Cataract Surgery

Before Covid set in I was promised cataract surgery in both eyes over a period of a few months, but only managed to have the right eye done before all appointments were cancelled.  Today I attended a long awaited pre-op assessment of my fitness to have the cataract removed from my left eye.

The nurse seemed unusually concerned about my pacemaker.  She didn't seem to know I had one, even though I had my right eye Cataract removed at the same hospital with a pacemaker.  I didn’t think a pacemaker was a problem and I told her so.  Anyway, she wanted to see my pacemaker ID and questioned me about my heart condition.  She told me to show my pacemaker details to the anaesthetist/surgeon on the day of surgery but otherwise declared me fit for the procedure.

Has anyone had any pacing problems during cataract surgery?  Other than triggering an arrhythmia with the numbing agents (local injection and eye drops), I cannot think of any harm that can be done to the pacemaker from cataract surgery, can you?  

I did find the following link helpful, but would still value your thoughts.  Thank you

https://journals.lww.com/anesthesia-analgesia/fulltext/2021/12000/preoperative_care_for_cataract_surgery__the.11.aspx


15 Comments

Re: Cataract Surgery

by H van Dyk - 2024-03-06 15:31:26

I've had my eyes done in December 2023 and January 2024. It was done at the same hospital where I got my pacemaker in March 2023. So everything concerning my medical history was in the file. Nevertheless I mentioned it a couple of times, but was told every time that this was a non issue.

They only used eye drops on me (no injection) and the whole 'show' was over in some 15 minutes. No problem.

👀

by Lavender - 2024-03-06 15:35:57

😘Gemita, our own site has several communications on this topic, here are a couple:

 

https://www.pacemakerclub.com/message/33291/routine-cataract-surgery-and-pacemakers

https://www.pacemakerclub.com/message/20172/cataract-surgery

 

I also found this article which is more indepth. An excerpt:

Does New-Onset Atrial Fibrillation Warrant

Cancellation of Cataract Surgery?

New onset, or more likely newly discovered, atrial fibrillation may occur on the day of surgery. However, for patients presenting for minor surgical procedures, typically of limited duration and complexity (eg, with minimal anticipated blood loss), it may be reasonable to safely proceed despite new onset atrial fibrillation, as long as the patient is asymptomatic and hemody-namically stable." These patients should subsequently be referred for early evaluation and management of atrial fibrillation. SAMBA recommends that cataract surgery not be delayed in patients with atrial fibrillation as long as the patient is asymptomatic with stable hemodynamics.

Can Patients With Implantable Cardiac Defibrillators Be Safely Cared for

It is important to determine the cardiac implantable electronic device (CIED) type, manufacturer, and primary indication for the device." This information is generally available from the manufacturer's identification card given to the patient, a review of the medical record or the most recent CIED interrogation report. Often the underlying condition, such as severe heart failure or malignant arrhythmias are more important than the presence of the device itself.

If patients have had routine follow-up with recommended yearly pacemaker checks and 6-month implantable cardioverter defibrillator (ICD) checks without new concerning symptomatology such as syncope or cardioversions, they can safely proceed with cataract surgery. The only potential concern is the possibility for patient movement if the ICD happens to activate during the surgery. The likelihood of this is quite low in patients who have not experienced recent or escalating episodes of cardioversions. Typically, there is no risk of electromagnetic interference during a cataract procedure. Some pacemakers with rate adaptive mechanisms may have variable pacing rates which can be triggered by changes in breathing, patient movement, or monitoring devices. These pacing rate changes have been mistaken for arrhythmias, so it is important for anesthesia providers to recognize this paced rate variability as normal functioning. *2-54 SAMBA recommends that practitioners be familiar with CIED functionality, and against reprogramming devices or use of a magnet for patients having cataract surgery.

