Rough time with cataract

Discussion in 'Optometry Archives' started by melindasaccount, Nov 19, 2005.

  1. Hello to all. . .I had an atypically tough time with my cataract
    surgery. It has been 2 1/2 weeks and I still have only blurred vision
    in the eye that was operated on. I had the old-fashioned, non-laser
    surgery, with cutting and stitching, because I'm on the "poor people's
    health plan". I had general anesthesia because I'm very squeamish
    about my eyes. The reaction to the anesthetics was terrible - I vomited
    for a day and a half and couldn't even tolerate water. I had facial
    spasms and my eye watered non-stop for 24 hours afterward, but I was so
    busy throwing up that I hardly noticed.Many blood vessels in the eye
    ruptured and my opthalmologist had to give me a steroid shot in the
    corner of my eye to reduce the swelling. I am currently on three
    medicines: Tobradex, Voltaren and Alphagan. An exam today by a
    different opthalmologist revealed that the eye is still very swollen
    and the lens seems improperly positioned. She is not sure whether this
    will resolve after the swelling goes down. After hearing such
    benevolent reports about how easy a surgery it is, I was truly
    unprepared for the ordeal. I have had to miss an entire month of work
    because my eyesight as of today is no better than with the cataract.
    Opinions, prayers, thoughts. . .all are welcome. The waiting is the
    hardest part - waiting to see if the eye will heal or if I have to
    undergo the ordeal of another surgery. Best wishes, Melinda
    melindasaccount, Nov 19, 2005
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  2. melindasaccount

    Dan Abel Guest

    I think the key word here is "atypical". I've had cataract surgery in
    both eyes, five years apart. The first one was a piece of cake.
    Unfortunately, the doctor retired and I got a new one. I was fine with
    her until the surgery. She didn't believe in tranquilizers. I missed
    three days work, versus the two days with the first one. I had some
    complications, perhaps because I was unable to stay still. She kept
    telling me to stay still, but I was literally shaking with fear and
    anxiety. This was three years ago.

    Fortunately, the outcome was excellent.

    I had eye surgery a few months back. It was much more major surgery
    (two hours working on the back of the eye). The anesthesia doctor
    assured me that they had lots of tranquilizers and would use them. It
    was another piece of cake. I was completely awake the whole time and
    happy as a clam (and about as lively). I was off two weeks, but felt
    pretty good.
    Dan Abel, Nov 19, 2005
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  3. melindasaccount

    CatmanX Guest

    firstly, lasers are not used for cataract surgery for anyone. If you
    had a scleral tunnel, then your doctor came from the dark ages, no-one
    in backwards AUstralia uses scleral tunnels any more. Corneal incisions
    are faster, cheaper and faster to resolve. ANy blur you have is
    possibly related to sutures pulling your cornea out of shape.

    dr grant
    CatmanX, Nov 19, 2005
  4. No one uses ether anymore, as far as I know. It is highly flammable, and
    thus explosive and dangerous.
    David Robins, MD, Nov 19, 2005
  5. There is still a role for scleral tunnels. If a rigid lens is required,
    rather than a foldable, a 6 mm optic requires such a large incision that
    clear-corneal really can't be used.

    Who needs a lens like this?
    Heparin-coated lens are used in uveitis patients occasionally. Bad diabetic
    may need a rigid lens. If a clear-corneal goes south, and an anterior
    chamber lens is needed, a scleral tunnel is a good, relatively
    astigmatically-neutral incision though which to place the lens. If you need
    to do an extracapsular cataract procedure due to a very hard cataract, for
    example, you can break the lens up into several pieces and get them out
    through a 6 mm scleral tunnel without making a traditional 9-10mm limbal
    incision, thereby closing up with 1 or no sutures. A limbal icision may
    requires up to 8-9 sutures.

