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Distortion in central vision after retinal detachment surgery
Hello,
I experienced a retinal detachment in my right eye 7 weeks ago, fixed with vitrectomy, laser 360 and gas bubble. The gas is going down below the central vision where I can see fine detail. My peripheral vision seems just fine, however, right in the center of my vision, everything is shrunk (the area of about 4 squares while holding the Amsler grid 14-16 inches away). This makes it so hard to see fine details even though my vision seems sharp (no blurriness). I am only able to see large enough word (the E character on the eye chart) when the distortion area becomes small enough compared to the word. Here are some concerns that I would need help with:
1. Is it normal to have distortion only in the central vision after surgery. Will the distortion be a sign of macular hole which I read somewhere might develop after vitrectomy. The doctor did the eye exam and said that 70% of the eye where the bubble goes away looks good but we still have to closely monitor every 2 weeks for macular hole/or redetachment. Words can hardly express how thankful I am to my doctor, but at the same time, I worry if it is because my eye seems to look worse/have higher risks than others or this close monitor happens to everyone after surgery. I'm 7 weeks post-operation and am still being examined every 10-14 days.    
2. I understand that even if there is no complication, my vision can stay the same with no further improvement. In that case, are there any visual aids/devices that can enlarge the word enough so that I can read in the future if something happens to the other eye. The reason I am so concerned with this is because both of my eye are highly myopic (-15D). The high myopia leads to lattice degeneration and a small area of myopic degeneration. All of these will increase the risk of detachment in the fellow eye.  
3. Is myopic degeneration common in people with myopia? Can it cause vision loss and is there any surgical treatment for the condition.
4. I am taking vitamins and eat healthy food (I do not exercise until my doctor allows to do so) in order to protect my eyes. But any advice to keep my eyes healthy is highly appreciated.

Thank you very much!      

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177275 tn?1511758844
1. The course of RD surgery is so varied and individualistic that generalizations are not possible. Much depends on whether the macula was on or off and any gas or air in the eye will cause distortion of areas of blurred vision. you can use the search feature and archives and there are many helpful posts that will demonstrate how varied the recovery is.
2. It may be as long as 6-9 months before you know what your vision will be in the operated eye. It is not possible to tell how visual aids will help you or how your eyes will work as a team once its possible to write new glasses or contact lens prescription.
3. You have pathologic high myopia, not simple myopia. Your eye is greatly elongated and it subject to higher rates of myopic macular degeneration, retinal detachment, retinal holes and tears, glaucoma and cataracts. Your fellow eye is at very high risk of RD as high as 10-15% so be sure it is checked regularly.
4 Avoid contact sports and activities (theme park rides example) that put high torque and jerk the eye and head about. Wear proper eye protection and avoid activities that have high potential for eye injury. Live a healthy lifestyle, eat well, exercise, don't smoke, if you drink alcohol do so in moderation, have an annual eye exam by an ophthalmologist and see your retina specialist annually (often see one then the other 6 months later and repeat so examined every 6 months).
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Thank you very much Dr. Hagan. The distortion according to my last OCT was due to the swelling and the macular pucker. My doctor decided to treat the swelling first before going with the peeling surgery. Would you please let me know the prognosis for patients with membrane peeling after retinal detachment surgery. I am now 2.5 month post-operation, my vision has been steady 20/200 after a month of NSAID/Steroid drops so I guess there's not much to lose, an improvement of 1 to 3 lines is essential to me, but I definitely do not want my vision to get worse. Is macular pucker a very complicated surgery. I tried to read other posts on medhelp first, but some say it's very complicated and you should not go for it if not necessary, other said it is a much less complicated surgery compared to vitrectomy and the success rate is higher. The posts were probably 5 or more years ago, so I am hoping that medical treatment has come a long way. So here I am hoping to have an answer with the current medical advancement/technology.
Two more questions are:
2. Do I have to do the face down position with macular pucker surgery? 3. It will happen to be around the time that I have to move for another job, I plan to travel by bus instead of plane because of the air bubble they will put into my eye. Do you think it's safe to be on the bus for around 16 hours? How long should I wait before traveling, will 10 days be enough?  
Again, thank you so much for taking the time to help patients like us.
  

  
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Avatar universal
Macular pucker surgery requires a vitrectomy to be performed at the same time.
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177275 tn?1511758844
Macular membrane peel and vitrectomy are complicated operations but retina surgeons do them often and the technology and success rates continue to improve every year. Many people Mr Presley I believe also have had the surgery with very good results. In my clinic today I saw two people with good results and a neighbor woman of mine did very well.   Face down position is only used when a macular hole is being closed or a retinal detachment is being repaired at the same time. So you may not need face down. Your eye drops are to get rid of the swelling (macular edema) under the membrane. You will need to ask your surgeon about your activities and travel restrictions.  You are asking about memebrane peel surgery but you say your are 2.5 months post -operation. Have you already had the peel surgery? Or did you have RD surgery?
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Regarding number 2 above, I did not have to do face down recovery, and my gas bubble disappeared after 2-3 weeks.  The only restrictions I recall was no flying and I was given a wrist band to wear for about a month afterward informing emergency medical personnel to not administer nitrous oxide (laughing gas).
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177275 tn?1511758844
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Thank you very much MrPresley and Dr. Hagan. I am 2.5 months after vitrectomy to fix RD. My doctor planned to see how well I responded to the drops first, but based on my personal experience so far, my vision stays consistently the same (20/200) with no improvement. My appointment will be in mid-Sep when I would be able to ask him those questions about travel restriction. I know a lot of people have good results with macular pucker alone, it's just I am not sure about cases where macular pucker is a complication after RD surgery. But it's encouraging to hear that.

