Phakic Intraocular Lenses (cont.)
BEFORE, DURING AND AFTER SURGERY
This section gives you a general idea of what you
might expect if you decide to have phakic intraocular
lens implantation surgery. What to expect before, during
and after surgery will vary according to:
- The type of phakic lens implanted
- The practices of the medical facility where the
surgery will be performed and of the doctor who will be providing your care
- Your unique health circumstances and body's
response.
The information provided here may not apply to your
particular situation and should not replace an in-depth
discussion with your doctor.
What should I expect before surgery?
Initial Visit
Before deciding to have phakic intraocular lens
implantation surgery, you will need an initial
examination to make sure your eye is healthy and
suitable for surgery. Your doctor will take a complete
history about your medical and eye health and perform a
thorough examination of both eyes, which will include
measurements of your pupils, anterior chamber depth (the
distance between your cornea and iris), and endothelial
cell counts (the number of cells on the back of your
cornea).
If you wear contact lenses, your
doctor may ask you to stop wearing them before your
initial examination (from the day of to a few weeks
before), so that your refraction (measure of how much
your eye bends light) and central keratometry readings
(measure of how much the cornea curves) are more
accurate.
At this time, you should tell your doctor
if you:
- take any medications, including over-the-counter
medications, vitamins and other supplements
- have any allergies
- have had any eye conditions
- have undergone any previous eye surgery
- have had any medical conditions.
Deciding to have Surgery
To help you decide whether phakic lenses are right
for you, talk to your doctor about your expectations and
whether there are elements of your medical history, eye
history, or eye examination that might increase your
risk or prevent you from having the outcome you expect. Before you sign an
informed consent document (a form giving permission to
your doctor to operate on your eye), you should discuss
with your doctor:
- whether you are a good candidate,
- what are the risks, benefits and alternatives of the
surgery,
- what you should expect before, during and after
surgery, and
- what your responsibilities will be before,
during and after surgery.
You should have the opportunity to ask your doctor
questions during this discussion. Ask your doctor for
the Patient Labeling of the lens that he or she
recommends for you. Give yourself plenty of time to
think about the risk/benefit discussion, to review any
informational literature provided by your doctor, and to
have any additional questions answered by your doctor
before deciding to go through with surgery and before
signing the informed consent document. You should not
feel pressured by anyone to make a decision about having
surgery. Carefully consider the pros and cons.
Preparing for Surgery
Within weeks of surgery
About one to two weeks before surgery, your eye
doctor may schedule you for a laser iridotomy
to prepare your eye for implantation of the phakic lens.
Before the procedure, your eye doctor may put drops in
your eye to make the pupil small and to numb the eye.
While you are seated, you doctor will rest a large lens
on your eye. He or she will then make a small hole (or
holes) in the extreme outer edge of the iris (the
colored part of your eye) with a laser. This hole
(holes) are to prevent fluid buildup and pressure in the
back chamber of your eye after phakic lens implantation
surgery. This procedure is usually performed in an
office or clinic setting, not in an operating room, and
usually only takes a few minutes.
After the iridotomy procedure, the doctor may have
you wait around awhile before checking your eye pressure
and letting you go home. The procedure should not
prevent you from driving home, but you should check with
your eye doctor when you schedule your appointment. You
will be given a prescription for steroid drops to put in
your eye at home for several days to reduce inflammation
from the iridotomy procedure. It is important that you
follow all instructions your doctor gives you after the
iridotomy procedure.
Possible complications of laser iridotomy include:
- iritis (inflammation in the front part of the eye)
- increase in eye pressure (usually within 1 to 4 hours
after the procedure)
- cataract (clouding of the natural lens) from the
laser
- hyphema (bleeding into the anterior chamber of the
eye, behind the cornea and in front of the iris, that can cause high pressure
inside the eye)
- injury to the cornea from the laser that can result
in clouding of the cornea
- incomplete opening of the hole all the way through
the iris
- closure of the new opening
- rarely, retinal burns
Your doctor may ask you to stop wearing
contact lenses before your surgery (anywhere
from the day of the surgery to a few weeks before).
Before your surgery, your eye doctor may ask you to
temporarily stop taking certain medications that
increase the risk of bleeding during surgery.
How long before surgery you may need to stop these
medications depends upon which medications you are using
and the conditions they are treating. You and your eye
doctor may need to discuss stopping certain medications
with the doctor who prescribed them, since you may need
some of these medications to prevent life-threatening
events. For example, you may need medications that stop
blood clotting to keep from having a stroke.
Within days of surgery
Your doctor may give you prescriptions for antibiotic
drops to prevent infection and/or
anti-inflammatory drops to prevent inflammation to put
in your eye for a few days before surgery.
Arrange for transportation to and
from surgery and to your follow-up doctor's appointment
the day after surgery, since you will be unable to
drive. Your doctor will let you know when it is safe for
you to drive again.
Your eye doctor will probably tell you not to
eat or drink anything after midnight the night
before your surgery.
What should I expect during surgery?The Day of Surgery
Just before surgery, drops will be put in your eye.