The full article:

https://samba.memberclicks.net/assets/docs/SAMBA_Statements/Preoperative_Care_for_Cataract_Surgery__The.11.pdf

 

Had my first eye done nearly 3 weeks ago

by atiras - 2024-03-06 16:16:25

I had cataract surgery on my left eye 18 days ago by a private company with an NHS contract (within 5 weeks of referral). No injection just eye drops and it was a very efficient conveyor belt of a process: Saturday, operations started at 0800 and wnt on until 1800, one every 30 minutes.

They were supremely uninterested in my pacemaker and the ultrasonic wotsit they used to remove the old lens didnt bother it at all. They were more worried aboutbthe fact that i was immunosuppressed and i had to get the ok from my transplant team for every drug they used. In writing.

Cataract Surgery

by Good Dog - 2024-03-06 17:28:25

I had both eyes done about 2 weeks from each other about 10 years ago. I advised that I had a PM and it was a non-issue! It was a high volume local Ophthalmologist office where we were each given a 5 mg valium ahead of the quick laser surgery. It was like an assemply-line where they were performing the surgery continuously and as quickly as they could get people in and out. The surgery was so fast and so minimally invasive that I cannot imagine a PM being an issue. But then; what do I know?

BTW: Saw the Doc driving in a beautiful Ferrari convertible as we were arriving. No surprise there!

H van Dyk, Lavender and Atiras

by Gemita - 2024-03-06 18:21:55

Lavender thank you for those valuable searches and for your fresh pair of eyes!  I am certainly reassured by Atiras’ and H van Dyk’s experience and it sort of mirrors mine during my right eye cataract procedure that I was so nervous about.  I did receive more in the way of sedation because of this. Fortunately I didn’t have any significant rhythm disturbances on the day that I can recall, but that would be my main concern. 

The link you posted is excellent.  I saw it too.  It tells the patient everything they need to know about having cataract surgery with a heart condition and other acute conditions and when we should, perhaps, not proceed. 

An AF episode with a rapid ventricular response rate could certainly cause problems for me, so I think this needs to be discussed in advance.  I may need to increase my beta blocker well before my procedure time.

Edit:  Lavender, I know pacemakers don't need reprogramming before cataract surgery (according to the article) but I might get them to turn off Rate Response beforehand.  It seems to be a definite trigger for rhythm disturbances in my case and I would rather have it off for the duration of the procedure ... and maybe for good.

Atiras, wow you are one tough lady.  Of course they would have been more concerned about you being immunosuppressed, but I see you came through it well.  The biggest concern is always the infection risk with any procedure.  I hope you are pleased with the result of surgery.  New eyes and a new heart ready for the year ahead.  My consultant (who works privately as well as for the NHS) is a charming, beautiful Italian lady.  She sings Italian songs with my husband when he accompanies me.  She was shocked to see that I have had to wait so long to get my left eye done.  Haven’t got a date yet for surgery, but it shouldn’t be long now.

H van Dyk, I like your comment, “the whole show was over in some 15 mins”.  I can remember how nervous I was going into my first cataract surgery.  I kept asking everyone what it was like, whether they felt anything.  The thought of someone touching my eyes while I was awake just frightened me, but as you say, it doesn’t last long.  I saw lots of strange colours and shapes during the procedure and thought I would feel uncomfortable as they held open my eyelids.  Not something I am looking forward to, but at least I know what to expect this time.  Hope your surgery has been successful.  My right eye is still good although I have started getting some foggy vision which may eventually need laser treatment

Good Dog

by Gemita - 2024-03-06 18:36:05

Oh Dave, you made me laugh about the Ferrari, but I know what you mean.  My dentist has a Ferrari too.  Hopefully though your eyes are still good.  As you say, pacemaker wise it seems to be a non issue.  I think it would be more of an issue if I started experiencing an irregular, fast heart rate while they were working on my eye.  I would never be able to lie still, so that would be a problem.

Gemita

by H van Dyk - 2024-03-06 20:04:28

Thank you for your kind words. My eyes have indeed improved a lot after the two operations. The procedure itself is more or less outpatient. With a little fantasy one could compare it to an assembly line. Checking in at 9 AM and leaving the hospital one hour later...

