Serious Can cataract surgery cause glaucoma ?

[hollowman]

This message is meant more for the resident doctor as pte pm is blocked.

Can a cataract surgery carried out by a unskillful surgeon causes glaucoma ?

The reason why i need to post it here is that the eye doctors wouldn't want to sabotage their counterparts.

One of my family member went to a eye consultation at snec for a intraocular lens exchange but not due to cataract but rather due to high myopia. The specialist at snec done a thorough check of his eyes and commented that this can be done but as a pte patient. The procedure is same as that of a cataract surgery - that is to replace the natural clear lens with a artificial lens tp correct the refractive errors.

He then went to another pte clinic and had his clear lens replaced. Everything was good until 2 months later he developed PCO posterior capsule opacity, which is quite a common post cataract surgery complications and can be easily treated by a laser treatment. But due to the costly laser treatment at the pte clinic, he went to the polyclinic to get a referal back to snec as a subsidized patient for this laser treatment.

Now the strange thing happen. The turnaround time from the very first snec eye check for the lens replacement to this PCO eye check was only a gap of 3 months and during this check the snec specialist told him he has glaucoma. Why this was not picked up during the first snec visits ?

He then went on to internet to search and it seems like there are unconfirmed cases whereby during cataract surgery, the pressure caused the nerve to be pressed and dead therefore causing glaucoma.

The main objective for this question is not to pursue who was at fault but rather to pinpoint was the glaucoma caused by the usual high iop or caused by this 1 time of negligent surgery.

Any feedback is greatly appreciated.

 

[hollowman]

dear doctor @nayr69sg can you kindly advise as you are not sg based doctor and should not be biased. This is very important to my family member as he is still very young and was hoping the glaucoma was caused by negligent than nature.

Thanks

 

[nayr69sg]

dear doctor @nayr69sg can you kindly advise as you are not sg based doctor and should not be biased. This is very important to my family member as he is still very young and was hoping the glaucoma was caused by negligent than nature.

Thanks

Why is he "hoping" the glaucoma is caused by negligence?

Frankly I dont know the answer to your question. I would have to search up potential complications of intraocular lens replacement to see if it is a known problem.

My go to search is Uptodate which is a subscription only medical resource for physicians

Here are the complications of cataract surgery

Complications — Complications of the procedure included the following:
●Endophthalmitis, a complication that can result in markedly reduced vision and typically leaves some impairment, occurred in 0.13 percent. Lower rates have been noted in later series. (See "Bacterial endophthalmitis", section on 'Acute postcataract endophthalmitis'.)

●Bullous keratopathy occurred in 0.3 percent.

●Intraocular lens malposition/dislocationoccurred in 1.1 percent.

●Clinically apparent cystoid macular edema occurred in 1.5 percent.

●Retinal detachment, which typically requires intervention in the form of laser, cryotherapy, or surgery, occurred in 0.7 percent. It can result in marked loss of vision and moderate impairment although sometimes can be treated with no loss of vision. (See "Retinal detachment".)

A population-based study suggested that the risk of retinal detachment is increased for up to 20 years after cataract surgery [76]. In one longitudinal study of 9400 patients, the cumulative rate of retinal detachment was 2.3 percent at eight years [77].

Highly myopic eyes appear to be at particularly high risk for retinal detachment after cataract surgery [77,78]. Patients with a history of retinopathy of prematurity (ROP) who develop cataracts at a relatively early age are also at high risk for postoperative retinal detachment; retinal tear or detachment occurred in 23 percent of 66 eyes with ROP in one retrospective series [79].

●Posterior capsule opacification developed in 19.7 percent of patients. This "complication" is successfully treated with YAG (yttrium-aluminum-garnet) laser capsulotomy and therefore is not considered a complication by many surgeons. The procedure does increase the risk of retinal detachment, however, and cannot be considered entirely benign. A meta-analysis found that biomaterials and edge design may influence posterior capsule opacification; incidence was lower for acrylic or silicone lenses and for those with sharp optic edges [80].

