 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / General / Vision / July 2005cataract surgery on both eyes separated by one week
I'm hoping you can help me figure out how things will work for me. I will be having cataract surgery on both eyes with one week between. I am quite nearsigted and have a lot of asigmatism. I currently wear progressive lenses. Once the first eye is done, I'm assuming that I won't be able to see clearly out of eyeglass on that side. I can't imagine how I will manage. I will have somewhat better vision in that eye but the astigmatism will still be there. Will we remove the lense from my glasses? One week later, I'm guessing I will have the same problem with the second lense. While most folks return to normal activity a few days after surgery I'm wondering if I will be able to drive, read, and function since I don't think I can have new glasses for a while. If anyone can ease my mind on this whole thing, I'd appreciate it. Myrna > I'm hoping you can help me figure out how things will work for me. I > will be having cataract surgery on both eyes with one week between. I > am quite nearsigted and have a lot of asigmatism. I currently wear > progressive lenses. It could be helpful if you post the numbers of your Rx. > Once the first eye is done, I'm assuming that I won't be able to see > clearly out of eyeglass on that side. I can't imagine how I will > manage. I will have somewhat better vision in that eye but the > astigmatism will still be there. Will we remove the lense from my > glasses? That can done, even though it looks wierd. Depending on how much better the operated eye sees than the other, you may prefer to just go without (plan on picking up some OTC readers) > One week later, I'm guessing I will have the same problem with the > second lense. While most folks return to normal activity a few days > after surgery I'm wondering if I will be able to drive, read, and > function since I don't think I can have new glasses for a while. Right. At that point you can discard both old lenses and use OTC readers. It's a snap. I know, I've been there. w.stacy, o.d. Here are the numbers: OD 6.50- 2.25,x061 and OS 4.50 - 2,25 x 121 The better eye is being done first. I'm not sure how I can go without the corrective lens on the second eye. And will I be able to drive to work? > Here are the numbers: > [quoted text clipped - 3 lines] > the corrective lens on the second eye. And will I be able to drive to > work? Since your first post said you're nearsighted, I'll assume the "OD 6.50" and the "OS 4.50" had minus signs before the numeric portion... Either way, I'll also assume the better eye is the left eye (unless it has a worse cataract, in which case it might be the worse eye. Whatever, you will probably have a problem, and I have no real way of knowing which is going to be your best situation. I suggest you wait to do anything until the day after surgery. At that point, if your old glasses seem not too bad as is, just wear them. If it's better without them than with them, I'd remove the lens from the operative side and see how things look to you. If this is intolerable, just go without glasses (except for the otc readers as needed). Good luck. w.stacy, o.d. > Here are the numbers: > [quoted text clipped - 3 lines] > the corrective lens on the second eye. And will I be able to drive to > work? Why would they do the better eye first? That doesn't sound right -- if something nasty happens (unlikely, but still...) it would be better if it happened to your worse eye, right?  SignatureCheers, Bev +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ "History I believe furnishes no example of a priest-ridden people maintaining a free civil government." -- letter from Thomas Jefferson to Baron vonHumboldt, 1813 Not only that, but I thought it was more common to wait a bit longer between the two surgeries. DrG > Not only that, but I thought it was more common to wait a bit longer > between the two surgeries. I only waited 1 week, and appreciated only having one week of significant anisometropia. With small, self-sealing incisions and no-injection anesthetic, there is no reason to wait. My vision has been very stable since day 1 post-op, and there is no restriction in activity, unlike LASIK. That's why I now recommend lens exchanges (by the right surgeon) for all presbyopic hyperopes (plus relaxing incision for those with significant astigmatism) who desire refractive surgery. w.stacy, o.d. I think it depends on the surgeon. When my mother had hers done, the surgeon wanted to wait four weeks just in case of some complication like steroid glaucoma or CME. DrG > I think it depends on the surgeon. When my mother had hers done, the > surgeon wanted to wait four weeks just in case of some complication > like steroid glaucoma or CME. It *definitely* depends on the surgeon. You probably won't find studies on this, but the truth is, the better the surgeon, the lower the complication rate. It is just common sense that the less time the eye is open and the smaller the incision, the fewer the complications, all things being equal. So you get a glaucoma or cme, does that mean he won't do the other eye? I suppose it might mean fewer office visits, but I think some day they will even do