Question: I have a question about Iris damage after cataract surgery. During cataract surgery how often does the removal of part of, or a thinning of the Iris, occur which then results in the necessity of a contact lens to stop excess light from entering the eye? This was noticed after my cataract surgery. I had Crystalens® lens implants put in. My right eye is perfect, but my left eye is like it has been dilated. I used Pred Forte drops for almost two months, the cataract surgeon thought it may be inflammation, but it is not, there is definitely an area of Iris removed.
Answer: It is really difficult, if not impossible, to know exactly why this happened. However, it is not uncommon to observe small or even larger areas of Iris damage after routine Cataract Surgery presenting as areas of Iris trans-illumination or seeming transparency as well as actual sectors of tissue appearing to be removed. Surgical trauma to the Iris may be noticed after Cataract Surgery to a greater or lesser extent and accompanied by increased glare and light sensitivity, as the eye can no longer effectively control the amount and quality of the light entering the eye. Sometimes just the manipulation and positioning of the Lens Implant as it slides into place, can chafe areas of the Iris during the procedure and sometimes an Iris prolapse can occur, whereby a section of Iris tissue makes its way through the incision, as a result of the large pressure gradients created inside the eye during Cataract Surgery.
Sometimes a patient squeezing their eyes or moving, can change the pressure gradients and cause chafing. Very difficult to say but not that uncommon. Cataract Surgery is very successful BUT it is also VERY complex. It must balance pressure gradients inside the eye, tissue removal, thermal gradients and many other factors that are occurring at the microscopic level.
If you are extremely bothered by this, depending on the exact nature of the Iris defect it may be possible to have a procedure called a "pupiloplasty" which is an advanced method of Iris reconstruction. Your Cataract Surgeon should be able to offer advice as to whether this is worth considering, or even appropriate, in your situation. If you are uncomfortable, or would like a second opinion, this is never unreasonable and you can consider scheduling a consultation with a Cataract Surgeon who has a special interest in anterior segment reconstruction such as a Corneal Specialist.
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