Have you had cataract surgery?

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Have you had cataract surgery?

Postby Aree314 » Sat Jan 30, 2010 8:15 pm

Finally the inflammation from the uveitis is quiet and now I am a candidate for cataract surgery. However, I have a consult with the the surgeon on Tues that my nerves are all frazzeled.

I think I am nervous about being awake for the procedure and what to expect after surgery.

For those of you who have had cataract surgery what can you share from your experience? Can you have cataract surgery more than once? As a first timer for this procedure, what are some questions or concerns I should address during my consult?

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Re: Have you had cataract surgery?

Postby Mike Bartolatz » Sat Jan 30, 2010 10:10 pm

Cataract surgery with Intra ocular lens implantation is done frequently on many of us after the uveitis and/or steroids have caused the cataracts to form. rarely does a person have to have an implanted intra ocular lens removed.
there is some discomfort until the stitches disolve but usually tylenol helps. I used ice packs for ten minutes at a time the first day and night with about a 20 minute break between applications. any longer and frost bite is possible of the eyelids and tissue surrounding the eye.
you will be sedated during surgery. you really won't care what they are doing or what they are saying.
you will be able to SEE again the next day when they remove the bandage.
a topical steroid Durezol is used prior to and after surgery which you will put in for about 2 weeks. sometimes they will give a periorbital injection of steroid to also help prevent the uveitis from acting up. For your information, cataract surgery is trauma to the eye which can in itself cause uveitis in a normal eye so preventative measures are used in the uveitis patient to try to keep this from occuring.

you will do fine. whatever meds they give you after surgery, make sure you use them according to instructions. don't miss any dose even if it means getting up in the middle of the night to instill them. make sure you oclude your punctum after each eyedrop to make sure they are absorbed properly.

I hope this helps,
Mike
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Re: Have you had cataract surgery?

Postby mtbargeman » Sat Jan 30, 2010 10:26 pm

HI, There!

I had cataract surgery about a year and a half ago. They give you a kit- it contains an eye shield, tape, drops- antibiotics, anti-inflammatories, and I THINK I had a dialator drop. YOu take the drops as directed for a couple days before surgery. When you go for surgery, wear comfy clothes, a button-down shirt. They will start an IV, and give you drops and drops and drops. The drops do sting. A lot. They give you a tranquilizer, llike Valium- that's what they gave me- and something thru the IV; I think I had something like Staidol. Once you are quite relaxed and happy, they put a paper cap on your head to keep your hair out of the way- I have quite a lot of hair. Then they put you on a gurney with a padded rack in it to put your head in. It holds your head and neck still. Then they duct tape _(no REALLY_ it was duct tape!)your head- across your forehead to the gurney. When you go into the operating room, they use a wire speculum to hold open your eyelids. They float your eyeball up with water, make an incision in the eye, break up your lens beneath the cornea, suck it out, and place the new lens in. You will feel a cold sensation while all this goes on, you will see the water washing over your eye. Its like looking at a window pane during a rainstorm. The new lens goes into the incision folded up. You will feel a little pressure when it unfolds and is placed. Your eye will feel 'full' for just a few minutes. Then they wheel you out, let you up, and give you a drink of juice or water, maybe some crackers, and send you on your way with the sheild over your eye, and a pair of shades, which should be in the kit you got that you will be told to bring with you the day of surgery. NONE of this hurts- there are no pain nerves in the eyeball. When your eyes hurt, it's usu. the muscles around them, or the muscles in the iris itself or the optic nerve, in my case. I have optic atrophy. You might get a little headache for a couple days, because the eye is dialated, and all that light can get in. The drops are more painful than anything else in cataract surgery. It's all over pretty quick, and only the first one is scary because it is your eye, after all, but it really isn't painful, and you really will be high as a kite and too stoned to care what they do when you go into the OR.I promise!


Because we have Uveitis, we are at very high risk of having a flare because they eye gets irritated a bit during sugery. Your doc will treat this inflammation. Some of us- me included- develop a subcapsular cataract- one that grows BEHIND the lens after this flare, but the doc just pokes a little pinhole in there with a YAG laser. This is done in the office, and it doesn't hurt- it's been described to me as being like watching fireworks, but not at all painful.

I hope this was helpful. It is very stressful waiting for that first surgery. YOu will be instructed to wear the shades all day, and the sheild at night, so you don't rub your eye in your sleep- it can be a bit itchy. Well, that's about all I can say. Keep your head up!