bilateral procedures (like when reimbursements are equal to the unilateral ones). w.stacy, o.d. I'm not sure what the skill of the surgeon has to do with the mean time between doing cataract surgery on both eyes, or even if that is what you were inferring. And, yes, I guess if one eye goes blind, it might impact when or how the surgery is performed on the fellow eye. DrG > I'm not sure what the skill of the surgeon has to do with the mean time > between doing cataract surgery on both eyes, or even if that is what > you were inferring. And, yes, I guess if one eye goes blind, it might > impact when or how the surgery is performed on the fellow eye. > > DrG I was inferring just that. The amount of trauma the eye receives during surgery in inversely proportional to the skill of the surgeon, to the time the eye is open, and to the subsequent healing time. No doubt about it. As to the blind eye comment, that's a very rare complication to uncomplicated lens exchange. Certainly it can happen, but lightning rarely strikes the same place twice, unless that place is a very high risk place. w stacy Some of this discussion is really frightening to me. I was concerned when the doctor said he wanted to do the left eye first since this eye is a little less myopic than the right eye. I don't remember which cataract is worse but I think it's the right eye. His reason is that I am right handed and very right sided with everything I do. I don't know the correct word for that but he seems to think it's better to do the left eye since I tend to rely more on the right eye. I've been very concerned because if something does go wrong then I'm left with the eye with the least vision. Bull sh.t. Your doc is just trying to appease you. It really doesn't matter which eye is done first, assuming you have a competent surgeon. You will be up and running the next day. If he is not competent, fire him and try another doc. Case closed. w.stacy, o.d. > Some of this discussion is really frightening to me. I was concerned > when the doctor said he wanted to do the left eye first since this eye [quoted text clipped - 5 lines] > concerned because if something does go wrong then I'm left with the eye > with the least vision. I forgot to clarify why I'm doing this one week apart rather than two. There are two reasons. We first tried to schedule two weeks apart but with the doc's schedule, mine, and my husband, there were no other options. Also, there was some suggestion that I will see double since the operated eye will have some much less myopia than the other eye and this will minimize that problem. I'm still really feeling scared about all of this. Are you indeed myopic? I don't recall seeing a negative sign in front of the first number. Anyhow, that is a moot point, since your surgeon could just as easily calculate the power of the IOL to leave you myopic/hyperopic so that you wouldn't have double vision. However, in the case that you were given an IOL that gave you "double vision," you can always simply patch the other eye. I am sorry if you are feeling scared, but in a way I am feeling "put-upon" for spending the time in consultation with you when your surgeon should be doing it. After all, he/she is getting paid and I am not. DrG > Are you indeed myopic? I don't recall seeing a negative sign in front > of the first number. Anyhow, that is a moot point, since your surgeon > could just as easily calculate the power of the IOL to leave you > myopic/hyperopic so that you wouldn't have double vision. What the hell? Whether she is myopic or hyperopic around 6 diopters, she's sure as hell going to have diplopia following the first procedure. I don't think it's a big deal, I mean it's only for a week, but to say that the surgeon can easily calculate it so that she won't have diplopia is crazy. Crazy. However, in > the case that you were given an IOL that gave you "double vision," you > can always simply patch the other eye. OK wierd, but ok. > I am sorry if you are feeling scared, but in a way I am feeling > "put-upon" for spending the time in consultation with you when your > surgeon should be doing it. After all, he/she is getting paid and I am > not. Damn. Get off the internet if you're feeling put upon. Damn. w.stacy, o.d. Chill, Bill. DrG Such a calculation would result in leaving the patient with about the same refractive error they have now, and this surgery is the one opportunity to reduce this very significant refractive error. I generally try to see pre-operatively if they could wear a contact lens in the unoperated eye afterwards, while waiting to do the other eye. This means doing a contact lens trial for a lens that they may never end up needing. Even if one PLANNED to do the second eye shortly after, events may preclude doing so, and one could end up having to wait a long time, so I think it is best to be prepared just in case. On 5/21/05 3:55 PM, in article 1116716104.962908.233800@g47g2000cwa.googlegroups.com, "Dr. Leukoma" <drg@leukoma.com> wrote: > Are you indeed myopic? I don't recall seeing a negative sign in front > of the first number. Anyhow, that is a moot point, since your surgeon [quoted text clipped - 9 lines] > > DrG I wasn't seriously suggesting that the patient not be made emmetropic following