ciliary spasm after getting IOL

[thea]

I had IOL placed in march 2005. My left eye had -9.5 and -2,5 cilinder. Now it is -0,5 and -0,25 cilinder. My right eye was -9 and -2 cilinder. It is now -0,5 and -0,75 cilinder. That is very good and I have no problems with my left eye. But soon after my operation, I suddenly had blurry view in my right eye, after sleeping. When I went out shopping, on my bike, and looked far away, my view suddenly cleared.
My docter told me I have ciliary spasm. He doesn't know why. It happens a few times a week. I am afraid some day my pupil will not open again! Sometimes I use homeatropine, but I want to open my pupil in a natural way. I stopped reading a book before going to sleep, in order to relax my eye. That helped a little bit. I read about ciliary spasm and the relation with stress, but I have no stress at all. I use the computer not much and look up from it, every few minutes.
I don't know if it has something to do with it, but the eye-chamber of my right eye, in witch the lens was placed, was barely deep enough.
Does anybody has any idea about the reason of my ciliary spasm and how to resolve it? I placed my question in a Dutch and British forum, but nobody had an answer.
I hope you understand my problem, because my English is a bit poor.

[LasikExpert]

Thea,

What type of IOL did you have implanted? Was it an aphakic IOL that replaced the natural crystalline lens inside the eye, or was it a phakic IOL that was placed in front of the crystalline lens? If it was a phakic IOL, was it the Verisyse/Artisan, STAAR ICL, or other type?

[thea]

I had an artisan lens implanted. I had no complications what so ever.
I am 49, so I need spectacles for reading. +1D is enough. When my pupil is open, the rest of the day it stays open. The problem is not big, but it irritates me that I cannot avoid my spasm.
Thanks for your reaction.

[LasikExpert]

The Artisan phakic intraocular lens (P-IOL) is attached to the iris with the use of the "iris claw" integrated into the lens. This attachment system causes a reduction of the pupil range. Simply put, the pupil cannot change after surgery like it could before surgery. It would appear that this effect is enough to cause the muscles within your eye to spasm. They are attempting to change the pupil size, meet resistance because of the P-IOL, and spasm as they continue to attempt the pupil size change.

We have an article about the Artisan-Verisyse P-IOL that may be helpful for others reading this thread.

It is possible that repositioning the Artisan P-IOL will improve this problem, but there is no way to know before surgery to reposition if this will improve the spasm. Repositioning would be very limited if your Artisan is also correcting astigmatism.

There are several articles in the medical journals that relate to pupil size issues with the Artisan/Verisyse P-IOL. You may want to read Artisan-Verisyse and Pupil Size and be sure to visit the related articles listed on the right side of the page.

[thea]

Thanks for answering my question. I read the articals, but it is difficult English for me. However, I think you may be right that the cause of my accomodative spasm, could be the artisan lens. Before my operation I had no spasm at all. My doctor told me, I have an elastic eyeball on the right side. Maybe the combination of that AND the artisan lens, makes my pupil doing funny.
I shall not have my eye operated again, because it is not sure it helps. The only thing I can do is to avoid working close by for a long time. Still, I want to find a way to open my pupil without going biking, as I do now. I searched on the internet for another way to solve my spasm, but nothing works. Is a prisma viewer something that helps?
Super, that I found someone on the other side of the world, who tries to help me! Many thanks again.
Greetings from Thea

[LasikExpert]

The only way I can imagine that you would be able to stop the spasms would be with a topical medication that would paralyze the eye functions. This would not just paralyze the iris movement, but it would also paralyze the natural crystalline lens. You would not be able to change focus to see objects near to you. This does not seem to be an adequate outcome.

I recommend that you create a short, but complete, email that describes your problem completely and send that email to different ophthalmologists around the world. You may find someone who comes up with an idea that resolves the problem.

Ophtec is the distributor of the Artisan P-IOL. On their website you can find an Artisan Doctor List. Country by country you can find the email address of surgeons who are currently implanting the Artisan.

The Artisan is not approved for the US. The lens in the US is the Verisyse which is nearly identical in regard to your situation.

I recommend that you send the following message, edited as required, to every Artisan doctor you find. Hopefully someone will have an idea.

Thank you in advance for considering my unusual surgical outcome.

In March 2005 I received uneventful bilateral implantation of an Artisan-Verisyse phakic intraocular lens (P-IOL). Preop OS -9.50 D sph -2.50 D cyl, OD -9.00 D sph -2.00 D cyl. Postop OS pl -0.50D cyl, OD pl -0.75 D cyl. I am 49 years old and use 2.00 D add reading glasses as required.

My complication has been diagnosed as ciliary spasm. After awakening from sleep, vision OD is blurred for a short period of time and pupil OD is constricted. Cessation of near vision prior to sleeping reduced symptoms, but did not eliminate symptoms. Computer use is infrequent; stress levels postop are equal to preop, with the minor exception of concern from surgical complication. Pupil will slowly expand to appropriate size and remain throughout the daytime, reducing again during sleep.

A search of the medical literature does not provide significant insight to pupil response issues with the Artisan/Verisyse P-IOL, however it appears my symptoms are not reported in the journal, nor is there an obvious method for treatment.

If you have any idea on the causation, treatment, or prognosis regarding my situation, I would greatly appreciate a response. My surgeon is available for consultation.

If you send enough messages, you will undoubtedly find someone who has had a patient with this problem. Perhaps a solution has already been found. You just need to find the doctor who has the solution.

[thea]

Thanks Glenn. I will certaynly do as you say. But I don''t want to be tedious. I am a nurse who works with patients who have cancer. I know what is really important in life. I am just curious what is wrong.
I will let you know what the outcome is.
Greetings from Holland

[Mary Zita]

Hello,
Thea, I am interested to see if you were able to make any more progress in understanding or resolving the spasm.
I have a similar issue with one of my eyes following an artisan lens implant. The pupil is very small in the morning (smaller than the other eye) and my vision is blurry. At this stage, we do not understand the cause.
Thanks

[thea]

Dear Mary, since 6 weeks I know the cause of my spasm. I had severe dry eyes because I sleep with my eyes a little bit open, since an eye-lid correction. I now use eye drops before I go to sleep. Hylo Care is without conserving things in it (I an allergic for it) and it contains vit B. I am very surprised that I found a cause 2 years after my operation!
My doctor confirms that any irritation can cause accomodative spasm. I hope you find the cause of your spasm too.
Greetings from Thea from Holland

[Mary Zita]

Hi Thea
Thanks for responding. This is interesting as I also have dry eye but did not think there was any connection with pupil size. I will follow up with my Dr.
Thanks