    I use scleral tunnels about once a year.
    David Robins, MD, Nov 19, 2005
  6. Sorry to hear that. What health plan, where? Cutting is not old
    fashioned, as all cataract surgery requires it. Stitchless surgery (self
    sealing incisions) are the most modern, but sometimes even that type
    incision needs a stich or two.

    I had general anesthesia because I'm very squeamish
    Too bad you apparently were able to convince the surgeon to "put you
    completely out"! It certaintly isn't necessary in most cases. The
    versed they use during procedures these days is sufficient to keep you
    happy, even though not completely out... but it's past so I won't dwell
    on that.

    I am currently on three
    That's pretty normal; I assume they are having a little concern about
    your eye pressure with the Alphagan.

    An exam today by a
    How is the other eye? What kinds of acuity do you have in each?

    w.stacy, o.d.

    (back from Cabo, sort of in recovery myself...)
    William Stacy, Nov 19, 2005
  7. melindasaccount

    Dan Abel Guest

    I've posted this before, but the guy before me on my first surgery got a
    general. My doctor's exam room is right across from the waiting room.
    We're waiting there, and my doctor is just yelling his lungs out. I
    couldn't believe it, because he is very quiet and calm. So we're called
    in, and he apologizes. The previous patient was very deaf, and very
    stubborn. The doctor tried to talk to his wife, but she wouldn't even
    try to talk to her husband. The doctor wasn't willing to do the surgery
    with the patient awake since he had no clue what was going to happen,
    not to mention his being stubborn. While we were there, the doctor
    called and ordered a general for the guy.
    Dan Abel, Nov 20, 2005
  8. Sounds like taking the easy way out for the doc, at the expense of the
    patient's best interest. If he were that deaf, what's wrong with paper
    and felt tip marker? Hey, I just had my first colonoscopy and with the
    versed/fentanyl combo they put to me, I was out for the duration, but
    it's still not a general; I'd call it deep sedation with a little
    amnesiac thrown in. No trache tube, so little danger, and I walked out
    on my own 30 minutes later, no nausea, no nothing, clutching a color
    photo of the inside of my own, as it turns out, healthy gut.

    w.stacy, o.d.
    William Stacy, Nov 20, 2005
  9. melindasaccount

    Dan Abel Guest

    Sounds like taking the easy way out for the doc, at the expense of the
    patient's best interest.[/QUOTE]

    I can't agree. I'm no doctor, and not even remotely connected to the
    profession, but they normally do cataract surgery with the patient awake
    for it.

    I've had a hernia repair, and a retinal detachment repair with
    vitrectomy, all wide awake (but heavily sedated). I was fine with that.
    This guy was just over the top. I could see him going ballistic during

    I can't blame the doctor, and I think that it was in the patient's best
    Dan Abel, Nov 20, 2005
  10. No disagreement there.
    OK I wasn't there, so maybe the guy was nuts, but maybe just deaf. I
    just can't imagine anyone going ballistic with enough valium and versed
    in them. I would not say that I was "wide awake" during cataract
    surgery, although I remember most of the details, including those little
    suggestions of "look over there" and "right there, good, hold steady",
    stuff like that, which if the patient couldn't hear might take away much
    of the advantage of local anesthesia in cataract surgery.

    BTW I also developed a peripheral flap tear of one retina and had it
    photocoagulated on the spot without any sedation at all. It hurt like
    hell and half way through I was offered a "block" and declined that, but
    I sure would have accepted a jolt of IV juice at that time. 15 minutes
    of sheer torture, but all is well now.

    w.stacy, o.d.
    William Stacy, Nov 20, 2005
  11. melindasaccount

    George Guest

    William Stacy wrote:

    Hey, I just had my first colonoscopy and with the
    As you said, you may not not remember all the details of the procedure
    since there is an amnesia effect associated with these drugs. To wit, I
    had a long conversation with a friend who I talked to soon after the
    colonoscopy and she couldn't remember it later on in the afternoon.
    That's why they probably told you not to sign any important papers for a
    day or two afterwards. But they rarely mention the amnesia effect to
    patients for obvious reasons.