surgery, especially if the second eye was being operated on within a week or two. It was just an academic discussion of options to diplopia if that is the over-riding concern. I could well imagine situations involving a unilateral cataract where years may elapse between surgeries, in which the patient was either intolerant of or didn't want to wear a contact lens, get LASIK, etc, and where the surgeon and patient might agree that the better option would be to match the refractive error with an IOL, especially if the patient was used to/didn't mind wearing glasses. I know, because I have had to counsel this type of patient. DrG Let me first say that my doctor is not using stitches and told me the reason to wait between surgeries is infection. He mentioned many things that could happen in this surgery and said there's a small percent of change that they would happen and this surgery does have a high degree of success. My eyes are healthy and my overall health is good. I am also fairly young (55) for this surgery in the scheme of things. If he mentioned all of these other things (that I don't understand since the terms are not for the layperson) then I don't know if I'd have had the nerve to go ahead with this. I'm still concerned. I'm sorry to anyone who has spent too much time trying to help me. I thought that replying to this is an optional thing. My surgeon should be tyring to alleviate my fears and should be trying to figure out what the best path is for the week after surgery as well as a plan for after the second eye is done. Yes, I am very nearsighted, and I guess I miswrote my prescription. But give me a break guys, I am not a professional like all of you. The doctor told me we have to wait and see how things are and then proceed which is why I've been in need of help from this forum. I drive to work and I need to be able to function. I used to wear contact lenses and this is a possibility for me. But my contacts have to correct astigmatism and I believe these have to be ordered and are not the throwaway kind. So I'd have to wait to get them and this means I'm having trouble seeing the world. Thank you to any of you who have given ideas and at least given me some hope that I won't have to stay home for weeks being incapacitated. MP I have a strong opinion that this forum -- or any other, for that matter -- should not be a substitute for a doctor/patient relationship. I would hope that none of my patients would have to post here to clarify something I failed to properly explain. You say that your doctor was basically in agreement with the comments you have solicted from this NG, yet you are "uneasy." Perhaps you need to have another conversation with your surgeon. DrG On 5/22/05 12:55 PM, in article 1116791715.678019.9450@o13g2000cwo.googlegroups.com, "myrnapap@yahoo.com" > Let me first say that my doctor is not using stitches and told me the > reason to wait between surgeries is infection. He mentioned many things [quoted text clipped - 8 lines] > since the terms are not for the layperson) then I don't know if I'd > have had the nerve to go ahead with this. I make it a point of mentioning a lot of the possible complications, in layman's terms that the patient can understand, yet try not to frighten them, just help them understand that there are a lot of things beyond our control. If these are not explained, then I feel I have not really given informed consent, as I see it. Yes, a lot of surgeons mention very little about possible complications and gloss over it, and I think they are doing the patient a disservice in many cases. They (the doctors) are also doing themselves a disservice, since when a complication does happen, the angriest patient is the one who said "he never said anything about that". Lawyers love it. If you tell the patient, and put it in your written informed consent, and a complication does happen that is not due to negligence, lawyers back off. I'm still concerned. > I'm sorry to anyone who has spent too much time trying to help me. I > thought that replying to this is an optional thing. [quoted text clipped - 17 lines] > > MP > I drive to work and I need to be able to function. I used to wear > contact lenses and this is a possibility for me. But my contacts have > to correct astigmatism and I believe these have to be ordered and are > not the throwaway kind. So I'd have to wait to get them and this means > I'm having trouble seeing the world. You should be able to get a trial toric lens for one eye of a disposable variety, and fairly quickly. They are widely available in those power ranges. w.stacy, o.d. > If he mentioned all of these other things (that I don't understand > since the terms are not for the layperson) then I don't know if I'd > have had the nerve to go ahead with this. I'm still concerned. I feel sorry for surgeons, they are damned if they do and damned if they don't. Patients get upset if they get a complication afterwards that they weren't told about in advance, and get upset when they are told about all the complications in advance. Of course, people are different, but the surgeon can't tell which patients are which. The surgery is wonderful. The risks are small and the benefit is huge. > I'm sorry to anyone who has spent too much time trying to help