●Toxic anterior segment syndrome (TASS) is inflammation of the anterior segment of the eye, occurring typically within 24 hours of surgery and related to noninfectious contaminants of equipment, solutions, or other supplies used during the procedure [81]. Clusters of cases have been traced to faulty preparation of sterilization equipment.

●HORV) is a rare and devastating condition that occurs 1 to 21 days after intraocular use of vancomycin [82]. For this reason, vancomycin is generally not recommended as prophylaxis against endophthalmitis in cataract surgery [64].

"Unfortunately" nothing on glaucoma. High myopia can be risk factor for retinal detachment.

High myopia is a risk factor for glaucoma.

Associated eye disorders — High degrees of refractive error (myopia >6.0 diopters [D], hyperopia >3.0 D, astigmatism >3.0 D) are associated with pathologic ocular changes [47].
Highly myopic patients have an increased incidence of retinal thinning, peripheral retinal degeneration, retinal detachment [48], cataract [49], and glaucoma [50,51]. Among patients with myopic refractive errors of 1 to 3 D, more than half of non-traumatic retinal detachments are attributable to myopia


I doubt the glaucoma is caused by the surgery. Rather you family member already has higher risk of developing glaucoma. The fact that his high myopia was bad enough to cause premature cataract means that he is also likeky to have the other associated complications of high myopia listed above.

 

[nayr69sg]

He then went on to internet to search and it seems like there are unconfirmed cases whereby during cataract surgery, the pressure caused the nerve to be pressed and dead therefore causing glaucoma.

The main objective for this question is not to pursue who was at fault but rather to pinpoint was the glaucoma caused by the usual high iop or caused by this 1 time of negligent surgery.

Any feedback is greatly appreciated.

There are 2 types of glaucoma. Open angle and angle closure.

I am assuming your relative has open angle since you didnt mention him having pain and red eye.

Was your relative told he had glaucoma in the setting of raised intraocular pressure? Or just optic nerve damage without elevated IOP?

 

[hollowman]

Thanks for your reply doc

Why is he "hoping" the glaucoma is caused by negligence?

We were hoping was caused by negligent so that his condition more likely will not worsen as that of a typical glaucoma.

I doubt the glaucoma is caused by the surgery. Rather you family member already has higher risk of developing glaucoma. The fact that his high myopia was bad enough to cause premature cataract means that he is also likeky to have the other associated complications of high myopia listed above.

Because prior to the IOL surgery glaucoma was not noticed and suddenly captured within 3 months and in quite a bad conditions so we suspect is something related to the surgery. Forgotten from somewhere forum we found a case of similar occurence in european side where they mentioned it could be a 1 time off injures to the optic nerve and doctors mentioned they wouldn't want to sabotage the practice.
Hope you can share more .

 

[hollowman]

There are 2 types of glaucoma. Open angle and angle closure.

I am assuming your relative has open angle since you didnt mention him having pain and red eye.

Was your relative told he had glaucoma in the setting of raised intraocular pressure? Or just optic nerve damage without elevated IOP?

According to the specialist it is a open angle non iop glaucoma which means even the iop was not high it could possibly lead to optic nerve damage. Even is non iop he is still given eye drops xalatan, alpagen and timolol to keep the iop as low as possible within range of 7 to 12.

 

[Leongsam]

According to the specialist it is a open angle non iop glaucoma which means even the iop was not high it could possibly lead to optic nerve damage. Even is non iop he is still given eye drops xalatan, alpagen and timolol to keep the iop as low as possible within range of 7 to 12.

High ocular pressure does not necessarily lead to glaucoma and those who suffer from glaucoma do not necessarily have high ocular pressure.

I am very familiar with this because my ocular pressure has been 24 in one eye and 25 in the other for the last 20 years and every time I go to my specialist for my annual eye exam I am told that my ocular nerve is absolutely healthy and I don't need any treatment. All I need to do is check my eyes regularly.

