Well, if the whole thing were removed from the eye (intra-capsular
extraction, a rare thing these days), she will indeed need some highly
specialized repair.  Either that or a very strong contact lens or very
thick eyeglass lens.  I'd have either a vitreo-retinal specialist or a
cataract specialist look at her, probably both.  They may still be able
to do an anterior chamber lens, which is probably her best hope.

w.stacy, o.d.

__________________________________________
-> The purpose of life is not to be happy. It is to be
-> useful, to be honorable, to be compassionate, to
-> have it make some difference that you have lived
-> and lived well. (Ralph Waldo Emerson)

Please don't rely exclusively on the internet for an answer. See a good
optholmologist in your area, fast, to get a second opinion. Your
grandmother may need coaxing to do this as she may feel that her surgeon
might get annoyed, but that is old school. Again, don't suggest to her
about getting a second opinion, implore her to do it, as soon as
possible. And, I suggest that you go with her to help ask the difficult
questions.

BTW, I have had cataract surgery in both eyes and the complication you
noted above was never mentioned to me. Sounds like it is not common.

George

Removing the capsule used to be the way it was done.  It isn't that way
anymore, and I would think that the doctor must have had a good reason to
remove it.  I had my second cataract surgery about three years ago, and
had that horrible pressure that caused great pain.  My doctor relieved the
pressure, and I was fine after that.  I couldn't see a thing with the
pressure, but measured 20/40 immediately afterward.  Of course, my capsule
wasn't removed and I had had an IOL inserted.  After 30 days, my vision
was 20/20.  With the capsule removed, most people won't see a thing until
they get glasses or contacts.

On 8/17/05 5:04 PM, in article 57j7g1t5t1jv8j3hg15v9mf5lhke42t4nb@4ax.com,

If the zonules are weak,such as from extreme age, pseudoexfolation syndrome,
or old injury, the zonules may not be strong enough to hold the capsule in
place during surgery. If that happens, the zonules "unzip", and the capsule
becomes free-floating. Then it must be removed, or it floats around. If the
cataract is still inside the capsule, it too is remains in the eye unless it
is removed before the capsular bag falls back into the vitreous cavity.

Don't know why there would be blood in the eye - it is not caused by the
capsule or zonules separating.

Pressure will go up int the eye after surgery in complicated cases. Once the
capsule tears, or the zonules rupture, vitreous presents to the anterior
chamber, and must be removed (anterior vitrectomy) using specialized
instruments. The extra manipulationin the eye, plus having to leave some
viscoelastic (the gel used during surgery0 in the eye can raise pressure to
high levels the next day.

You cannot replace the capsule; it is attached to the eye by the zonules
(fibers) that cannot be reattached.

There must have been some bleeding into the vitreous of the eye for some
reason, or a choroidal hemorrhage, which is beneath the retina and occurs
due to the low pressure in the eye when it is opened for surgery, and in
elderly people especially can cause bleeding in the choroid. It is not
caused by instruments damaging that area, just having fragile blood vessels.
Choroidal hemorrhages generally reabsorb (ie 1 month) but sometimes require
a retina specialist to drain them.

Lots of things can happen during surgery, and are part of the risks
involved. Of course, if the surgeon really did something bad, that is one
thing. In general, these complications can occur with any surgeon at some
point.

If there is no capsular support for a posterior chamber lens, the options
for implant later are: anterior chamber lens (a tried and true backup lens
for cases such as this), or a sutured-in [posterior chamber lens, where the
IOL is sutured through the wall of the eye where the capsule would have held
it before. This entails much more manipulation in the eye, with its
attendant risks. The A/C IOL is preferred for its rapid speed of
implantation, with very little open-time for the eye and virtually no
manipulation. Manipulation in the eye can also increase risk of corneal
decompensation.

A second opinion would be a good idea, but the doctor may not know all the
details of the surgery and the complications.


David Robins, MD
Board certified Ophthalmologist
Pediatric and adult strabismus subspecialty
Member of AAPOS
(American Association of Pediatric Ophthalmology and Strabismus)