me. I > thought that replying to this is an optional thing. Nobody has spent too much time on this. As you say, anyone who isn't interested in this topic or doesn't want to help can simply move on to the next post. > My surgeon should be tyring to alleviate my fears and should be trying > to figure out what the best path is for the week after surgery as well > as a plan for after the second eye is done. Yes, I am very nearsighted, > and I guess I miswrote my prescription. But give me a break guys, I am > not a professional like all of you. My experience with posts on this group is that most are laypersons like myself. I have had cataract and cataract surgery in both eyes, so I can give the point of view of the patient, but I'm no expert. > I drive to work and I need to be able to function. I used to wear > contact lenses and this is a possibility for me. But my contacts have > to correct astigmatism and I believe these have to be ordered and are > not the throwaway kind. So I'd have to wait to get them and this means > I'm having trouble seeing the world. I'm a "belt and suspenders" kind of guy. I wouldn't want to agree to have the surgeries a week apart. I need my eyes, and I don't want to risk both of them at once. I would want to be all done and past all possibilities for complications before I had the second surgery. Of course, it wasn't an option anyway. My one eye went bad long before the other, so the surgeon wouldn't have agreed to do both anyway. It was five long years in between surgeries. After the first one, I had the lens removed from my glasses over the operated eye until six weeks had passed, at which time I got a new prescription for that eye. That worked fine for me. I think that you have a serious concern, and it should be answered before the first surgery. I would think that your surgeon would be the best person to talk to. Find out what your surgeon's plan is for your vision after both surgeries and explain your concern that you won't be able to see to work and drive for a long time. If there isn't a plan, ask for one, to include the idea of separating the surgeries by a longer period. SignatureDan Abel Sonoma State University AIS dabel@sonic.net > Let me first say that my doctor is not using stitches and told me the > reason to wait between surgeries is infection. He mentioned many things [quoted text clipped - 30 lines] > > MP Don't worry about posting so much about your worries about the cataract operations; the cause is know as "too much time prior to an operation". I had alot of time prior to my gall-bladder operation & somehow thought that I was going to be on a "restricted" diet of low-fat; stocked up on frozen low fat stuff for after the operation & ate out at a place called "the Skinny gourmet". I wasn't restricted to any diet except for a "personal preference"....couldn't eat at McDonalds anymore as something in their burger goes right thru my system, in-->out immediately. Then I had my "emergency" by-pass surgery which was done right after the angiogram; the doctor found that 2 arteries had 99% blockage & his consulation with 3 other doctors said....by-pass surgery; no time for me to think about it so wasn't worried/concerned except about getting transportation back home. Looking at the newsgroups and various forums, I am finding that people "about to" get get by-pass surgery are very worried because, now, there is the internet & lots of information of all kinds....especially warnings about loss of memory and functions which may or may not occur; i.e. people have gotten killed crossing the street but that usually don't stop people from crossing the street. It only dawned on me that I had open-heart surgery after a friend brought me home & the neighbor asked where I was; the friend said I had open heart surgery & chills went up & down my spine; the 1st open heart operation happend in my lifetime & it wasn't that long ago!!! I'm here now because I will be undergoing cataract surgery as well & have decided to opt to have it done next summer; just being chicken. I live alone & don't have anyone to provide transportation to/from the surgery so is quite concerned that the surgery on eyes may not be done at the same time. With my high myopia (-12.75 & -9.50), being able to function somewhat independently is a primary factor; if not allowed to drive shortly after the operation, there will be quite a mental trauma as the environment necessitates driving a vehicle to get around....escpecially for groceries & other necessities. I'm now retired & have moved to a place where I don't have any friends or acquaintances I would be to call for transportation....such is life I will need to deal with it. I am lucky in a way that I dont' need to rush into cataract surgery as the OD tells me that I don't feel the effect of cataracts because I was operating on "1 good eye". :-) > I'm here now because I will be undergoing cataract surgery as well & > have decided to opt to have it done next summer; just being chicken. There's nothing to be chicken about. It's a snap these days. > I live alone & don't have anyone to provide transportation to/from > the surgery so is quite concerned that the surgery on eyes may not be [quoted text clipped - 3 lines] > a mental trauma as the environment