On the other hand I have a good friend who is now on eye drops daily for glaucoma but his ocular pressure was 17 (well within the range of 11 to 22) when his glaucoma was first detected.

The question I have was whether the cateract surgery actually caused an increase in his ocular pressure even though it is still considered to be within the acceptable range.

If it did then the surgery could well have played a part in causing nerve damage.

If there has been no change in his ocular pressure then I cannot see how an operation involving the cornea could possibly cause any issues with the optic nerve.

 

[hollowman]

High ocular pressure does not necessarily lead to glaucoma and those who suffer from glaucoma do not necessarily have high ocular pressure.

I am very familiar with this because my ocular pressure has been 24 in one eye and 25 in the other for the last 20 years and every time I go to my specialist for my annual eye exam I am told that my ocular nerve is absolutely healthy and I don't need any treatment. All I need to do is check my eyes regularly.

On the other hand I have a good friend who is now on eye drops daily for glaucoma but his ocular pressure was 17 (well within the range of 11 to 22) when his glaucoma was first detected.

The question I have was whether the cateract surgery actually caused an increase in his ocular pressure even though it is still considered to be still within the acceptable range.

If it did then the surgery could well have played a part in causing nerve damage.

If there has been no change in his ocular pressure then I cannot see how an operation involving the cornea could possibly cause any issues with the optic nerve.

Boss understand where you coming from.
Sad to say the pte clinic surgeon he went for the IOL exchange is a well known and experinced sg doc but apparently due to aging (probably) after the surgery , a simple eye prescriptions was given incorrectly by 300 degrees more than what was needed. He didn't pursue the matter and just stop going for further post operative consultantations and pco laser treatment done at snec. Lesson learnt is do not go for someone who is very experienced but has aged. This is also 1 of the reason we suspect a cornea surface surgery could lead to nerve damage if done badly.

 

[nayr69sg]

In medicine the WHY a person has a condition is the hardest to answer. Impossible even.

Western medicine is good at identifying a condition and researching how to treat it

The WHY is often a theory and a series of guesses.

As I have mentioned your relative has high myopia. Why? Well we know it is a condition we know the possible complications we can try to treat. But to give a definitive answer why. Very hard.

Ophthalmology is a very specialized field. Besides the eye surgeons you can try asking optometrists for an opinion.

 

[Leongsam]

https://www.mayoclinic.org/diseases-conditions/glaucoma/symptoms-causes/syc-20372839

Risk factors

Because chronic forms of glaucoma can destroy vision before any signs or symptoms are apparent, be aware of these risk factors:

• Having high internal eye pressure (intraocular pressure)
• Being over age 60
• Being black, Asian or Hispanic
• Having a family history of glaucoma
• Having certain medical conditions, such as diabetes, heart disease, high blood pressure and sickle cell anemia
• Having corneas that are thin in the center
• Being extremely nearsighted or farsighted
• Having had an eye injury or certain types of eye surgery
• Taking corticosteroid medications, especially eyedrops, for a long time

 

[nayr69sg]

https://www.mayoclinic.org/diseases-conditions/glaucoma/symptoms-causes/syc-20372839

Risk factors

Because chronic forms of glaucoma can destroy vision before any signs or symptoms are apparent, be aware of these risk factors:

• Having high internal eye pressure (intraocular pressure)
• Being over age 60
• Being black, Asian or Hispanic
• Having a family history of glaucoma
• Having certain medical conditions, such as diabetes, heart disease, high blood pressure and sickle cell anemia
• Having corneas that are thin in the center
• Being extremely nearsighted or farsighted
• Having had an eye injury or certain types of eye surgery
• Taking corticosteroid medications, especially eyedrops, for a long time

Sue ah! Looks like the surgeon also didnt warn your relative about possible glaucoma.

Hollow man time for you to hire a lawyer.

You can also start by writing a complaint to SMC.

http://www.healthprofessionals.gov....submitting-a-complaint/submitting-a-complaint

 

[sweetiepie]

In medicine the WHY a person has a condition is the hardest to answer. Impossible even.