Mary

PS-
Mike had stiches, but I did not- the doc said it would close up on its own very quickly. I reckon it just depends on the doc.
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Re: Have you had cataract surgery?

Postby jacs528 » Sun Jan 31, 2010 6:11 pm

Hello! I have had cataract surgery on both of my eyes, my left about a yr ago, and in my right a yr and a half ago. I was very concerned about the procedure, too, but I had no problems, and most importantly, no flares from it. I have had anterior uveitis for almost 4 yrs, and have been on Cellcept for almost 2 yrs with good results. Like the previous posters said, they will sedate you and you will be fine. They numbed half of my face for the procedure, possibly a nerve block, but gave me some type of medication where I didn't even remember that happening.

I remember the procedure, but it is fuzzy, (probably because I was sedated), and it was worry free. You know what they are doing, but can't feel anything but pressure. I had a stitch, which my dr took out about a wk after the procedure. The really wonderful thing was that I was able to see the next day as soon as they took off my eye patch. I required correction previously, so I was able to have correction with the implant as well. It was great! You will be so happy you are able to see clearly again w/o the cataract. I went in for my 2nd eye with no qualms or worries at all.

I'm sure you will have a smooth procedure, feel free to post with any other questions!

Jacqueline
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Re: Have you had cataract surgery?

Postby beeinformed » Mon Feb 01, 2010 1:55 am

Hi Jacqueline!

I also have cataracts and eventually will have to have surgery to remove them. My eye doctor has suggested taking Cellcept in the near future and since you said that you have been on Cellcept for two years with good results, I hope you don't mind if you can tell me what dose of Cellcept you are taking. Thanks.

Pam
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Re: Have you had cataract surgery?

Postby jacs528 » Mon Feb 01, 2010 10:13 pm

Hi Pam,

I am taking 1000 mg Cellcept twice a day. I have had great results, no side effects, effectively controlling my uveitis, so that is great. I was taking Methotrexate before I started Cellcept, which didn't work for me, Cellcept is the 2nd immunosuppressive drug I have tried. Like I said before, I think you will do great w/cataract surgery and will be happy with the results. Let me know if you have any more questions, take care!

Jacqueline
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Re: Have you had cataract surgery?

Postby Mike Bartolatz » Tue Feb 02, 2010 12:03 pm

just remember that it takes TWO YEARS of immunomdulation with the clock starting to tick once off all steroids without inflammation. Don't get frustrated if it takes a few months to get your eyes quieted down and the dose gets found for YOU as we are all different in how we react to meds. I do encourage you to do this to get to REMISSION from your uveitis.
we are all here to help you through this. YOU ARE NOT ALONE!

wishing you quiet eyes,
Mike
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Re: Have you had cataract surgery?

Postby jacs528 » Tue Feb 02, 2010 10:06 pm

Hi Mike,

Can you elaborate a little bit on your previous post about 2 years of immunomodulation once off steroids? Do you mean it takes that long to find the correct dose, or to get the eyes quiet?

Thanks,
Jacqueline
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Re: Have you had cataract surgery?

Postby Mike Bartolatz » Wed Feb 03, 2010 10:42 am

no, it means that once you get to 'off all steroids without inflammation in your eyes' then the time it takes to retrain your immune system is TWO YEARS on the chemotherapeutic immunomodulatory drugs. if you stop them sooner than this, your inflammation will return because the cells that remain will start replicating. the antimetabolite drugs such as Methotrexate or cellcept are critical to this process working the best. sometimes it can take several months initially to find the drugs that will work for you and steroids will be slowly tapered until you are off all steroids without inflammation. after two years you are tapered off of the drugs.

some rheumatologists try to wean you off patients sooner than this and most end up with uveitis again. the dose of the DMARD drug often has to be pushed to a larger amount in uveitis patients than the rheumatologist is used to employing in
arthritis patients. often they use a maintnance dose rather than for years and the eye remains inflammed needing steroids still which will accumulate and lead to cataracts and possibly glaucoma. the smoldering eye can also lead to Cystoid macular edema with ensuing blindspots and sometimes detached retina. progression of uveitis to vascularization of the retina can also occur if the underlying autoimmune disease has it as a component of normal disease processes. Epiretinal membranes can grow over the point of CME causing distortion. this is why we tell people to move on quickly if this becomes recurrent or chronic tolerating NO INFLAMMATION using a steroid sparing approach to treatment. Don't get me wrong as sometimes corticosteroids are the ONLY way to quiet down the eye.


wish you the best,
Mike
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