Seeking advice on surgery for Macular Pucker

I'm considering vitrectomy surgery for macular pucker and am
interested in other people's experiences with this type of procedure.
Would appreciate any helpful advice. Thanks!
macpuckergal

My experience has to be an exception rather than the norm, but maybe
not such a rare exception. I had a vitrectomy with epiretinal
membrane peeling in January 2006. My vision in the affected eye went
from about 20/40 to better than 20/20 post-surgery. Of course, I
developed a cataract, but that wasn't such a bad thing because I went
from being a high myope to having 20/20 uncorrected vision. (I did a
lens exchange in the other eye.) But there's been a major down side.
My affected eye teared continuously post-surgery, for which I was
prescribed a variety of dry eye remedies. I also noticed that objects
viewed from my affected eye were larger than those viewed from my
other eye. I told my retinal surgeon, my cataract surgeon and my
optometrist about this, but no one found it significant. About 10-11
months post-vitrectomy, I also noticed that distant objects seemed to
be on the verge of doubling. (And occasionally did double.) I began
doing my own research into my symptoms (tearing, binocular vision
problems) and diagnosed myself with retinally-induced aniseikonia.
(Aniseikonia involves a disparity in image size between the eyes and
involves a number of possible symptoms.) Apparently, the epiretinal
membrane had damaged my macula, compressing the retinal receptor
distribution. The blur from the epiretinal membrane masked the
damage, and the peeling revealed the problem. Since there are no eye
care providers in my area who treat aniseikonia, I've been forced to
coordinate my own treatment. Ironically, most treatment methods
involve blurring the vision in the affected eye. I probably would
have been much better off if I had not had the surgery, and I would
certainly have been spared a lot of anxiety.

If you do opt to remove your pucker with a vitrectomy, I would suggest
two things. (1) Find the very best retinal specialist in your area.
(2) Use the new 25-gauge vitrectomy equipment (as opposed to the 20-
gauge equipment). Recovery is reported to be much faster.

On Mar 26, 7:12 am, "macpucker...@gmail.com" <dorothy.we...@gmail.com>
wrote:
> I'm considering vitrectomysurgeryformacularpuckerand am
> interested in other people's experiences with this type of procedure.
> Would appreciate any helpful advice. Thanks!
> macpuckergal

I can reassure you to have this procedure done. I am grateful to my
ophthalmologist to urge me to have it done. At the same time I
recommend that you try to find the best available eye surgeon, who has
much experience with this operation. I asked my surgeon how many times
he had performed it. He said he does it 440 times per year and in the
last 20 years had done it 6000 times. My ophthalmologist had
recommended this particular doctor ond did not think so well about
another hospital.
I was diagnosed macular pucker, epiretinal membrane, 8 years ago on my
right eye. 4 years later my left eye began to develop it also. I was
reluctant to have it operated because I am not fond of my eyeball
being pierced or stung or whatever horrible things one can imagine.
But blurred vision and straight lines turning curvy got worse, so I
followed the advice of my ophthalmologist to have it treated. The eye
clinic of the Lucerne (Switzerland) has an excellent reputation. I had
an interview with the performing doctor, and he was very confidence
inspiring. I would first have the right eye operated. The left eye
could follow 3 months later. The operation would last for about one
hour.
The operation consists mainly of removing the vitreous body and
removing the membrane causing the problem. I addressed the often
mentione problem of a cataract developing in the year after the
operation. The doctor said they routinely do the cataract operation
preventively at the same go, so there would not be the need to have it
done later.
I had the operation 3 weeks ago. It was under local anesthesia. The
injection of the anesthetic beside or behind the eyeball was painless
as a short acting sedating agent was injected intravenously in the arm
beforehand. The whole operation was truly painless. I was conscious
all the time, but did not understand much of the conversation above my
head. They spoke in a low voice and the doctor gave only short and
clear commands. My experience was not at all frightful.