Western medicine is good at identifying a condition and researching how to treat it

The WHY is often a theory and a series of guesses.

As I have mentioned your relative has high myopia. Why? Well we know it is a condition we know the possible complications we can try to treat. But to give a definitive answer why. Very hard.

Ophthalmology is a very specialized field. Besides the eye surgeons you can try asking optometrists

 

[nayr69sg]

https://www.mayoclinic.org/diseases-conditions/glaucoma/symptoms-causes/syc-20372839

Risk factors

Because chronic forms of glaucoma can destroy vision before any signs or symptoms are apparent, be aware of these risk factors:

• Having high internal eye pressure (intraocular pressure)
• Being over age 60
• Being black, Asian or Hispanic
• Having a family history of glaucoma
• Having certain medical conditions, such as diabetes, heart disease, high blood pressure and sickle cell anemia
• Having corneas that are thin in the center
• Being extremely nearsighted or farsighted
• Having had an eye injury or certain types of eye surgery
• Taking corticosteroid medications, especially eyedrops, for a long time

Hmm what are the certain types of eye surgery that predispose to glaucoma?

 

[hollowman]

In medicine the WHY a person has a condition is the hardest to answer. Impossible even.

Western medicine is good at identifying a condition and researching how to treat it

The WHY is often a theory and a series of guesses.

As I have mentioned your relative has high myopia. Why? Well we know it is a condition we know the possible complications we can try to treat. But to give a definitive answer why. Very hard.

Ophthalmology is a very specialized field. Besides the eye surgeons you can try asking optometrists for an opinion.

Well like i mentioned earlier this session is not to pinpoint the why but to find out if a badly done IOL surgery can lead to optic nerve damage and to be diagnosed for glaucoma as a result.

 

[nayr69sg]

Seems like any injury to the eye is a risk factor for glaucoma.

So basically ANY surgery to the eye is a risk factor for glaucoma.

Was this explained to your relative before he had surgery?

They will fine surgeon the max amount for even minor complications of steroid injections.

So if this wasnt covered by the eye surgeon then you will win the case for sure.

 

[hollowman]

Sue ah! Looks like the surgeon also didnt warn your relative about possible glaucoma.

Hollow man time for you to hire a lawyer.

You can also start by writing a complaint to SMC.

http://www.healthprofessionals.gov....submitting-a-complaint/submitting-a-complaint

Hmm... if the case is really due to the IOL surgery will the glaucoma progress as a typical glaucoma ? This is more important than suing . This question could not be asked or probed in snec as the docs wouldn't want to link this to the iol surgery.

 

[hollowman]

Seems like any injury to the eye is a risk factor for glaucoma.

So basically ANY surgery to the eye is a risk factor for glaucoma.

Was this explained to your relative before he had surgery?

They will fine surgeon the max amount for even minor complications of steroid injections.

So if this wasnt covered by the eye surgeon then you will win the case for sure.

Complications like retina detachment was mentioned but not glaucoma. That's why he was stunned.

 

[nayr69sg]

Complications like retina detachment was mentioned but not glaucoma. That's why he was stunned.

Time to write to SMC. Only that way will you get an honest answer.

 

[Leongsam]

Hmm... if the case is really due to the IOL surgery will the glaucoma progress as a typical glaucoma ? This is more important than suing . This question could not be asked or probed in snec as the docs wouldn't want to link this to the iol surgery.

The human body is very complex and everyone is different so I don't think any doctor has the ability to forecast the future for a particular individual.

Rather than fret over what has happened I would suggest that the negative energy of trying to pin blame should be redirected towards achieving a positive outcome.

There are many treatment options including the use of cold lasers to increase the drainage rate via the trabecular meshwork to the point where the eyedrops regimen is no longer necessary.

 

[Leongsam]

Complications like retina detachment was mentioned but not glaucoma. That's why he was stunned.

I would assume then that his glaucoma was NOT a result of eye surgery. He could well have some of the other risk factors mentioned.