IOL Lens Half in the Bag

Eye care
1

It’s been 3 months since my cataract surgery for my left eye. Visual acuity is excellent however the biggest problem I have had is a maddox-rod effect. So when I’m driving, every headlight and streetlight has a single long streak of light through it at the same angle. I have edge glare as well but this doesn’t bother me as much and I can resolve this by wearing anti-glare glasses.

I was slated for an acrylic toric iol but for some reason the surgeon upgraded me without my knowledge or consent to a Trulign lens. I talk about this in a discussion I created here:

I finally was able to have a 2nd opinion yesterday and I found out that the iol is only half in the bag and because of this is slightly at an angle ( the left edge farthest from nose sticks forward a bit more than the edge closest to nose). I believe this is why I have the maddow-rod effect and probably the edge glare as well. This 2nd doctor recommended that I do nothing surgically since he believes my eyes are very complicated. In that left eye I used to wear -10 spherical, -3.5 cylidrical, I’ve had scleral buckles from a retinal detachment in my 20s, and I’ve recently had a vitrectomy in that eye. The first surgeon did happen to mention that the components in the front of my eye were “loose” (zonules?) although he never bothered to tell me that the lens was only half in the bag.

The 2nd doctor mentioned that my vision is impressively good now compared to where it was. He said the only things that could go wrong are the typical PCO (which he can see a little building up) and the possibility that when the bag tightens up after a complete healing that it may squeeze the lens causing it to get unaligned even more since half the lens is out of the bag.

Otherwise the 2nd doctor said I should leave it alone because the risks of worse complications are greater by trying to surgically exchange it or adjust it. I guess due to my eye history and that I may have weak zonules.Since that eye was adjusted for intermediate vision he gave me a prescription for driving glasses which brings the left eye up to 20/20 for distance saying that this should make the maddox-rod effects less noticeable since the lights will be in a tighter focus.

I’ve wondered if the 1st doctor used an acrylic toric like we agreed that this wouldn’t have happened. But perhaps it would have. I can’t change the past since what’s done is done and it doesn’t look like I have the option of having a lens exchange or even a surgical adjustment.

I’ve read that a Yag laser can fix some maddow-rod effects but that seems to be for wrinkled capsular bags where I may have a different issue. The 2nd doctor said he wouldn’t want to even consider a Yag laser for the PCO until a year from now because of my situation. Do you think the Yag laser could actually help reduce the maddox-rod effect in my case?

Has anybody else had a misaligned or half-in-the-bag iol? And if so, how did things work out?

I guess I should be happy that I do have pretty good vision in that left eye that’s been through so much. I can tolerate some imperfections like the edge glare but I’m worried that the maddox rod effect may prevent me from doing night driving.

2

yes i had an iol 1/2 out of the bag and the haptic free floating around. i went to an exchange iol specialists and have very good results.

my second opinion noticed the misalignment during dilation as i was thinking of having yag done to correct shadow/ double vision effect that the original dr said would go away ( it never did). this opinion wanted me to wait 4 months to see what would happen…
3 rd opinion was very familiar with this situation, and had done several exchanges do to this effect. stating not all dr should be performing surgery. as it was completely wrong in all aspects, wrong lens for which sight outcome i was looking for, wrong power…we exchanged from acrysoft restor toric 2.5 to the 3.0 version and changed the power

my results are 25/20 per eye ( and 20/20 with both eyes) due to this was actually my 3rd exchange. original dr did an exchange and was not able to get the lens back into the bag…it was a pretty painful and lengthy surgery in the end…the final surgery was a success and i have a video recording of the entire exchange, i believe 18 minutes long

my suggestion: find a skilled exchange surgeon and trust his/her recommendations

3

This kind of issue is way beyond my comprehension of eye surgery. However, I stumbled onto an article that you might find of interest. Google the following to find it.
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How to Manage Dislocated IOLs Michelle Stephenson Review of Ophthalmology

4

Thank you for your response. I actually have pretty good vision in my eye but I do have the issue with the glare and the maddox-rod effect at night. I may have loose zonules which makes my situation more difficult to fix. Have you been told that your zonules are loose? Did you ever find out why the first doctor didn’t get the lens correctly put in the bag? In my case I don’t know if it’s because the surgeon didn’t give me the best iol or if it was because getting it half in was the best he could do if I do have loose zonules as he indicated.

Did your first surgeon actually tell you that the iol was half in the bag or did you have to find out from the 2nd doctor?

How do you find a good iol exchange specialist? Are there any notable ones in the midwest that you are aware of?

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Thanks for the link.