necessitates driving a vehicle > to get around....escpecially for groceries & other necessities. You just need transp from the surgery center only. Should be able to drive the next day. It will be up to whether you're more comfy driving with the old glasses (using the unoperated eye)or no glasses at all (using the "new" eye) for the time between surgeries. good luck w.stacy, o.d. Don't be chicken. See if there is a red cross near you. They often provide this type of ride. I started this chain a few months before my surgery. Aside from the fear of surgery, I could not understand how I was going to function (drive, etc) without my glasses. Well I had both eyes done separated by a week. I was very myopic (in the 5 and 6 range) and also needed progressives for reading. The day after the surgery I went to an optical place and got a temp lense for the operated eye. This gave me vision to drive. I also realized how bad my vision was since now I could compare the new vision to the old, cloudy vision. I wish I had done the surgery sooner! You don't realize how badly the cataract affects the vision. So I drove but only locally and during the day. Then I had the second eye done and got a lense for the second eye. These lenses don't correct for reading but I can read fairly well without any glasses which is what I have been doing. I just had my 6 week checkup and I have my new prescription. Unfortunately since I want progressives the lenses will still be very expensive. I had hoped for better. Anyway, there was no pain with this surgery. Surely an easier surgery than open heart! I had no complications and I could drive the next day and felt recovered in 24 hours. I only needed a day to rest after going through the surgery and having had to be at the hospital at 6 am. Surgery is serious and not a piece of cake at all. But the anticipation was much worse than the actual event. Make sure he is doing small incision (about 3 mm) and stichless. If not, fire him and hire a new doc who is up to snuff. Sorry to be so abrasive, but I'm tired of hearing these weak excuses from these guys. w.stacy, o.d. > I forgot to clarify why I'm doing this one week apart rather than two. > There are two reasons. We first tried to schedule two weeks apart but [quoted text clipped - 3 lines] > this will minimize that problem. I'm still really feeling scared about > all of this. By the way, some of the most compulsive excellent surgeons use sutures routinely, because they believe it reduces the incidence of a "sucking" wound right after surgery if the eye gets a little hypotonic. Studies have shown that the eye can drop to a pressure of less than 5 within an hour or two after surgery, which could put one at risk of endophthalmitis. Those surgeons put in a sutures, not because they are inexperienced or bad surgeons, but because they believe it is in their patient's best interest. They use absorbable sutures, or use nylon and remove it at 1 week. This is using small incisions (2.5-3.0 mm). Myself, I do not use sutures routinely, but will in a heartbeat if the wound is at all unstable due to an especially elastic cornea. On 5/21/05 9:21 PM, in article FNTje.1989$kj7.882@newssvr21.news.prodigy.com, "William Stacy" <wstacy@obase.net> wrote: > Make sure he is doing small incision (about 3 mm) and stichless. If > not, fire him and hire a new doc who is up to snuff. Sorry to be so [quoted text clipped - 9 lines] >> this will minimize that problem. I'm still really feeling scared about >> all of this. I apologize for seeming a little short. When I read your post, I got the impression that it was something I said that made you feel scared, when that was probably not the case at all. There is no need to be scared. This surgery is typically a piece of cake. I have been referring patients to the same cataract surgeon for nearly two decades, and cannot recall a single complication. DrG Regarding the statement following the small,self-sealing incisions: The IS a reason to wait, that does not have to do with incision size or anesthesia. Despite the small incisions and no-injection, there are still risks that only surface weeks later. Endopthalmitis is still a risk at 1 week, although it is reducing by 1 week. But there is the entity of late endophthalmitis.. In particular, I find that cystoid macular edema may not rear its ugly head until 6-10 weeks later. If so, you could then have 2 eyes with the same significant problem. I usually recommend waiting, if possible, 3-4 months between surgeries, based on the experience of myself and my colleagues. On 5/21/05 7:36 AM, in article SHHje.1449$mK.215@newssvr13.news.prodigy.com, I only waited 1 week, and appreciated only having one week of > significant anisometropia. With small, self-sealing incisions and > no-injection anesthetic, there is no reason to wait. My vision has been > very stable since day 1 post-op, and there is no restriction in > activity, unlike LASIK. That's why I now recommend lens exchanges (by > the right surgeon) for all presbyopic hyperopes (plus relaxing incision > for those with significant astigmatism) who desire refractive surgery. > > w.stacy, o.d. > Endopthalmitis is still a risk at 1 week, although it is reducing by 1 week. > But there is the entity of late