.
Then such a marked improvement happened overnight.
I wonder what my new Rx will be. The surgeon had said she was aiming for around
some residual myopia of -1 in the IOL, so yesterday I'd replaced my previous
glasses lens (sph -4.50; cyl -3.25) with a -1.00 to try to give me some basic
focus. But now that I can see better with almost zero haze the -1.00 lens seems
too strong. Or might that be the astigmatism.
Brian
--
Auckland NEW ZEALAND |
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David Robins, MD
medicine forum Guru Wannabe
Joined: 02 May 2005
Posts: 135
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| Posted: Thu May 19, 2005 1:58 am Post subject:
Re: Cataract Surgery yesterday
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While the cornea is healing, it changes power, especially if there is some
edema.
Which is why a refraction to order glasses is usually about 4 weeks postop,
not a few days.
Also, the "aimed for" power is only a estimate - once it heals you can
easily be +/- 0.50 to 1.00, mainly because the instrument and equations
don't know where the IOL will heal in the eye until it does., so it uses
averaged estimates.
| Quote: | Then such a marked improvement happened overnight.
I wonder what my new Rx will be. The surgeon had said she was aiming for
around
some residual myopia of -1 in the IOL, so yesterday I'd replaced my previous
glasses lens (sph -4.50; cyl -3.25) with a -1.00 to try to give me some basic
focus. But now that I can see better with almost zero haze the -1.00 lens
seems
too strong. Or might that be the astigmatism.
Brian |
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William Stacy
medicine forum Guru
Joined: 01 May 2005
Posts: 1177
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| Posted: Thu May 19, 2005 2:45 am Post subject:
Re: Cataract Surgery yesterday
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quattrocchi wrote:
| Quote: | Then such a marked improvement happened overnight.
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Glad to hear it. Always helps to shake the pred forte.
| Quote: | I wonder what my new Rx will be. The surgeon had said she was aiming for around
some residual myopia of -1 in the IOL, so yesterday I'd replaced my previous
glasses lens (sph -4.50; cyl -3.25) with a -1.00 to try to give me some basic
focus. But now that I can see better with almost zero haze the -1.00 lens seems
too strong. Or might that be the astigmatism.
|
Could be. If you didn't have astigmatism relaxing incisions, you'll
still need a significant cylinder in your glasses, unless that was late
developing astigmatism (lenticular as opposed to corneal).
Either way, you'll do fine.
w.stacy, o.d. |
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quattrocchi
medicine forum beginner
Joined: 14 May 2005
Posts: 37
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| Posted: Thu May 19, 2005 7:08 am Post subject:
Re: Cataract Surgery yesterday
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In article <BEB15CEC.4B19F%trashadd@bigfoot.com>,
"David Robins, MD" <trashadd@bigfoot.com> wrote:
| Quote: | While the cornea is healing, it changes power, especially if there is some
edema.
Which is why a refraction to order glasses is usually about 4 weeks postop,
not a few days.
Also, the "aimed for" power is only a estimate - once it heals you can
easily be +/- 0.50 to 1.00, mainly because the instrument and equations
don't know where the IOL will heal in the eye until it does
|
So, does the IOL heal in the capsule into a permanent position which might be
slightly variable, unpredictably, WRT distance from the cornea/retina, within
certain parameters? Interesting. I naiively assumed first that the natural lens
was free inside the capsule, and second the IOL sits inside the newly vacated
capsule.
I find it all very fascinating, and thirst for more details.
| Quote: | ., so it uses averaged estimates.
|
I shall wait the prescribed 4wks with bated breath.
Brian
--
www.adam.co.nz |
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William Stacy
medicine forum Guru
Joined: 01 May 2005
Posts: 1177
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| Posted: Thu May 19, 2005 10:28 am Post subject:
Re: Cataract Surgery yesterday
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quattrocchi wrote:
| Quote: |
So, does the IOL heal in the capsule into a permanent position which might be
slightly variable, unpredictably, WRT distance from the cornea/retina, within
certain parameters? Interesting. I naiively assumed first that the natural lens
was free inside the capsule, and second the IOL sits inside the newly vacated
capsule.
|
The capsule actually can "shrink wrap" around the IOL and little or no
movement takes place, except maybe the crystal lens which is designed to
move a little. Jury still out on that one.
w.stacy, o.d. |
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David Robins, MD
medicine forum Guru Wannabe
Joined: 02 May 2005
Posts: 135
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| Posted: Fri May 20, 2005 1:44 am Post subject:
Re: Cataract Surgery yesterday
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On 5/19/05 2:08 AM, in article
1116493871.48e6734c23beda609c58b3ef915d80ae@teranews, "quattrocchi"
<quattrocchi@ww.co.nz> wrote:
| Quote: | In article <BEB15CEC.4B19F%trashadd@bigfoot.com>,
"David Robins, MD" <trashadd@bigfoot.com> wrote:
While the cornea is healing, it changes power, especially if there is some
edema.
Which is why a refraction to order glasses is usually about 4 weeks postop,
not a few days.
Also, the "aimed for" power is only a estimate - once it heals you can
easily be +/- 0.50 to 1.00, mainly because the instrument and equations
don't know where the IOL will heal in the eye until it does
So, does the IOL heal in the capsule into a permanent position which might be
slightly variable, unpredictably, WRT distance from the cornea/retina, within
certain parameters?
|
Answer: YES.
| Quote: | Interesting. I naiively assumed first that the natural
lens
was free inside the capsule,
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NO. It has attachments to the capsule that have to be lysed to make the lens
mobile.
| Quote: | and second the IOL sits inside the newly vacated
capsule.
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CORRECT.
| Quote: |
I find it all very fascinating, and thirst for more details.
., so it uses averaged estimates.
I shall wait the prescribed 4wks with bated breath.
Brian |
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