Eye surgery

Thank you to all of the friends, and friends of friends, and contacts of friends of friends (!) who shared their advice, thoughts, warm wishes and professional opinions with me when I was deciding how to proceed with the slipped IOL (artificial lens) in my right eye.

I’m documenting discussions I had with my ophthalmologist and his colleagues, the decisions I made, the operation and ongoing status here.

Discussion

The initial problem: I have artificial lenses in both eyes, surgically implanted in 2004 with 2 operations per eye (I had severe cataracts caused by the medication I’ve been using since 1980 or thereabouts to manage pars planitis).  In late January, though, the implant in my right eye slipped out of position, leaving me with vision that was askew, doubled, and out of focus.

I dug through all of my old records to give my ophthalmologist (Dr. Hugé, pronounced OO-zhay) as complete a picture as possible of what he was dealing with (a pretty standard implant tucked into the natural lens capsule… in an eye with the vitreous already removed and various work done to repair retinal detachments).  He in turn brought in a colleague to discuss possible styles of replacement implant, leaning towards an Artisan lens, which clips to the outside of the iris instead of being further back in the eye.

I did some research online, and collected thoughts and responses from a few different doctors in the US, and wrote everything up in French for Dr. Hugé.

I also did some experiments with an optician here to see if perhaps I could avoid surgery by correcting the new vision with a new lens like you’d correct for astigmatism (thanks for the idea Dr. Walji!): it was a long shot, and didn’t pan out because the implant continued to move and was more than just a little out of position, unfortunately.

The main argument against the clip lens was my history of inflammation — it’s been very quiet since the surgeries in 2004, but not completely gone, and an iris clip lens could cause some irritation of the iris that might cause the old inflammation to flare up.

An alternative we discussed was leaving the capsular bag in place, removing the old implant and replacing it with a new one similarly placed, but perpendicular to the old one to avoid the weak areas that caused the old implant to slip.  They discarded this idea after discussing it with a third ophthalmologist, though — who examined me and felt that there wasn’t likely to be enough of the sac intact to provide reliable support for it.

Suturing an implant in place (instead of relying on the capsular bag to hold it) was another option — this is how my left eye implant was done.  The main argument against this was… cultural, I guess?  I’m not sure of the full story, but in short, French eye surgeons in general strongly prefer other solutions, so they aren’t nearly as practiced with suturing implants as their American counterparts.  They may have some good reasons for this preference — I have only the anecdotal case of my left eye, but the vision isn’t very good even though the optic nerve is in much better condition than in my right, and I know that surgery took a very long time and was very tricky.

Anyway, the end result of all this was to bring us back to the iris clip lens, which is what we ended up using.  We scheduled the surgery for February 24th, and Dr. Hugé gave me a prescription for oral prednisone to take 3 days before and after the surgery to supplement the normal post-op eyedrops in suppressing any inflammatory response.

Surgery

Here’s the summary of the surgery, in a letter from my ophthalmologist to my primary care physician (…given to me to deliver, so of course I saved a copy for myself).  Translation below.

Nom: Monsieur WHELAN Robert
Date: 24/02/2010
Chirurgien: Dr HUGÉ Laurent
Anesthésiste: Dr. ALLEMAND
Anesthésie générale
No Salle Bloc: 3
Intervention  DÉBUT: 12h00  FIN: 12h45

Intervention:
Désinfection cutanée a la Bétadine OPH.
Mise en place d’un champ et d’un adhésif incise recouvrant les cils.
Immersion des culs de sac conjonctivaux a la Bétadine OPH pendant 2 minutes.
Incision supérieure de 6 mm de large.
Haelon GV en chambre antérieure
Extraction de l’implant subluxé a la pince
Exérèse du sac capsulaire apr vitrectomie antérieure.
Mise en place d’un implant Artisan de 12,0 D no 2354273 clippé a l’iris
Suture de l’incision par 4 points séparés de Nylon 10/0
Aspiration du visqueux
Injection par la contre ponction de 1 mg de Cefuroxime dans 0,15 ml de BSS.
Protea sur la cornée.  Instillation de 2 gouttes de Bétadine OPH.
Coque.

—> translated to English via Google Translate (and left uncorrected for entertainment value):

Name: Mr. Robert Whelan
Date: 24/02/2010
Surgeon: Dr. Lawrence HUGE
Anesthesiologist: Dr. GERMAN
General Anesthesia
No Room Block: 3
Intervention START: 12:00 END: 12:45

Intervention:
Skin disinfection was Betadine DPOs.
Establishment of a field and an adhesive incise covering the eyelashes.
Immersion of the conjunctival cul de sac has Betadine DPOs for 2 minutes.
Superior Incision of 6 mm wide.
Haelon GV anterior chamber
Extraction of the implant has subluxated clamp
Excision of the capsular bag after anterior vitrectomy.
Establishment of an implant Craftsman 12.0 D No. 2,354,273 clipped to the iris
Suture the incision by 4 points separated Nylon 10 / 0
Aspiration of viscous
Injection against the aspiration of 1 mg of Cefuroxime in 0.15 ml of BSS.
Protea on the cornea. Instillation of 2 drops of Betadine DPOs.
Hull.

Post-op

The few days following the surgery weren’t much fun, because I had an nasty reaction to the general anesthetic (I was out cold for 5 hours, then about an hour after going home the rollercoaster ride started — I’d feel very cold, then very hot, then I’d vomit a few times.  Then the cycle would repeat.  Ugh.  This varied but didn’t go away entirely for about a day and a half.  Silver lining: I discovered the ambulance gurneys in France seem to be made only for people no taller than 5’6!).

But the surgery itself went fairly well.  The eye had a “beat-up” feeling for about two days, then was just somewhat sensitive for a few days, then felt (and looked!) mostly normal again — and it was never anywhere near as bloodshot or gruesome-looking as after my 4 earlier surgeries in 2004 in the US. Visual acuity now (about 2 weeks later) has recovered to where it was before the old implant slipped out of place, except for a few small distorted spots still remaining (these have been disappearing as healing continues).

Aesthetically: the implant itself isn’t easy to see (though it’s just there, on top of the iris…) but the pupil is significantly off-center and no longer round.  I asked Dr. Huge about this; he said he nicked (or just bumped?) the iris while cleaning out the remnants of the lens capsule, but then the clip lens is probably preventing the iris from returning to its natural shape.  Preeta tells me it’s closer to normal now than immediately after the op, so maybe it’ll continue to recover on its own.  (And either way, fortunately I have dark eyes so it’s not very obvious).

Dr. Huge reported a little extra inflammation in the 1st post-op visit, but in the second visit (March 9th) it was quiet again, so for now there’s no sign of a flare-up or iritis caused by the new lens… of course, we’ll have to see how it goes over the long term.

That’s it!  Feel free to ask if you have any questions.