Cataract surgery and CLL

[MikeOr]

My dad, 82yo, has been suffering from CLL for 7.5 years. He is on Ibrutinib, which seems to help, but he has low platellets count. He will need a cataract surgery on both eyes pretty soon. I am interested to hear others' experiences with cataract surgery while on CLL treatment.

[Alpha66]

I'm on w&w for CLL and had cataract surgery about a year ago with no issues. It's fairly minor with a local and sedation and takes about 15 minutes. I wouldn't see it as an issue as no bleeding is involved.

[annmcgowan]

I have had 2 cataract opps since being on ibrutinib with no issues. My Haemotology consultant insisted I come off ibrutinib 1week before and after surgery.

Ann

[PaulaS Volunteer]

Hi MikeOr,

Last year I had cataract surgery on both my eyes. I had been on Ibrutinib for 2 years, and was advised to stop Ibrutinib for 3 days before and 3 days after the surgery.

I wrote about my experience in the following post, but will take some stuff from what I said, and paste here the most relevant to your father. healthunlocked.com/cllsuppo...

Some people say that cataract surgery doesn’t really bleed so the danger is very minimal. However, it’s interesting to read what lankisterguy says. I quote:

“A odd medical fact I learned from this, was when I asked why it was necessary to pause Ibrutinib (for cataract surgery).

The response from Dr. Furman and the ophthalmologist that he usually works with for CLL patients, was that the ultra sound tool that is used to dissolve the natural lens can disturb blood vessels on the retina and cause a bleed. Those bleeds can damage portions of the retina permanently, so the pause is done to reduce that risk.”

I know from experience that the blood vessels in the retina are quite fragile. I’ve had some spontaneous bleeding there in the past, and also a tear in the retina that needed repairing with laser surgery. So, I think it’s a good idea to reduce the risk of damaging the retina whenever possible. Hence the need to stop the Ibrutinib before and after surgery.

For me, the cataract surgery wasn’t painful but it was a bit uncomfortable. I found the flashing lights somewhat unpleasant, though it was soon over. However, that evening, my eye became red and swollen and the white of the eye was bloodshot. I looked like I’d been punched in the face! There had clearly been some bleeding somewhere, though I’m glad to say it wasn’t in the retina!

Over the next few weeks it gradually got better.

I did have slight Blepharitis before the surgery, so it's possible that made my experience not as straightforward as other people's.

I'm very glad I had the surgery done. The benefits certainly outweighed the inconvenience. My vision is now so much better - I can see all distances without needing glasses (except for reading). Colours are MUCH brighter, more vivid. The glare of street lights at night has gone. Details are clear and distinct. I feel much safer driving.

Wishing all the best to your Dad,

Paula

[MLGallays]

Hi! I’m 73 yrs old and was diagnosed w/CLL Apr/‘17. started ibrutinib (420mg: 1xd) Jul/‘17. I had cataract surgery in my left eye Dec/‘18, followed by surgery on my right eye Jan/‘19. I did not interrupt my daily dose of Ibrutinib either time. The surgeries went very well with no complications whatever, and I now have 20/20 vision in each eye! It feels great to no longer need glasses!! Both my haemotologist and my eye surgeon agreed that the surgeries did not require interrupting my Ibrutinib, and they were right!

[PaulaS Volunteer in reply to MLGallays]

Hi MLGallays,

It’s great that your cataract surgeries went well, and you now have 20/20 vision in each eye!

However, although your doctors didn’t see any need to interrupt the Ibrutinib and in your case all went well, other doctors have different protocols and they have their reasons for this.

My eye surgeon and haematologist both said their policy is for people to stop any blood-thinning medications (including Ibrutinib) for at least 3 days before and after cataract surgery. As annmcgowan has said above, for her it was 1 week before and after.

I stopped for the 3 days before and after as instructed, but I still got a lot of bruising, swelling, and a bloodshot eye after one of my ops. I may have done better to have had a longer break, as Ann did. At least I didn’t get any bleeding in the retina, which would have been much more serious.

So glad all went well for you though. I know what you mean re it feeling great to no longer need glasses! I still need them for reading, but for the rest of the time, there’s a nice sense of freedom in not needing the glasses.

Paula

[Nucleusman]

Had cataract surgery for both eyes with two weeks apart. All went well on first eye but on second he hit a blood vessel and I ended up with a black and bruised eye for a month. I did stop my Calquence a week before and after but it could be a combination of this plus blood thinners has caused it to take so long to recover. Now I have significant bruising on upper arm and torso but I think that is a side effect of Calquence