Cataract surgery - can lens implant be rejected ?

[Speedo1968]

I had a cataract operation in Khon Kaen on one eye at the end of April and made a wonderful difference to my sight.
The op used ultra sound and a special lens from the US.

All went well and my new sight settled.

About a month ago the operated eye ( right ) started to feel strange, as though it was trying to close ( yes what I see is more bright than the left eye ), frequently becoming dry, vision looking forward is strained. I can only think of it as some kind of rejection to something foreign being in the body ( no not because it came from the US and I am from the UK ).

 

My whole body is sensitive to changes and I often get issues with static, even not being to shake hands or touch a car under certain conditions ( a big issue for me before / during sandstorms when working in the Middle East ).   Here my hair can stand on end when passing under electric cables.

 

Has anyone had similar problems with lens rejection ???
Yes, I will make a hospital visit to check.

[Sheryl]

rejection no

 

But the lens can become displaced

 

See an opthalmologits as soon as possible

[geriatrickid]

Yes, you need to see the doctor asap since no one here can examine your eye for damage.

You may be in the very small minority of patients who has a problem. 

 

That being said, it is highly unlikely it is a rejection. Yes, the lens may have shifted, but you would have noticed a change in your vision. There is the potential for retina detachment in some patients or infection. All of this is rare.

 

Here's the most likely scenario; You have dry eye and the result is that you are irritating the eye. Keep in mind that you had a small incision to your cornea, which damaged your nerves. In addition, you had some trauma as a result of the emulsification process that broke down your old lens and sucked it out. Then you administered an anti inflammatory and topical antibiotic which can irritate the eye. And  you are most likely  older and more prone to dry eye. Toss in in the air pollution of  CNX and you were going to have an irritated eye. The good news is that if you act quickly, you can deal with this.  

 

In the countries which pioneered the advances in cataract surgery, they realized some time ago, that the use of a lubricating eye drop for a 1-3 months after the surgery  helped in healing and reduced the problems of surgery induced dry eye. There are multiple clinical studies that showed that the use of replacement "tears" made a big difference in both the healing process and the outcome.  There is no need for you to suffer with the relatively low cost  treatment available.    When your eye is irritated, you can inadvertently rub your eye, even when you are  "asleep". This can cause damage the eye. Unlikely, but possible.

 

In respect to the difference in  visual perception, it is normal. Your old lens had a natural tint to it that made things seem less bright. As well, depending on the extent  and age of the cataract, there was an impact on the perception of colour brightness. Remember, too that your brain is still adapting to the change.  As your doctor may have explained; the basic replacement lens will have corrected much of the eye's  physical defect, and if you had one of the newer toric lenses which corrects astigmatism, the  lens placement is  truly an art and requires the use of some complex mathematical computations to get the positioning just right. It takes some time and skill to get the toric lens properly positioned. Sometimes they ahve to go back in and adjust it.

 

Go see your doctor without delay and please do give an update.

The relationship between dry eye and outcomes has been  known for 15+ years,. Here's something you may find helpful.

https://www.reviewofophthalmology.com/article/the-relationship-between-dry-eye-and-cataract-surgery

 

If it turns out that you do have post op dry eye, see if you can get something like  Hylo Lubricating Eye Drops. (it is OTC and a sterile sodium hyalluronate solution, preservative free and without phosphate).  Do not self medicate with products like visine or anything else that have "medications" as they can damage your eye.    Do not be shy in discussing the issue with your doctor.

best of luck.

 

 

[Speedo1968]

4 hours ago, geriatrickid said:

Yes, you need to see the doctor asap since no one here can examine your eye for damage.

You may be in the very small minority of patients who has a problem. 

 

That being said, it is highly unlikely it is a rejection. Yes, the lens may have shifted, but you would have noticed a change in your vision. There is the potential for retina detachment in some patients or infection. All of this is rare.

