Phakic Intraocular Lenses (cont.)
In this Article
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 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?
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:
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:
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
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:
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.
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.
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