endophthalmitis.. In particular, I find that > cystoid macular edema may not rear its ugly head until 6-10 weeks later. If > so, you could then have 2 eyes with the same significant problem. What exactly is accomplished in these cases by waiting? If you get an infection or cme, is there a greater risk that you'll get the same thing in the other eye? Would you do the procedure differently? w.stacy, o.d. On 5/23/05 7:27 AM, in article WKlke.20212$J12.576@newssvr14.news.prodigy.com, "William Stacy" <wstacy@obase.net> wrote: >> Endopthalmitis is still a risk at 1 week, although it is reducing by 1 week. >> But there is the entity of late endophthalmitis.. In particular, I find that [quoted text clipped - 6 lines] > > w.stacy, o.d. You might chose a different antibiotic based on the flora uncovered by culture of the first eye. If there were an infection in the first eye, there would be a significant risk of endogenous spread to the other eye at the same time. You might pretreat with an NSAID or or NSAID depending, if there were CME. You also wouldn't operate while the first eye was still having trouble, so as to not have 2 eyes in trouble at the same time. That is precisely what you accomplish by waiting. Not having a blind or virtually blind result. Yes the odds are small, but why have the odds, period? I see no reason to hurry it up any faster than is absolutely necessary. > You might chose a different antibiotic based on the flora uncovered by > culture of the first eye. If there were an infection in the first eye, there > would be a significant risk of endogenous spread to the other eye at the > same time. Well that's certainly possible, but if endophthalmitis is a "rare" complication of cataract surgery, then bilateral endo. has got to be exceedingly rare. I'm trying to envision how the microbe could get across and into the interior of the 2nd eye, esp. with the great antibiotics in use, other than intraoperatively. > You might pretreat with an NSAID or or NSAID depending, if there were CME. Other than the usual pretreatment? What would that consist of? > You also wouldn't operate while the first eye was still having trouble, so > as to not have 2 eyes in trouble at the same time. I have a problem with that being a problem. It seems almost easier to treat 2 eyes together than separately (e.g., half as much treatment time). > That is precisely what you accomplish by waiting. Not having a blind or > virtually blind result. Yes the odds are small, but why have the odds, > period? The odds of blindness are very, very low, and bilateral blindness? has that *ever* happened. My comments probably should have been restricted to ordinary, uncomplicated cataract/iol surgeries. > I see no reason to hurry it up any faster than is absolutely necessary. Having gone through it, one week was too long for me. But then I'm a bit compulsive... Thanks for the input. w.stacy, o.d. On 5/24/05 7:32 AM, in article 8WGke.20704$J12.19924@newssvr14.news.prodigy.com, "William Stacy" <wstacy@obase.net> wrote: >> You might chose a different antibiotic based on the flora uncovered by >> culture of the first eye. If there were an infection in the first eye, there [quoted text clipped - 6 lines] > across and into the interior of the 2nd eye, esp. with the great > antibiotics in use, other than intraoperatively. Endophthalmitis is felt to occur from bacteria either on the lids, which are ubiquitous, or possibly endogenous, from other areas of the body. Most likely, it is bacteria in the area getting in through the wound, especailly a "sucking" wound. Instruemnts are sterile, but at the end of cases, studies have shown that bacteria are already in the aqueous, from bacteria on the nonsterile conjunctival surface, or from the oil gland secretions that continue during the case. Yes, most eyes clear out the bacteria, but they can stay there and multiply. You are assuming bilateral would be very rare (multiplying the rarity by itself, yes), but bilateral could happen more easily, because the infection could spread through the bloodstream, for example. And why did the first eye get it, in spite of the "great" antibiotics? Resistance is a problem with all drugs. And if it is resistant, there is then no protection for the second eye. Thus, a double whammy. >> You might pretreat with an NSAID or or NSAID depending, if there were CME. >> [quoted text clipped - 22 lines] > > w.stacy, o.d. > You are assuming bilateral would be very rare (multiplying the rarity by > itself, yes), but bilateral could happen more easily, because the infection > could spread through the bloodstream, for example. And why did the first eye > get it, in spite of the "great" antibiotics? Resistance is a problem with > all drugs. And if it is resistant, there is then no protection for the > second eye. Thus, a double whammy. This is a very interesting area. Obviously, an internal eye infection or inflammation is one of the worst possible outcomes of cataract/lens exchange surgery. I think it can be avoided pretty much completely if certain safeguards are taken, like 1: pre-op eradication of any ocular surface or lid inflammations; 2:pre-op use of the latest generation fluroquinolone, a strong steroid and a NSAID; 3: pre-op meticulous cleansing, rinsing and sterilization