 

Here's the most likely scenario; You have dry eye and the result is that you are irritating the eye. Keep in mind that you had a small incision to your cornea, which damaged your nerves. In addition, you had some trauma as a result of the emulsification process that broke down your old lens and sucked it out. Then you administered an anti inflammatory and topical antibiotic which can irritate the eye. And  you are most likely  older and more prone to dry eye. Toss in in the air pollution of  CNX and you were going to have an irritated eye. The good news is that if you act quickly, you can deal with this.  

 

In the countries which pioneered the advances in cataract surgery, they realized some time ago, that the use of a lubricating eye drop for a 1-3 months after the surgery  helped in healing and reduced the problems of surgery induced dry eye. There are multiple clinical studies that showed that the use of replacement "tears" made a big difference in both the healing process and the outcome.  There is no need for you to suffer with the relatively low cost  treatment available.    When your eye is irritated, you can inadvertently rub your eye, even when you are  "asleep". This can cause damage the eye. Unlikely, but possible.

 

In respect to the difference in  visual perception, it is normal. Your old lens had a natural tint to it that made things seem less bright. As well, depending on the extent  and age of the cataract, there was an impact on the perception of colour brightness. Remember, too that your brain is still adapting to the change.  As your doctor may have explained; the basic replacement lens will have corrected much of the eye's  physical defect, and if you had one of the newer toric lenses which corrects astigmatism, the  lens placement is  truly an art and requires the use of some complex mathematical computations to get the positioning just right. It takes some time and skill to get the toric lens properly positioned. Sometimes they ahve to go back in and adjust it.

 

Go see your doctor without delay and please do give an update.

The relationship between dry eye and outcomes has been  known for 15+ years,. Here's something you may find helpful.

https://www.reviewofophthalmology.com/article/the-relationship-between-dry-eye-and-cataract-surgery

 

If it turns out that you do have post op dry eye, see if you can get something like  Hylo Lubricating Eye Drops. (it is OTC and a sterile sodium hyalluronate solution, preservative free and without phosphate).  Do not self medicate with products like visine or anything else that have "medications" as they can damage your eye.    Do not be shy in discussing the issue with your doctor.

best of luck.

 

 

Many thanks for the comments and explanations.
I am highly allergic to many antibiotics and have had severe allergic responses.  I made the eye doctor aware of this and alternatives to the normal ones given were provided.
Still had issues with 2 of them which gave a numbness to one side of my face and mouth ( cataract side ).  Reported this to the doctor a few days after operation but no other alternatives available

 

Have heard about replacement tears and have tried them, results are so so.
 

I did return a few days after treatment as something didn't feel right, tests were done and everything was normal.    My final followup ( 3 months ) is due next month, was told during final one month check after op that I could maybe need to check again in 5 years time.

 

Thanks for the link etc.
Will head back to the hospital for a check.

[Speedo1968]

7 hours ago, Sheryl said:

rejection no

 

But the lens can become displaced

 

See an opthalmologits as soon as possible

Thanks Sheryl
Doesn't feel like a displacement but will head for the hospital in Khon Kaen this week.

[Dumbastheycome]

For the dry eye see if you can get a gel type lube. Feels bloody uncomfortable at  first but  lasts  much longer than  drops like  Visilube.

A possible is a post op reactive increase in pressure . A simple  glaucoma test can detect it.

I had a  cornea transplant due to  a laceration and perforation of the cornea and  it  took 8 months  for the eyeball pressure  to normalize which as a symptom caused  a persistent  aching sensation but no issues with normal vision but a sensitivity to  bright  light.

My remedy was to invest is  some  good quality auto darkening prescription  glasses .... yes  I have dry  macular degeneration anyway so I wear glasses.