You will have to lie down for the surgery and remain
still. If you cannot lie down flat on your back, you may
not be a good candidate for this surgery. Usually,
patients are not put to sleep for this type of surgery,
but you may be given a sedative or other medication to
make you relax and an i.v. may be started. Your doctor
may inject medication around the eye to numb the eye.
The doctor also may give you an injection around the eye
to also prevent you from being able to move your eye or
see out of your eye. You will have to ask your doctor to
find out exactly which of these types of anesthesia will
be used in your case. Your eye and the surrounding area
will be cleaned and an instrument called a lid speculum
will be used to hold your eyelids open.
The doctor will make
an incision in your cornea, sclera (the white part of
your eye), or limbus (where the cornea meets the
sclera). He or she will place a lubricant into your eye
to help protect the back of the cornea (the endothelial
cells) during the insertion of the phakic lens. The
doctor will insert the phakic lens through the incision
in the eye into the anterior chamber, behind the cornea
and in front of the iris. Depending upon the type of
phakic lens, the doctor will either attach the lens to
the front of the iris in the anterior chamber of the eye
or move it through the pupil into position behind the
iris and in front of the lens in the posterior chamber
of the eye. The doctor will remove the lubricant and may
close the incision with tiny stitches, depending upon
the type of incision. Your doctor will place some eye
drops or ointment in your eye and cover your eye with a
patch and/or a shield. The surgery will probably take
around 30 minutes.
After the surgery is over, you may be brought to a
recovery room for a couple of hours before you will be
allowed to go home. You will be given prescriptions for
antibiotic and anti-inflammatory drops to use at home as
directed. You will be given an Implant Identification
Card, which you should keep as a permanent record of the
lens that was implanted in your eye. Make sure you show
this card to anyone who takes care of your eyes in the
future. You will be asked to go home and take it easy
for the rest of the day.
What should I expect after surgery?
Immediately After Surgery
After the surgical procedure, you may be sensitive to
light and have a feeling that something is in your eye.
You may experience minor discomfort after the procedure.
Your doctor may prescribe pain medication to make you
more comfortable during the first few days after the
surgery. You should contact your eye doctor
immediately if you have severe pain.
You should see your eye doctor the day after surgery.
Your doctor will remove the patch and/or shield and will
check your vision and the condition of your eye. Your
doctor will instruct you on how to use the eye
drops that you were prescribed for
after the surgery. You will need to take these
drops for up to a few weeks after surgery to decrease
inflammation and help prevent infection. Your doctor may
instruct you to continue wearing the shield all day and
all night or just at night. You should wear the shield
until your doctor tells you that you no longer have to
do so. The shield is meant to prevent you from rubbing
your eye or putting pressure on your eye while you sleep
and to protect your eye from accidentally being hit or
poked while it is healing.
As You Recover
Your vision will probably be somewhat hazy or blurry
for the first several days after surgery. Your vision
should start to improve after the first several days,
but may continue to fluctuate for the next several
weeks. It usually takes about 2 to 4 weeks for the
vision to stabilize. Do NOT rub your eyes, especially
for the first 3 to 5 days. You may also experience
sensitivity to light, glare, starbursts or halos around
lights, or the whites of your eye may look red or
bloodshot. These symptoms should decrease as your eye
recovers over the next several weeks.
You should contact your doctor immediately
if you develop severe pain or if your vision or
other symptoms get worse instead of better. Follow
all postoperative instructions given to you by your
surgeon and surgical center.
Remember to:
- Wash your hands before putting drops in your eye.
- Use the prescribed medications to help minimize the
risk of infection and inflammation. Serious infection or inflammation can
result in loss of vision.
- Try not to get water in your eyes until your doctor
says it is okay to do so.
- Try not to bend from the waist to pick up objects on
the floor, as this can cause undue pressure to your eyes. Do not lift any
heavy objects.
- Do not engage in any strenuous activity until
your doctor says it is okay to do so. It will take
about 8 weeks for your eye to heal.
Long-term
Your doctor will instruct you to return for
additional follow-up visits to monitor your progress.
Initially, these visits will be closer together (a few
days to a few weeks apart) and then they will be spread
out (several weeks to several months apart). It is
important to go to all these appointments, even if you
think you are doing well, so that the doctor can check
for complications that you may not be aware of.
Because you will have a permanent implant in your eye
with long-term risks, and especially since all these
risks are not known at this time, you will need
to be followed by an eye doctor on a regular basis for
the rest of your life. Endothelial cell counts will have
to be performed on a regular basis. You and/or your
doctor should maintain records of these measurements, so
as to be able to estimate the rate of cell loss.
It is especially important for you to have your
endothelial cells counted before you and your eye doctor
consider any other intraocular procedures, such as
cataract surgery, that will decrease the endothelial
cell count even further.
Annual eye exams are usually recommended. However, if
you have any problems with your vision or your eyes,
such as flashing lights, floating spots, or blank spots
in your vision (symptoms of a retinal detachment), you
should see an eye doctor right away and inform him or
her that you have a phakic lens implant. When
participating in sports or other activities during which
you might injure your eye, like home improvement work,
always wear protective eye wear, such as safety goggles.
Next: Questions for your doctor before undergoing phakic
lens implantation »
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