CLL Support Association
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Has anyone with CLL experienced difficulties after cataract surgery?

I had the surgery over two months ago and am still experiencing inflammation that is causing blurred vision. My opthamologist is beginning to think that my CLL may be a variable. I was diagnosed 64 months ago and am still w&w. Anyone have any experience with this? Thanks in advance.

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When my vision got blurry before cataract surgery a Neuro-ophthalmologist at NY Presbyterian ran a series of laser and imaging scans to make certain that CLL cells were not invading my optic nerve or brain stem.

They eventually diagnosed mine as dry cornea caused by insufficient oil in my tears (Ibrutinib as a possible cause) and my eyelid remaining part way open at night, allowing the cornea to dry. Artificial tears fixed my problem, but I suspect your cause is different than mine.

Len

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Thanks for your reply. So far, it doesn't seem that one has anything to do with the other - except in cases where medication could be a factor. Glad I asked, though.

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Hi, I’ve had CLL for almost 17 years and had cataract surgery done a little over 2 years ago with no issues at all.

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Thanks - good to know.

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Hi thanks you for posting on this subject. I can’t help you but I have a similar dilemma myself which I can share.

I am currently taking Ibrutinib and rituximab for CLL almost 3 months in now and doing really well. I need surgery for fast growing catteracts. My haemotologist would prefer me to come off my Ibrutinib for 2 weeks before and after catteract surgery and to wait until 3 months after rituximab ends. I am on the flair trial so I am only on rituximab for 6 months. My eye surgeon says I can afford to wait but he does not feel I need too as he can do the surgery while I am on the drugs. Ibrutinib has bleeding implications so I understand my haemotologists perspective but the eye surgeon does not agree. I have left it to them to discuss but I will go with the haemotologists advice over the eye surgeons, as my CLL has to come first.

I would prefer not to interrupt treatment wether I have the eye surgery now or early next year as my haemotologist suggests. I just wondered if anyone out there has had a similar experience or can advise?

Regards

Ann

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Ann, good luck with your dilemma. Hopefully, others will be able to shed some light with like experiences.

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Thank you some have and it looks like I need to ask my haemotologist more about the reasons why I need to come off. Someone did for one eye and had bad experiences off the treatment and stayed on for the second eye saying wished they had not come off the meds. I think he may be taking me off for trial protocol reasons which I need to discuss further with him. I appreciate your support. I will post the outcome to help others with similar dilemmas.

Regards

Ann

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Cataract surgery is bloodless surgery. When my first eye was done my clotting factor was WAY off (Coumadin), as in stay away from knives and any other sharp objects. I discussed it with both my cardiologist and my surgeon. Both agreed that I could go ahead with the surgery. I had no problems.

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I had cataract surgery in January and March of 2017, about 6 and 8 months into Ibrutinib.

For the first eye, I stopped Ibrutinib for 3 days prior to the surgery. My nodes started growing and I ran a slight fever. For the second eye, I did not stop Ibrutinib, and all went well. I wish I hadn't stopped it the first time, and would not have stopped if I had a third eye.

It did take longer for my eyes to settle than my ophthalmologist expected. He refracted for glasses a month after the second eye was done. By the time I got the glasses, my vision had changed already. I could feel periodic vision changes for 2-3 months. It made sense to me, since bruises and cuts take longer to heal, so why not eyes?

Once I got new lenses, I never felt that my left eye was being corrected well enough to do my precise calligraphic artwork. A month ago, when I mentioned that it was blurry whether or not I was wearing glasses, or looking close or far, my ophthalmologist had an aha! moment.

He looked at the back of my eye, and discovered a "post-cataract subcapsular haze." During cataract surgery, they remove the cataract at the front of the eye. They tend to leave small amounts of cataract at the back of the eye. Sometimes, it starts to grow enough to interfere with vision. The cataract at the back of my left eye was pretty much covering the area.

Just today, I had a YAG laser procedure to zap the growing cataract. It seemed like about 20 zaps. There is no cutting, and I did not stop Ibrutinib. There has been some discomfort from the device slipped into the eye to keep it open, which is already lessening. Because my pupil is still slightly dilated, 12 hours later, I can't yet tell if the vision is improved. I'm told the broken pieces will float around and eventually settle around the edges, and that I may experience some floaters for a while.

Hope your vision improves, and they figure out what is going on. We get only one pair of eyes, and they are our windows to the world.

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Thanks for this information. I had read about this and suspect that it could be the issue but my opthamologist has not mentioned the YAG, yet. I hope it worked for you. Keep me posted as I would like to know. Take care!

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Hi Starsafta,

Any improvement after the YAG, yet?

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A resounding yes!

It took about a week of random floaters, which eventually settled out of sight. My vision in that eye is now much clearer, in fact better than the other eye. I suspect the other will eventually require laser YAG as well. This is what I had hoped for after cataract surgery.

Your ophthalmologist can pretty easily look with a bright light to see if you have the posterior cataract growth. Mine even transferred the image to a monitor so I could see it. If this is what you have, go for the laser zapping. Hope you get satisfaction.

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Good for you! So glad to hear the procedure worked for you. My opthamologist stated that YAG wasn't what I needed - that it was just inflammation. However, I went for a second opinion and was then told I needed YAG. Can't win. Anyway, your good news is encouraging. Thanks!

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Personally, I would want proof of a correct diagnosis, particularly when there seems to be disagreement. I would ask to see the image, with a verbal description and explanation, such as the one I was able to see on the monitor. I am glad my ophthalmologist has all the new-fangled equipment. Hope it all works out for you. We get only one pair of eyes, and they are our windows to the world. I hope yours are working well for you soon.

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Thank you to everyone for posting their experiences it has helped me. I suspect the need to come off my meds before catteract surgery may be to do with the fact I am on a trial. I will have to discuss this further with both doctors. Thank you all for your support.

Ann

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The comments about cataract surgery being bloodless are correct.

However when Dr. Furman and my ophthalmologist discussed the surgery, the concern was from the ultrasonic device that is used to destroy the old lens affecting the retina. The intense vibrations can rupture a blood vessel in the retina. While the chance is low, if it happens, the damage is irreversible, and the longer it bleeds the worse the damage to your eyesight.

So the more conservative approach is to pause Ibrutinib 3 to 5 days before the surgery and as soon as the retina is confirmed clear of any bleeding, Ibrutinib can be restarted.

Len

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After my cataract surgery I still had that blurry vision and the ophthalmologist said I had dry eye syndrome and I have been on restasis for two years. Still can’t see without using frequent artificial tears. I do hope you find out an answer soon.

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I'm now using the Prednisolone drops every two hours. Opthamologist said my inflammation had reduced by 50% and I do notice a slight improvement - but very slow. Did you have dry eyes before you had the surgery?

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No, it developed after the surgery.

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