 

 

 

 

 

 

[crazykopite]

I would love to get laser treatment on my eyes as I always struggle wearing two types of glasses one reading one distance up until 15 years ago my sight was perfect but as each month goes by they have deteriorated however when I read issues as above I’m put off as the thought of making my eyes worse is pretty frightening, I hope that your problem will be resolved sooner rather than later 

[Speedo1968]

1 hour ago, crazykopite said:

I would love to get laser treatment on my eyes as I always struggle wearing two types of glasses one reading one distance up until 15 years ago my sight was perfect but as each month goes by they have deteriorated however when I read issues as above I’m put off as the thought of making my eyes worse is pretty frightening, I hope that your problem will be resolved sooner rather than later 

I probably damaged my eyesight over the years, firstly from hours spent body surfing when I lived in Australia for a few years ( a kind of snow blindness ).    Secondly from living and working ( farming ) in desert climates and other hot countries.    Thirdly from not wearing sunglasses.

 

I started off in 1999 wearing special glasses for reading under fluorescent lighting, my general vision was fine.      Later special glasses for some loss of vision and again with special lens for fluorescent lights and to stop sun glare - very good and not too expensive.

 

After I finished working here for 10 years ( again in farming ) my eyesight changed often and found that glasses from a 20 baht shop were sufficient for reading.   Eventually the difference in vision for each became too much and with some hesitation, as is normal when it comes to our eyes  I spoke to the hospital who were very very helpful and I felt brave enough to have the op.    I had worried unnecessarily  a short pre-op then 30 minutes of a little discomfort and I could see properly again.

 

The hardest part after the op was to REST my eyes for a month for which you need someone to help.
I am used to living alone but was lucky enough to have a friend help me out during that month.

I still found I was doing what comes naturally, looking up looking down, bending down standing up, looking left looking right.   It is very important for at least one month to let someone help you and for the second month to take things easy.     Like no TV but you could listen to the radio or download radio plays etc.
If I had my first post-op one month again I would remember and do what the doctor said.

GO FOR IT - it's a whole different world out there waiting to be looked at again.

 

The hospital I went to was the Bangkok Hospital in Khon Kaen

 

 

 

 

[Speedo1968]

13 hours ago, Dumbastheycome said:

For the dry eye see if you can get a gel type lube. Feels bloody uncomfortable at  first but  lasts  much longer than  drops like  Visilube.

A possible is a post op reactive increase in pressure . A simple  glaucoma test can detect it.

I had a  cornea transplant due to  a laceration and perforation of the cornea and  it  took 8 months  for the eyeball pressure  to normalize which as a symptom caused  a persistent  aching sensation but no issues with normal vision but a sensitivity to  bright  light.

My remedy was to invest is  some  good quality auto darkening prescription  glasses .... yes  I have dry  macular degeneration anyway so I wear glasses.

 

 

 

 

 

 

Thanks for your comments.

Yes, a few days after the op I went back to the hospital as my eye felt weird, they did a pressure check and said all was perfect - I was told to "stop doing things" AGAIN, it's hard isn't it to keep ones eyes still !

I still wear dark glasses as I step out of the front door, even tinted ones when in a shopping mall.

[phantomfiddler]

3 hours ago, crazykopite said:

I would love to get laser treatment on my eyes as I always struggle wearing two types of glasses one reading one distance up until 15 years ago my sight was perfect but as each month goes by they have deteriorated however when I read issues as above I’m put off as the thought of making my eyes worse is pretty frightening, I hope that your problem will be resolved sooner rather than later 

I hope you realize that laser treatment (Lasik) has got absolutely nothing to do with cataract surgery, and whether laser is suitable for you depends on many factors. For starters, all laser treatment does is reshape the outside curvature of the cornea, and is mainly of benefit to people who are fed up with wearing  very thick and heavy glasses during normal wear. This curvature can also change gradually after the operation, tending to revert back. Also what it gives you at one one end of the sight range, it takes away from the other end of the range, so you will still need glasses.

