Post-Retinal Detachment Cataract Surgery Complications

Cataract surgery after retinal detachment surgery?

Hello, doctor! I would like to ask the following questions:
1.
I underwent surgery for retinal detachment and tears in my left eye last June (with scleral buckle placement).
The doctor mentioned that the macula was damaged.
Since then, I have been experiencing visual distortion.
Is this condition irreversible or unlikely to improve? My binocular vision is very uncoordinated; how can I adjust this?
2.
After the retinal detachment surgery in my left eye, cataracts developed, and I underwent cataract surgery in early February of this year, during which a tension ring was placed (the doctor suggested this due to the looseness of the ligaments after the retinal detachment).
I received a government-subsidized intraocular lens.
Now, over a month later, my vision is becoming increasingly blurry, almost like there is a layer of fog.
Is this due to damage to the retina (macula), or could it be caused by proliferative tissue in the capsule, or other factors? Just a few days after the surgery, the blurriness became noticeably worse! During my recent follow-up, the doctor said to observe the situation for another two months.
Additionally, the doctor mentioned that the government-subsidized intraocular lens offers less protection, which may increase the likelihood of postoperative blurriness.
Is that correct? I appreciate your clarification! Thank you for your response!

HO, 60~69 year old female. Ask Date: 2023/03/10

Dr. He Jianxian reply Ophthalmology

Hello,
1.
The macula has sustained damage and deformation, which not only leads to a decline in vision but also causes visual distortion that is difficult to change or adjust.

2.
It is recommended to observe further, as postoperative vision typically takes some time to stabilize.
Regarding the coverage of artificial intraocular lenses by health insurance, it should be adequate, as the material is essentially the same as that of privately paid artificial lenses, differing only in the shape of the mold.

Director He Jianxian, Ophthalmology, Nantou Hospital

Reply Date: 2023/03/10

More Info

After undergoing retinal detachment surgery and subsequent cataract surgery, it is understandable to have concerns about visual changes and complications. Let's address your questions systematically.

1. Visual Distortion and Coordination: Following retinal detachment surgery, particularly when the macula is involved, patients often experience visual distortions such as metamorphopsia (where straight lines appear wavy) or a general sense of distortion. This can be due to damage to the photoreceptors in the macula, which is responsible for central vision. Unfortunately, if the damage is significant, it may not fully recover. However, some patients report gradual improvement over time, so it is essential to maintain regular follow-ups with your ophthalmologist. For the issue of visual coordination between both eyes, it may be beneficial to explore options such as vision therapy or corrective lenses that can help balance the visual input from both eyes.

2. Post-Cataract Surgery Blurriness: The development of cataracts after retinal detachment surgery is not uncommon, especially if the surgery involved the use of silicone oil or other materials that can affect the eye's internal environment. After your cataract surgery, if you are experiencing increasing blurriness, it could be due to several factors. One possibility is the formation of a secondary cataract, also known as posterior capsule opacification (PCO), which can occur when the thin membrane behind the lens becomes cloudy. This condition is treatable with a simple outpatient procedure called YAG laser capsulotomy.
Additionally, if your surgeon mentioned that the artificial lens provided by health insurance has less protective coating, it could mean that the lens is more susceptible to clouding or other complications. While the lens itself is designed to improve vision, the quality of the lens can influence the clarity of vision post-surgery.
It is also important to consider that if the macula was damaged during the initial retinal detachment, this could contribute to ongoing visual disturbances. The brain may struggle to interpret signals from the affected eye, leading to a perception of blurriness or fogginess.
In summary, the visual changes you are experiencing can stem from multiple sources, including the initial retinal damage, the quality of the artificial lens, and potential complications like PCO. It is crucial to maintain open communication with your ophthalmologist regarding these symptoms. They may recommend further diagnostic tests to assess the condition of your retina and the artificial lens.
In terms of management, ensure you attend all follow-up appointments, and do not hesitate to express your concerns about your vision. If the blurriness persists or worsens, your doctor may suggest additional interventions to improve your visual clarity.
Lastly, while it can be disheartening to deal with these complications, many patients find that with appropriate care and time, their vision can stabilize and improve. Stay proactive about your eye health, and consider seeking a second opinion if you feel your concerns are not being adequately addressed.

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