Cataract Surgeon cross section of eye nick andrew sight specialists southport gold coast ophthalmologist eye surgeon cataract surgery

If cataract surgery is well planned by your surgeon, then your result should be excellent. However, poor outcomes do occur occasionally, either as a result of errors made during surgical planning, or from surgical complications.

Correcting previous cataract surgery is much more challenging than performing primary cataract surgery. For example, eye surgeons can often perform cataract surgery in just 15 minutes, whereas the operations required to correct cataract surgery will typically take one to two hours. The complex surgical steps require a meticulous approach. Due to the training required to perform these operations safely, most ophthalmologists either never perform this work, or will perform these operations only once or twice each year.

I am fortunate to have been fellowship trained by the world leader in this field, Dr Ike Ahmed. As a result, I have extensive experience with the techniques required to correct previous cataract surgery. This work now forms a large part of my practice, and I performs these operations frequently (at least 50 every year).

The three surgeries that I most commonly perform to correct cataract surgery are piggyback lenses, intraocular lens exchanges, and sutured intraocular lenses. Each surgical technique has its own advantages and considerations. The specific operation recommended for you will depend upon your situation.

Symptoms of imperfect cataract surgery

Patients come to see me with a wide variety of symptoms following previous cataract surgery. Below is a list of the most common symptoms that patients seek my help with:

  • Severe glare and light sensitivity
  • Seeing prominent halos around lights
  • Feeling unsafe when driving at night, due to light sensitivity
  • Blurred vision, with or without glasses
  • Inadequate range of vision (requiring reading glasses very frequently)
  • Seeing a dark arc in the peripheral vision (negative pseudophakic dysphotopsia)
  • Seeing a dark arc in the peripheral vision (positive pseudophakic dysphotopsia)

Piggyback Lens Implants

Following cataract surgery, you may have residual defocus (blurry vision) or be seeing a shadow cast by the edge of your artificial lens implant. The shadow typically appears as a dark crescent in the outer part of your vision. These post-operative problems are easily corrected with a piggyback lens.

A piggyback lens is a very thin, foldable lens that sits between your artificial lens implant and your iris. The operation is performed in a day surgery and takes less than 10 minutes.

correction of imperfect cataract surgery - sulcoflex lens nick andrew sight specialists southport gold coast eye surgeon ophthalmologist
correction of imperfect cataract surgery - add on lens

Image above: the two piggyback lenses available in Australia. The Sulcoflex lens (left) and the AddOn lens (right). The “arms” attached to the circular optic are designed to keep the lens correctly centered and aligned inside of your eye. Images courtesy of Rayner and 1st Q.

Intraocular Lens Exchange

If the design of your artificial lens implant is in appropriate for your eye then it will need to be replaced. This is called an “intraocular lens exchange”. When performing this surgery, my goal is to delicately remove your artificial intraocular lens without disturbing any other structure inside of your eye. A well-performed intraocular lens exchange should place no stress on the eye and therefore have an excellent safety profile. Achieving this requires a surgical approach that is meticulous and well rehearsed.

Dr Nick Andrew sight specialists southport gold coast ophthalmologist eye surgeon cataract surgery

I find that many patients are told that a lens exchange is not possible after they have had laser performed on their lens capsule (YAG laser capsulotomy). This is not entirely correct. Although surgery is more challenging in these patients, it is certainly possible, and a high margin of safety can be maintained. Each year I perform several lens exchanges in patients who have had previous YAG laser capsulotomy.

What if the lens inside your eye has dislocated?

The lens of the human eye is suspended in place place by delicate fires called zonules. These are like tiny guy ropes that hold the lens in place. They can become weak from eye trauma, from old age, from previous traumatic cataract surgery, or as a result of medical conditions affecting the eye.

If your lens has dislocated then I can usually re-fixate it to your iris or sclera.  This can be done using either Gore-Tex suture, or Prolene (plastic) suture.  If it is not possible to re-fixate your existing lens, then I will remove it and replace it with a new lens.

If the lens capsule of your eye has been damaged, then a new lens will need to be attached to your iris or sclera. There are numerous ways to achieve this. The image below shows a few of the ways that a lens can be fixated to your eye using a non-dissolvable suture such as GoreTex or Prolene.

correction of imperfect cataract surgery - lens exchange, nick andrew sight specialists southport gold coast eye surgeon ophthalmologist

See Dr Andrew’s Surgical Results

Correction of Imperfect Cataract Surgery

correction of imperfect cataract surgery - lens exchange surgery nick andrew sight specialists southport gold coast eye surgeon

The patient shown above presented with severely blurred vision following previous cataract surgery (performed elsewhere). The patient had a dislocated multifocal lens that was prolapsing through their pupil (arrow). I removed this lens from the eye and fixated a new lens to their sclera using GoreTex suture. The post-operative photos show the normal appearance of the eye. The sutures are not visible and the patient is seeing well again.

correction of imperfect cataract surgery - lens exchange surgery 3 nick andrew sight specialists southport eye surgeon

The photograph above shows the appearance of an eye after I sutured a new lens to their iris. The blue suture material is much finer than a human hair and is not visible to the naked eye (arrows).

NOTE: ALL SURGICAL PROCEDURES CARRY RISK. BEFORE PROCEDING WITH ANY OPERATION, ALWAYS CONSIDER OBTAINING A SECOND OPINION FROM AN APPROPRIATELY QUALIFIED HEALTH PRACTITIONER.

Monday to Friday: 8am – 4.30pm

Dr Nick Andrew

Ophthalmologist and Eye Surgeon Gold Coast

Sight Specialists, Level 2, 95 Nerang St, Southport QLD 4215

Medical disclaimer

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All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions.

Neither Dr. Andrew nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content.