Rough time with cataract

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

 

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.

 

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

 

No one uses ether anymore, as far as I know. It is highly flammable, and
thus explosive and dangerous.

 

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.

 

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...)

 

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.

 

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.

 

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
surgery.

I can't blame the doctor, and I think that it was in the patient's best
interest.

 

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 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

 

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.

 

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.

 

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).

 

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.

 

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.

 

ROTFLMAO!!!!!

 

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

 

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

 

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.
Melinda