The things I saw during the operation reminded me of certain psychedelic light shows in the 70s. Quite pleasant really.
Sorry to hear about the foggy vision. This can happen after a couple of months of even years. I think this is called 'after cataract'. It can be cured by a short laser treatment. Not to worry...

By the way: If you let the forum know the date and time of the operation, I'm sure the members will give you mental and spiritual support.

glad to hear you are now going to have the other eye done

by new to pace.... - 2024-03-06 20:13:26

The only thing i know is  have a friend in Canada tell me that she had the antibiotic put in her eyes after the surgery.  Then did not have to use the alternating eye drops.

Am pretty sure you will let us know when this will happen and how much better you are seeing.

new to pace

Good Dog

by atiras - 2024-03-07 04:33:58

I know what you mean about the Ferrari. However, I'm pretty sure my opthamologist went into that specialism because of his lack of bedside manner. I said as much to him while I was on the table (possibly rash, but I waite duntil he was finished). After he had flounced out of the threate, the remaining staff dissolved into laughter.

Gemita

by atiras - 2024-03-07 04:37:39

I do hope you get your date soon.

I'm pleased with the result so far -- driving without glasses for the first time ever. I will have to go back for a laser procedure in a month or so 'to make things brighter' but that shouldn't be a big deal.  Not sure how long it will be before the second eye needs treatment, but I'm guessing a year or less as I'm still on steroids.  And then I'll have to put up with glasses for reading, wich will be s shame but hardly the worst thing ever to happen to me.

Ferrari

by piglet22 - 2024-03-07 05:33:09

atiras

You obviously struck gold there to have the honour of being treated by a celebrity eye surgeon.

Did he have the flashy headscarf to match?

No doubt a busy man rushing around earning a few quid so a Ferrari is appropriate.

As long as he sorted you out is the main thing.

Yes, I've seen a few ballerinas as well.

new to pace

by Gemita - 2024-03-07 06:27:14

Mary the idea of not having to use daily anti-inflammatory/antibiotic eye drops following cataract surgery is music to my ears and I hope this will soon be available and safe for us all to have, but it hasn’t been approved everywhere.

We all know that drops are not always used properly and there may be absorption and toxicity problems, so all of us would love to eliminate them.  I am sure in the future we will see this routinely happening when newer treatments that combat inflammation and infection are placed directly inside the eye during surgery.  Not sure when this will be readily available to all of us though?  Thank you for that exellent piece of information.  I must remember to ask about this.

Hope You Don't Have to Wait Too Long Gemita

by SeenBetterDays - 2024-03-07 10:46:18

Hi Gemita

From the literature and others' experiences it seems as though the pacemaker will not be an issue during cataract surgery.  My husband is also in the queue and is awaiting a date, they said eighteen months but hopefully not that long.  I hope you get a date for your procedure soon. I know what you mean about the uneasiness with someone working on your eyes.  I had laser eye surgery years ago as I was very short sighted and had quite a dramatic light show during the op.  Made me feel a bit peculiar but was worth it for the result.  I'm sorry that the rate response isn't feeling good for you.  It seems as though it can take a lot of tweaks and adjustments to get this right for each individual.  I hope they can switch this off during your surgery so you can have a slower more steady heart rate.  I know my heart can do all sorts of dances if I am feeling a little nervous! Sending you much love and wishing you a successful surgery in the not too distant future.

Rebecca x

 

Cataract surgery

by Aberdeen - 2024-03-07 15:50:35

I hope you get a date for your surgery soon. I am sure all will go well for you. Xx
 

SeenBetterDays and Aberdeen

by Gemita - 2024-03-07 18:06:42

Thank you both for your kind wishes.  It shouldn't be too long now because they would have to do another pre op assessment if it went over 3 months.  I am expecting to hear in the next month.  That gives me time to return to the pacing clinic for a few adjustments.  Yes I will be pleased to get it done and to balance the two eyes after all this time.

Stay well both of you xx

Hope hubby gets an appointment through soon too Rebecca.

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