of the eye, lids, adnexa and all instrumentation; 4: surgical technique that results in a self-sealing incision that is open less than 15 minutes; 5: the constant infusion of vancomycin while the eye is open; and 6: positive verification that the wound is neither leaking nor sucking immediately post-op and on 1 day post-op, and; 7: post-op meticulous and proper use of the same drugs as in #2. I don't think many microbes can stand up to that rigorous a protocol, and would hope that something like it is or soon becomes the norm. Do you know of any microbes that can resist that regimen? w.stacy, o.d. Constant infusion of vancomycin is not felt to e good medicine these days. While Jamie Gills popularized it about 10 years ago, most surgeons do not use it any longer. It doesn't stay in the eye very long, and is of very weak concentration. All it does it to encourage resistant organisms. The conjunctiva and lids are not capable of being "sterilized". You can reduce the baterial flora concentration, particularly with betadine instilled in the ey during the scrub, but it still does not sterilize the surfaces. Preoperative use of the lastest fluoroquinolone, while I myself believe in it and use it, had no evidence-based medicine study to PROVE it makes a difference. Certainly steroids and NSAIDS don't reduce infection in the usual sense (but does make the outcome smoother). The wound sucking issue was shown in a study to occur easily, with what was a perfectly self-sealing wound on the table. The problem is the IOP can reduce to less than 5 between the time of immediately post-op, and day 1, so it looks fine at both those times. When the IOP is less than 5, in the study, the wound became a sucking wound, and India ink particles from the conjunctiva ended up inside the eye. Problem is, regardless of your or my beliefs, there are no good studies showing explicitly how to eliminate endophthalmitis. And all it takes is a limited number of microbes to cause an infection. On 5/24/05 11:32 PM, in article 8_Uke.1373$rY6.886@newssvr13.news.prodigy.com, "William Stacy" <wstacy@obase.net> wrote: >> You are assuming bilateral would be very rare (multiplying the rarity by >> itself, yes), but bilateral could happen more easily, because the infection [quoted text clipped - 22 lines] > > w.stacy, o.d. > You are assuming bilateral would be very rare (multiplying the rarity by > itself, yes), but bilateral could happen more easily, because the infection > could spread through the bloodstream, for example. And why did the first eye > get it, in spite of the "great" antibiotics? Resistance is a problem with > all drugs. And if it is resistant, there is then no protection for the > second eye. Thus, a double whammy. 1. Could you explain how a bacteria that enters the aqueous of one eye can then enter the systemic blood circulation, cause a systemic infection and then "spread" to the other eye (without killing the patient)? Has that *ever* happened? 2. Has there been, with exception of the extremely rare (like perhaps one case per million) occurrence of staph resistance to the latest generation fluoroquinolones? I understand your reluctance to increase risk factors. I'd like to see the stats for simultaneous bilateral surgery vs two week delay vs three month delay. Then, the patient can make an informed decision. I have one person right now that, following unilateral IOL is plano OD and -5D OS. She can't use spectacles, can't wear contacts, has constant diplopia and now cannot renew her driver's license, is at risk of falling and breaking a hip or leg. Which is greater risk---bilateral surgery or the current situation? --LB, O.D. Forgot to add vancomycin to the bug-killer mix. Almost all infectious disease specialists, including those specializing in the eye, do not recommend the prophylactic use of vancomycin in cataract surgery. On 5/25/05 10:04 AM, in article larrybic-E4C2C0.10041025052005@news.verizon.net, "LarryDoc" <larrybic@yahoo.remove.com> wrote: > Forgot to add vancomycin to the bug-killer mix. > > You are assuming bilateral would be very rare (multiplying the rarity by > > itself, yes), but bilateral could happen more easily, because the infection [quoted text clipped - 11 lines] > one case per million) occurrence of staph resistance to the latest > generation fluoroquinolones? Being of a more pessimistic nature, and more or less resistant to infection, my main worries would be an earthquake, the doc sneezing, electrical outage, stuff that you just can't anticipate. I would want to know for an absolute fact that my bad eye had become at least useful before I let anybody hack into the good one. > I understand your reluctance to increase risk factors. I'd like to see > the stats for simultaneous bilateral surgery vs two week delay vs three [quoted text clipped - 4 lines] > falling and breaking a hip or leg. Which is greater risk---bilateral > surgery or the current situation? What about patching the -5 eye until she has her second eye done? If she can't drive anyway that doesn't seem like a monumental hardship. My right eye is +3 and my right is +6. If I put in the right contact only I can still function -- left vision is blurry, but it's always a little blurry at best, even with spectacles. And how