    Age is also an important factor also. Just about everyone gets cataracts sooner or later, and when they implant the new lens they do the calculations such that the focal length of the new implanted lens will give you perfect clear distance viewing without glasses. Here one can make a choice between fixed focal length and variable focus. If you require the highest degree of "acuity" the fixed focus is the best and also the cheapest way to go, but you may need a cheap pair of reading glasses for near work. I was told by the best in Bangkok that the variable lens carries with it a bit of "trade-off" in acuity at distance. Almost all normal vision falls within the comfortable range of fixed focus lenses, but most important is to go to a highly reputable place that does thousands of operations, and they can advise you best. I have had them all, Lasik, Intra-Ocular Lens transplants, Detached retina repair (total and partial) and the good news is that they have really got it down in the eyes department, nearing 80 and awesome eyesight ???? 

Edited July 6, 2020 by phantomfiddler
Minor spelling correction

[brianbbb]

What is the cost of a cataract operation

[Sheryl]

1 minute ago, brianbbb said:

What is the cost of a cataract operation

Anywhere from 20-22k to 100+  per eye depending on the hospital. The low end being provincial government hospitals, the high end being large private hospitals in Bangkok.

 

This is for standard lens, if you opt for "progressive" lens implant then much more. Most people opt for standard lens.

[grumpy 4680]

        I had an eye test at a private hospital about 3 months ago, they used an eye drop prior to the examination, but it caused a stinging in eye, my eye now worse than when I first in, as I have now a problem keeping my eye open.

       When I went back for the follow up, I explained what happened, and said my it felt like the nerves in the corner of the eye were damaged, after that, it was a face saving exercise, and nothing was done to help the problem.

       So now I have lost faith in Thai eye hospitals, and that was a C/M major hospital.

[allanos]

In my late sixties I developed cataracts and my vision was as though I had a heavy mist over my eyes.  I persevered for over a year like this, and then opted for lens implants.  During the pre-op consultation the ophthalmologist told me that there was a statistical 5 percent chance of failure.  I went for the cheapest option of fixed focus lenses as the multifocal ones were too expensive for my budget.  What the surgeon did, however, was to vary the focus point in each eye, to an optimal situation.  Hence, I can read without glasses (near vision) and drive without glasses (far off vision), for example.  The result seems to have been excellent and, some 8 or 9 years later, my vision is excellent.

 

Other than putting anti-infection drops in my eyes each day for around a month post-op, I have never needed to "rest" them, as some folk are suggesting, nor use "comfort" or lubrication drops.

 

 

[sandyf]

4 hours ago, phantomfiddler said:

I hope you realize that laser treatment (Lasik) has got absolutely nothing to do with cataract surgery, and whether laser is suitable for you depends on many factors. For starters, all laser treatment does is reshape the outside curvature of the cornea, and is mainly of benefit to people who are fed up with wearing  very thick and heavy glasses during normal wear. This curvature can also change gradually after the operation, tending to revert back. Also what it gives you at one one end of the sight range, it takes away from the other end of the range, so you will still need glasses.

    Age is also an important factor also. Just about everyone gets cataracts sooner or later, and when they implant the new lens they do the calculations such that the focal length of the new implanted lens will give you perfect clear distance viewing without glasses. Here one can make a choice between fixed focal length and variable focus. If you require the highest degree of "acuity" the fixed focus is the best and also the cheapest way to go, but you may need a cheap pair of reading glasses for near work. I was told by the best in Bangkok that the variable lens carries with it a bit of "trade-off" in acuity at distance. Almost all normal vision falls within the comfortable range of fixed focus lenses, but most important is to go to a highly reputable place that does thousands of operations, and they can advise you best. I have had them all, Lasik, Intra-Ocular Lens transplants, Detached retina repair (total and partial) and the good news is that they have really got it down in the eyes department, nearing 80 and awesome eyesight ???? 

"I hope you realize that laser treatment (Lasik) has got absolutely nothing to do with cataract surgery,"

That is no longer true. Last autumn I had both eyes done(Sep & Nov), the first was done manually and the second at the same hospital but they had moved on to a laser technique, which was significantly more painful. Following the first op I had a "foreign body" effect for a couple of weeks, surgeon said it was where he had cut the eye, something I didn't get with the laser.

