Too Much Surgery?

Sometimes what starts out as one eye operation turns out to be four...sometimes six.

With all respect to my dermatology colleagues, performing an eye operation is not like having a wart frozen. "There, that's done. You're cured!"

Eye surgeons frequently counsel their preoperative patients that it's possible that more surgery may be needed down the road. Here are some of the more common reasons for that precaution:

• The original surgery could not be not completed. This happens during cataract surgery if a chunk of lens material falls away into the back of the eye. The judicious action is to schedule a second procedure to retrieve any residual lens fragments.


• Something new was discovered. During performance of the planned eye operation the surgeon discovers a new problem that was not recognized beforehand. If the cornea is cloudy or if the eye is full of blood it may not be possible to fully assess all of the problems prior to surgery.


• The first operation was so successful that new symptoms emerge. After years of poor vision an eye can drift. Fixing the vision problem may leave the patient with double vision since the previously poorly-seeing is slightly misaligned. Adjustable eye muscle surgery may help eliminate that situation.


• Complications can occur. A small percentage of patients develop problems related to surgery (infection, bleeding, elevated pressure, retinal detachment, dislocated lens implants, etc.). Most of the time the problem can be fixed with a second procedure.

The surgeon must balance the patient's need for another trip to the O.R. with the knowledge that too many operations may be unhealthy for the eye. Delicate limbal stem cells on the surface of the eye are essential to a healthy ocular surface and these stem cells are often damaged with the 'trauma' of entering the eye. Another cell population, the corneal endothelia, are also compromised every time surgical instruments enter the eye.

Darned if you do, darned if you don't? Not necessarily!

Common sense must prevail. If the patient is likely to benefit from another operation then the procedure will likely be scheduled. Having said that, after all of the fixable eye problems are 'fixed' there may still be the need for one more procedure like a corneal transplant or limbal stem cell autograft.

Related Topics:

• WebMD Video: Aiding Eye Surgery
• WebMD Video: A Less Invasive Corneal Transplant Surgery

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