frequently do accidents occur? A friend's mom had a terrible time with her second cataract operation -- pressure increased in the eyeball, squirting the IOL back out (or similar to that, if that's impossible) and causing intense pain. I think they tried again a few weeks later and it went OK. What happened there? SignatureCheers, Bev =================================================== "I love deadlines... especially the whooshing sound they make as they go by." -Douglas Adams > A friend's mom had a terrible time with her second cataract operation -- > pressure increased in the eyeball, squirting the IOL back out (or similar to > that, if that's impossible) and causing intense pain. I think they tried > again a few weeks later and it went OK. > > What happened there? Weird things do happen, and that's got to be one for the books, but as I've said before, with uncomplicated cataract surgery, I think problems are inversely related to the number of iols the doc has done. My first rule is you don't want to be one of the first 100 or one of the last 100 a doc is going to do in his/her career. The second rule is don't go to a surgeon who does fewer than 10 per week. So no kids, no retirees and no part time fiddlers need apply. w.stacy, o.d. > A friend's mom had a terrible time with her second cataract operation -- > pressure increased in the eyeball, squirting the IOL back out (or similar to > that, if that's impossible) and causing intense pain. I think they tried > again a few weeks later and it went OK. > > What happened there? A miracle? DrG > > A friend's mom had a terrible time with her second cataract operation -- > > pressure increased in the eyeball, squirting the IOL back out (or similar to [quoted text clipped - 4 lines] > > A miracle? <sigh> No, I wondered what was actually happening if the IOL was NOT actually being squirted out by the increased pressure within the eyeball. People occasionally describe medical things in ways that are not especially accurate :-( SignatureCheers, Bev XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX "Tip: Place your houseplants in front of the television during the next presidential debate and watch how leafy they get." -- Scott Adams once again I'll warn you guys. Please check the "send to " part of the header when replying to some of the off-the-wall stuff. If you *really* want to post to alt.suicide.holiday, go ahead, but you might want to subscribe to that group first and then reconsider. it's pretty simple to remove that group from the send-to part of your postings... It's causing a stupid meltdown on this list. w.stacy, o.d. On 5/25/05 10:02 AM, in article larrybic-7E7B27.10023925052005@news.verizon.net, "LarryDoc" <larrybic@yahoo.remove.com> wrote: >> You are assuming bilateral would be very rare (multiplying the rarity by >> itself, yes), but bilateral could happen more easily, because the infection [quoted text clipped - 22 lines] > > --LB, O.D. SHE DOES NOT HAVE TO WAIT FOREVER TO REDUCE THE ENDOPTHALMITIS RISK. One week is enough for that. In that 1 week she isn't going to lose her license, etc. However, this still puts her at risk for the other issue, such as CME, occurring later, and could then be bilateral. IS the risk worth it for her, describing the problems you mention? I don't know - that would be up to the patient to decide for themselves. In this kind of a case, it may be worth it to operate on the second eye in a shorter time frame than would usually would. Infections still happen despite the latest fluoroquinolones. Is it resistance, or other factors that don't have to do with resistance. That I can't say. But the risk is never zero. It still tends to run about 1:1,000. You don't have to die to seed bacteria to an eye. I see numerous hospitalized patient consults, and you can see bacteria seeded to the eye in people with unexplained fevers, for example. Uncommon, but it happens. And they aren't dead when I examine them :-) However, I didn't mention that spread would be most likely from surface contamination from eye to eye. I don' think the staph resistance to the fluoroquinolones in down in the 1 in a million range. Nothing is that good. The bacteria are too smart, and learn how to change their genes to accomplish resistance. It just takes time. They thought ofloxacin (Ocuflox) would be the savior drug for a long time. It don't take very long for significant resistance to occur. >>Here are the numbers: >> [quoted text clipped - 7 lines] > something nasty happens (unlikely, but still...) it would be better if it > happened to your worse eye, right? It isn't clear what she meant by "better". It could be the less myopic eye, but it could mean the more myopic eye if the cataract were more dense in that eye. It also could mean that there is another unmentioned defect in the "worse" eye. That said, I don't think it's a big deal, but yes, the "norm" is to do the more cataractous eye first, all other things being equal. Oops, make that "less dense" > It isn't clear what she meant by "better". It could be the less myopic > eye, but it could mean the more myopic eye if the cataract were more > dense in that eye. Forget to add that there is +2.5 at the end of each string of numbers. |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.