The laser is more accurate and not so dependent on surgeon experience.

 

You are right about age, the longer cataracts are left, the less effective the treatment. In the UK it is regarded as non essential surgery so it is not done on NHS until you are almost blind.

[sandyf]

3 hours ago, brianbbb said:

What is the cost of a cataract operation

I had both eyes done at a government hospital and the cost was 13K per eye and about 5K in aftercare for both eyes.

I took the most expensive single focal lens on offer but they had other prices down as low as 6.5K /eye, the one you would get on the health system. Friend of my wife's had his done and they never told him he had the option of paying the difference for a better lens.

[Speedo1968]

4 hours ago, Sheryl said:

Anywhere from 20-22k to 100+  per eye depending on the hospital. The low end being provincial government hospitals, the high end being large private hospitals in Bangkok.

 

This is for standard lens, if you opt for "progressive" lens implant then much more. Most people opt for standard lens.

At a private hospital in Khon Kaen for ultra sound cataract op one eye, with special lens from US, for me was 48k which included all meds and an extra visit on my part.

[sandyf]

On 7/5/2020 at 1:27 PM, geriatrickid said:

There is the potential for retina detachment in some patients or infection. All of this is rare.

Infection is not rare and here in Thailand there is a particular risk from water. The hospital I went to was quite paranoid about it, apparently a couple of years ago they had a foreigner that didn't follow the advice and ended up virtually blind.

[Speedo1968]

18 hours ago, sandyf said:

Infection is not rare and here in Thailand there is a particular risk from water. The hospital I went to was quite paranoid about it, apparently a couple of years ago they had a foreigner that didn't follow the advice and ended up virtually blind.

Me too regarding the warnings about getting water in the eye.   But good for them ( hospital ) for the warnings.
To shampoo my hair I laid on my back on an armless sofa, my head hanging over one end with a plastic bag underneath my head.     A friend then used bottles of water to wash my hair with a large bowel underneath. 

I did not wash my hair for the first 5 days then continued to wash using the above method for a month.

Fantastic, never once did water get near my eyes.

[giddyup]

On 7/7/2020 at 9:30 AM, Speedo1968 said:

Me too regarding the warnings about getting water in the eye.   But good for them ( hospital ) for the warnings.
To shampoo my hair I laid on my back on an armless sofa, my head hanging over one end with a plastic bag underneath my head.     A friend then used bottles of water to wash my hair with a large bowel underneath. 

I did not wash my hair for the first 5 days then continued to wash using the above method for a month.

Fantastic, never once did water get near my eyes.

What about showering?

[Speedo1968]

8 hours ago, giddyup said:

What about showering?

For the first 5 days I showered below the head only - not washing my hair - covered my eye with the special cover the hospital gives you, kept my treated eye closed and held the shower head.

 

Once I started to wash my hair on day 6, after I washed my hair in the lounge then i went and had a shower - holding the shower head.   Still used the eye cover.   After the first month I showered normally but kept my eyes closed.   Depends on if you have a shower or a shower over a bath.    I sat on a plastic chair in the shower, which I do anyway, some people if they close one or both eyes can have a problem with their balance, I do it because I had a bad stroke with complications 4 years ago which affected my muscles, I can walk fine but standing for a longish period can be a bit dodgy.

 

Showering is easy and just needs some fore thought.

Edited July 8, 2020 by Speedo1968
missed text

[Speedo1968]

As an after thought, did you see my previous posting ?
There are many things you need to change that one does without forethought.
As you need to restrict eye movement things like watching tv / laptop should be very limited.
Reading a book if done carefully can be pleasurable.
Not sure which country you are from but I downloaded to my laptop BBC radio plays / dramas, comedy shows etc. in advance of surgery so I had, within little eye movement hours of listening pleasure.