For about half a day my vision on the right eye was only diffuse
light. After the vitrectomy the eyeball was filled partly with a
liquid, partly with air. The refraction of light by air gives a very
blurred image on the retina. After a day the air bubble had already
slightly shrunk and I could see normally in the uppermost field of
vision. The air bubble is of course on top, but as the lens inverts
the image, it looks as if it were on the bottom. The bubble shrunk
progressively. After three days the field of vision was sufficient for
driving. On day 10 the bubble had gone completely.
I stayed in hospital on the day before and on the day of the
operation, but could go home the day after. I had to return daily for
checks on the first few days.
A concern, which I had from searching the Internet, was that one would
have to stay and sleep head down for up to 2 weeks. Operation
techniques seem to have improved tremendously, I did not receive any
such instruction. I should however not sleep on the back, but on the
side. For as long as the air bubble was there I should not go to
altitudes higher than 1200 m (about 4000 feet). Which means I should
also not travel by air.
How is the success? The recovery of the retina needs several months.
At this time the improvement is clear, but not great. There is a clear
improvement of near-vision, reading in books and on computer screens.
I can even read font 10 texts again on the computer screen without
glasses, though not comfortly. Far vision and seeing distorted
straight lines seems to improve only slowly, but I was told that the
retina needs time to rearrange itself. I will need new glasses after
full recovery.
My conclusion at this time: I am very happy. Anxiety before the
operation was unfounded. I had the impression I was in caring and
competent hands at the Lucerne hospital. I guess they use the most up
to date equipment and are very experienced. I look forward for a great
hiking season in the Swiss Alps without being afraid of stumbling
because of bad vision.
I wish you good luck. Be confident!

Franz

On Mar 26, 5:44 am, "Jane" <clinton6...@hotmail.com> wrote:
> My experience has to be an exception rather than the norm, but maybe
> not such a rare exception. I had a vitrectomy with epiretinal
> membrane peeling in January 2006. My vision in the affected eye went
> from about 20/40 to better than 20/20 post-surgery. Of course, I
> developed a cataract, but that wasn't such a bad thing because I went
> from being a high myope to having 20/20 uncorrected vision. (I did a
> lens exchange in the other eye.) But there's been a major down side.
> My affected eye teared continuously post-surgery, for which I was
> prescribed a variety of dry eye remedies. I also noticed that objects
> viewed from my affected eye were larger than those viewed from my
> other eye. I told my retinal surgeon, my cataract surgeon and my
> optometrist about this, but no one found it significant. About 10-11
> months post-vitrectomy, I also noticed that distant objects seemed to
> be on the verge of doubling. (And occasionally did double.) I began
> doing my own research into my symptoms (tearing, binocular vision
> problems) and diagnosed myself with retinally-induced aniseikonia.
> (Aniseikonia involves a disparity in image size between the eyes and
> involves a number of possible symptoms.) Apparently, the epiretinal
> membrane had damaged my macula, compressing the retinal receptor
> distribution. The blur from the epiretinal membrane masked the
> damage, and the peeling revealed the problem. Since there are no eye
> care providers in my area who treat aniseikonia, I've been forced to
> coordinate my own treatment. Ironically, most treatment methods
> involve blurring the vision in the affected eye. I probably would
> have been much better off if I had not had the surgery, and I would
> certainly have been spared a lot of anxiety.
>
> If you do opt to remove yourpuckerwith a vitrectomy, I would suggest
> two things. (1) Find the very best retinal specialist in your area.
> (2) Use the new 25-gauge vitrectomy equipment (as opposed to the 20-
> gauge equipment). Recovery is reported to be much faster.

Thank you so much for your response. I hope things go better for you.
I would appreciate your keeping me posted on how you're doing.