    George, Nov 20, 2005
  12. George wrote:

    To wit, I
    Er, I don't recall not remembering anything...
    Mostly they were concerened that I shouldn't drive. I was ready to go
    back to my office (walking distance) and do some paperwork, and asked
    how long would it be before I could drive. They said none at all that
    day. I thought that was extreme prudence, but for legal reasons I can
    understand it. So I just had my wife drive me home. Again, I don't
    recall forgetting anything, but I can't seem to locate my will...

    w.stacy, o.d.
    William Stacy, Nov 20, 2005
  13. melindasaccount

    Dan Abel Guest

    I wasn't really there either. The fact that his wife refused to
    translate spoke a lot, though.

    I have no clue what this "versed" is. This surgery was almost ten years
    ago. Did they have that back then?

    The wife wasn't exactly shy. She and my wife talked a lot in the
    waiting room, while our surgeries happened. His surgery was right
    before mine, and of course he spent more time in recovery since he had a
    general and I didn't. The wife didn't understand why her husband had a
    general and I didn't. I had to remind my wife of what had happened.
    Dan Abel, Nov 21, 2005
  14. Contraindications for topical anesthesia include inability to hear and
    follow directions, language problems that preclude following directions, as
    well as extreme nerves.

    Versed also does not work for everyone. I find that background jazz, coupled
    with keeping the patient updated as to where we are, and how it's going, is
    a better relaxant than the Versed. It is easy to get a little too much - the
    patient falls asleep and suddenly wakes up and jerks around, or even tries
    to get of the bed since he is disoriented. Or, the are so sleepy the eye is
    rolling all around and they can't control themselves.

    I had one poor fellow who we tried 2 prior times to operate under either
    topical or retrobulbar. He had spent the evening before surgery so nervious
    that he rubbed his forehead above the eye so hard with the finger that it
    was bloody. He was not a candidate for anything other than general (which I
    only do about once every year or two).
    David Robins, MD, Nov 21, 2005
  15. How can the patient follow directions during the surgery if he can't hear?
    The paper and felt marker may be fine for in the office to communicate, but
    won't work while he is lying under the operating microscope.

    Yes, in some cases, if they are very cooperative, it is possible to
    establish a communication "code" beforehand, as I did with one gentleman.
    David Robins, MD, Nov 21, 2005
  16. I agree that inability to hear eliminates some of the advantages of
    local anesthesia, and may render the general mandatory.
    No doubt. As always, the skill of the surgeon is paramount, and
    communication skills are probably near the top of importance.

    w.stacy, o.d.
    William Stacy, Nov 21, 2005
  17. melindasaccount

    George Guest

    George, Nov 21, 2005
  18. My other eye shows no sign of cataract but it is very astigmatic and
    has been since childhood. I don't know my exact prescription. I am
    seeing the eye surgeon tomorrow and can get that information for you.
    Thanks, Melinda
    melindasaccount, Nov 22, 2005
  19. Thanks for reminding me of something. The anesthesia not only induced
    vomiting for 2 days; it had strange, lingering side effects. One in
    particular was unsettling: when I was between sleep and waking for days
    afterward, I couldn't locate my limbs mentally. Now if I told them to
    move, they would do it, but I had to issue the command, and then my
    body would 'remember' where they were. It wasn't exactly paralysis; it
    was just that movement wasn't automatic. It had to be consciously
    ordered and executed. Needless to say, I'm going to find out what they
    gave me and studiously avoid it from now on. Melinda
    melindasaccount, Nov 22, 2005
  20. Thanks for thinking about this. But if the cornea is being pulled out
    of shape, can it be corrected without having to go under the knife
    again? Also, I notice my pupil is not contracting the way the other,
    healthy eye does. This makes it impossible to endure keeping the eye
    open for any length of time. Hope to hear from you again about this.
    melindasaccount, Nov 22, 2005
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