6

well, i have a long story, so ill try to keep it quick.

im a previous lasik patient and do not have a history of eye trauma. and i wanted multifocal lenses, one eye required a toric lens to correct astimatism

i chose my local eye dr to do the surgery as he seemed confident to do the job, little did i know then.

my first surgery left me with ghosting/double vision and we assumed the power was inaccurate, so dr made adjustment for second eye surgery the following week. that also was inaccurate but better.

i had an exchange of first eye with original dr 4 months later. to try to correct the power and ghosting. the exit was easy, but replacing the iol was not. it was painful and very stressful as thw anestesia was wearing off. i was given another dose. afterwards the dr just left, did not come out to see me, which he had done with the previous two surgeries. the following day i had a follow up. when i asked how it went, he said it was a success , but i was still left with ghosting/shadow effect and now a depth perception issue

his next suggestion was to have another lasik procedure to correct the new astimatism left by surgeries. heres where i decided to find a second opinion. nothing was making sense as the dr wanted to see me weekly for follow ups, gave me free glasses,etc i was left with a depth perception issue, things appeared closer

my second opinion was from baptist in miami. dr trattler couldnt see why i was having an issue at first, and was ready to proceed with yag that day!! until he dilated my eyes ( this was the first time i was dilated since my original surgeries @ 6 months prior) upon dilation, the haptic was out of the bag, free floating and rubbing on the iris. since i wasnt in immediate pain and my eye pressure was within range, dr trattler asked that we wait 4 months to see what happens(assuming the bag would colapse around the iol and settle ok)

i was really uncomfortable with that decision to wait and went for a 3rd opinion, which was the sister company with whom i had my lasik with 17 years prior. sight trust institute in sawgrass/ft lauderdale florida

i had gone to sight trust for an evaluation prior to choosing my local dr . this is a 3 hr drive one way and out of pocket expenses were higher

dr shatz from sight trust had experience with my situation and has done many exchanges. he also invented the tool to hold the bag open while reinserting the iol during an exchange. i felt safe in his care

so this may answer some of your questions. the first dr never mentioned anything. he would look through the slit lamp for about10- 20 seconds and say everything was fine. at first he mentioned that if he didnt get the power correct he would exchange and has done that before, then when it came time to exchange his story changed to ive only done this a few times… i felt like i got the run around by him and his staff, as i called the office on a saturday, left a message about severe pain and light issues( had to wear my dark sunglasses inside the house, led lights from the oven clock burned) and they didnt bother to return a call until wednesday!! it was a horrible experience. i also have a friend who had cataract surgery with this guy, and his right eye lens is also tilted ( both surgeries in right eye resulted in tilted lens, the exchange was tilted and haptic was outside of the bag)

to answer your questions:

  1. haptic free floating wasnt discovered until dilated with second opinion. a call to the first dr got me no where. he didnt return the call. i consulted an attorney, and the surgical center where the surgeries were performed, thats all i can do. medical malpractice law suit will cost more than what i would have received, bcbs would have been refunded first, and it was a fixable item, no real long term effects ( i call bs, i now have astigmatism that i didnt have before because right eye had 3 surgeries)

  2. zonules has never come up, and honestly i dont even know what that is…something to google

  3. finding a good iol exchange surgeon? hmmm, well, research. we have balsam palmer down here in florida that is ranked #1, but i chose dr shatz at sight trust because he could give me what i really wanted : vision at near and far without glasses mid range i could use a pair of reader cheaters if needed probably 1.50+ that i could buy at the dollar store.

you have a unique situation, google to see who has performed an exchange with your situation. and travel outside your area to get the best dr to perform the procedure. in the end it will be worth every penny spent

dr trattler in miami baptist has a good rep for exchanges as well, but for me his wait and see method wasnt for me. dr shatz said we need to do this soon, very soon and i scheduled a few weeks later when my mom could visit and help me out

i wish you the best of luck and know that others have gone through this too and there is hope for a better outcome

be patient and really think about your next step
dr shatz said to me, that this would be my last chance on my right eye. he did me well!! yag may be in my future, but i will hold off as long as possible

best of luck

7

Wow that sounds like quite an ordeal and it sounds like you’ve been through a lot. I’m glad to hear that it worked out in the end. Thank you for that detailed information.

It really is a shame how many surgeons will not admit that the iol was not put in the eye correctly. I suppose it’s safer for them to continue to lie than to admit fault and potentially be liable for a lawsuit. My surgeon didn’t bother to tell me either.

It sounds like I don’t have quite the issues you initially did. I do have some ghosting but it only appears with white lettering on black backgrounds. Otherwise I don’t notice it. The 2nd doctor who told me about my lens being half in the bag suggested I not do anything unless it gets worse when the bag starts to close up on the iol and potentially shifts it more out of place. But I’d still like to get a 3rd opinion I think. I live in Ohio and there are a lot of good hospitals here like Cleveland Clinic and Ohio State University. I’d like to find an expert in one of these places that has handled a complicated issue like mine (and yours) but it’s hard to distinguish by just looking at the websites.

Thanks again for that information, I really appreciate it.

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youre welcome and i truly wish you the best. its so discouraging when we find out the hard way that we’ve been deceived.

i can’t remember how i found a dr at balsom palmer, but i searched for iol displacement surgery, tilted iol, etc, and some how lead me to studies done, and dr referenced…that might be helpful