On Mar 29, 2:14 am, fbuhol...@gmail.com wrote:
> On Mar 26, 7:12 am, "macpucker...@gmail.com" <dorothy.we...@gmail.com>
> wrote:
>
> > I'm considering vitrectomysurgeryformacularpuckerand am
> > interested in other people's experiences with this type of procedure.
> > Would appreciate any helpful advice. Thanks!
> > macpuckergal
>
> I can reassure you to have this procedure done. I am grateful to my
> ophthalmologist to urge me to have it done. At the same time I
> recommend that you try to find the best available eye surgeon, who has
> much experience with this operation. I asked my surgeon how many times
> he had performed it. He said he does it 440 times per year and in the
> last 20 years had done it 6000 times. My ophthalmologist had
> recommended this particular doctor ond did not think so well about
> another hospital.
> I was diagnosedmacularpucker, epiretinal membrane, 8 years ago on my
> right eye. 4 years later my left eye began to develop it also. I was
> reluctant to have it operated because I am not fond of my eyeball
> being pierced or stung or whatever horrible things one can imagine.
> But blurred vision and straight lines turning curvy got worse, so I
> followed the advice of my ophthalmologist to have it treated. The eye
> clinic of the Lucerne (Switzerland) has an excellent reputation. I had
> an interview with the performing doctor, and he was very confidence
> inspiring. I would first have the right eye operated. The left eye
> could follow 3 months later. The operation would last for about one
> hour.
> The operation consists mainly of removing the vitreous body and
> removing the membrane causing the problem. I addressed the often
> mentione problem of a cataract developing in the year after the
> operation. The doctor said they routinely do the cataract operation
> preventively at the same go, so there would not be the need to have it
> done later.
> I had the operation 3 weeks ago. It was under local anesthesia. The
> injection of the anesthetic beside or behind the eyeball was painless
> as a short acting sedating agent was injected intravenously in the arm
> beforehand. The whole operation was truly painless. I was conscious
> all the time, but did not understand much of the conversation above my
> head. They spoke in a low voice and the doctor gave only short and
> clear commands. My experience was not at all frightful.
>
> For about half a day my vision on the right eye was only diffuse
> light. After the vitrectomy the eyeball was filled partly with a
> liquid, partly with air. The refraction of light by air gives a very
> blurred image on the retina. After a day the air bubble had already
> slightly shrunk and I could see normally in the uppermost field of
> vision. The air bubble is of course on top, but as the lens inverts
> the image, it looks as if it were on the bottom. The bubble shrunk
> progressively. After three days the field of vision was sufficient for
> driving. On day 10 the bubble had gone completely.
> I stayed in hospital on the day before and on the day of the
> operation, but could go home the day after. I had to return daily for
> checks on the first few days.
> A concern, which I had from searching the Internet, was that one would
> have to stay and sleep head down for up to 2 weeks. Operation
> techniques seem to have improved tremendously, I did not receive any
> such instruction. I should however not sleep on the back, but on the
> side. For as long as the air bubble was there I should not go to
> altitudes higher than 1200 m (about 4000 feet). Which means I should
> also not travel by air.
> How is the success? The recovery of the retina needs several months.
> At this time the improvement is clear, but not great. There is a clear
> improvement of near-vision, reading in books and on computer screens.
> I can even read font 10 texts again on the computer screen without
> glasses, though not comfortly. Far vision and seeing distorted
> straight lines seems to improve only slowly, but I was told that the
> retina needs time to rearrange itself. I will need new glasses after
> full recovery.
> My conclusion at this time: I am very happy. Anxiety before the
> operation was unfounded. I had the impression I was in caring and
> competent hands at the Lucerne hospital. I guess they use the most up
> to date equipment and are very experienced. I look forward for a great
> hiking season in the Swiss Alps without being afraid of stumbling
> because of bad vision.
> I wish you good luck. Be confident!
>
> Franz

Thank you so much for the detailed information on your surgery, as
well as your good wishes! Sorry I'm not in Europe to check out the
facility and doctor you used. I'm in the Los Angeles area of
California and a member of Kaiser Permanente medical group. My
retinologist has excellent training and does a lot of these
operations, but not as many as your doctor.
Please keep me informed as to your progress. I'm excited to learn
about other people's experiences on this Google group. I know of no
one personally who has gone through this surgery, so this group
discussion is very helpful. Thanks so much.

Your surgery and recovery should be painless. Usually it is done with
local anesthesia and IV sedation. I chose to skip the IV sedation,
and I actually walked over to my local multiplex that afternoon
(wearing an eye patch) and stayed for a double feature. (By the way,
I was able to watch my surgery, because my "block" never reached my
optic nerve. It was an extremely interesting and hopefully once-in-a-
lifetime experience, but not for everybody. IV sedation is the norm
in the US.)

Do inquire whether the newer 25-gauge "sutureless" vitrectomy
equipment can be used for your surgery. It should greatly speed up
your visual recovery. In my case, those horrible sutures were the
worst part of my recovery experience.

I don't know how frequently retinally-induced aniseikonia occurs in
cases of macular pucker, since there is no data about this. My
surgery was done at a teaching hospital, and the resident I saw on my
last visit told me that he knew nothing about aniseikonia. (I hope
this changes if he is going to be seeing retinal patients. I emailed
a couple of excellent articles on the subject as my contribution to
his education.) But until retinal specialists become more aware of
and knowledgeable about this condition, I guess people like me are
going to have to diagnose and treat themselves using the resources
available on the internet. (Yes, I'm angry about being forced to
assume this responsibility.) Dr. David Robins did a good job of
explaining the etiology of retinally-induced aniseikonia in previous
posts to this group.