Dr. Hagan, one thing, like you said before, I am really paying close attention to my other eye, and have it checked by Amsler grid every day, except for not exercising under my doctor's current restriction, I eat healthy food, take supplement, reduce coffee intakes, no alcohol, less phone use, adding meditation to my routine. I am working for the university, so my time frame allows me to go see eye doctor every month for check-up. Do you think it is too much? Honestly, I try to err on the safe side because I had a RD 4 months after my last eye checkup and it went supper fast (flashes on friday afternoon and macular-off RD on saturday night). Despite for being heavily myopic, I never really appreciated my vision until now and I want to do everything to protect the "good" eye for my job and my family.

I am also taking a supplement that's called "bird nest" which is well-known in Asian country to strengthen your immune system and good for post-operative patients to help them recover faster. One of the benefits of this supplement, I read "Previous research has indicated that the nests contain substances that can stimulate cell division and growth, enhance tissue growth and regeneration".
I read the the development of epiretinal membrane is due to some growth factor and young people were more susceptible than seniors. I guess when you are young, you immune system responses more aggressively to inflammation. Do you think I should stop using this as this might proliferate the membrane growth factors?
Sorry for the long post, to summary, my questions are: 1. prognosis for macular pucker after RD surgery, 2. Membrane growth and bird nest soup, 3. Checkup appointment for every month.
Thank you very much for your time.    
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177275 tn?1511758844
In your case the prognosis for vision recovery is diminished because you had a macula off RD. Even without epiretinal membrane (ERM) the visual recovery of an eye is less after mac-off RD than mac-on RD.  Some eyes do recover 20/20 but some don't even though the retina and macula re anatomically attached.   The prognosis for ERM surgery is less when done after mac-off RD than when a primary ERM without a RD. Even the surgeon looking in your eye will have problems giving you odds or prognosis after ERM removed.   As for the bird nest soup I don't have a clue. I practice western medicine. Certainly if scientific medicine could confirm a lot of the practices and herbs/nostrums used in Oriental medicine the entire world would use them.  Some probably are helpful but some are not and some in fact harmful. Some cultures believe in the powers of bear bile? Some believe in the power of 4 leaf clovers.    i do not think you are going to need to see an ophthalmologist every month the rest of your life.  I will also post the recommendations I made to people that have had RD in one eye. You know the symptoms of RD? sudden increase of new floaters; bright flashes of short duration, loss of any peripheral vision.

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177275 tn?1511758844
What to avoid if RD in one eye or high risk of RD (high myopia).  We always suggest you specifically ask your Eye MD ophthalmologist but these are the guidelines I use for my patients and follow myself being moderately myopid -3.00

Walking, running, swimming no problem. Tennis and racket sports okay with proper sport specific eye protection,  contact sports such as football, wresting, soccer do involve increased risk.  Some people will accept those risks others want no part of sports like that. If you do participate sports specific face, head and eye protection is mandatory. Yoga and calisthenics are okay but avoid head down positions and standing on head or shoulders.  Bicycling is okay but the risks of fall and head/eye trauma great. Mountain biking is best avoided. Head/face/eye protection mandatory.  Weightlifting is not high risk provided you use moderate weights and use high reps to fatigue and stress the muscles. So power lifting and trying to grab and snatch or military press 400 lbs is best avoid. Boxing and martial arts are totally out. Also avoid amusement type rides that whip, jerk and snap the head and body around.
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Yes, Dr. Hagan, I made myself aware of the RD symptoms now. It should have been better if I had knew the urgency of RD when it happened 2.5 months ago. It also happened at the weekend so time was against me as well.
As per the bird nest, I will stop using it for now and resume when my eye fully recovers. I think it's meant to prevent/protect, not to treat.
I always tried to think of my eyes first before doing anything. I read your thread about activities post RD surgery and learnt that swimming is fine, however, i was wondering about the effect of swimming glasses which attach to the eye and might increase the eye pressure?

And I know once the macular is off, your eyes will never be the same. I just hope that surgery might bring it back to 20/100 or so. It's not like I have a lot of distorted spots in my vision, but the only one "pinched" distortion I have is right in my center vision.  
My pupils keeps dilated so not sure if it's partially the cause of the blurriness. The blurriness seems to be fixable by glasses as when i put my current glasses a bit further away from the eye and look through it, things get clearer. I read some posts that say it might be permanent, but the atropin effect might take 4-6 months to wear off, so hopefully it is my case.
I also lived with the impression that my eyes can get worse one day due to the high risk for myopic degeneration, however, I do hope that advance medical treatment might come into effect 10 years or so down the road. My father used to have RD in one eye and was completely blind in both eyes about 20 years ago, given the poor technology in developing countries. So I really appreciate what I have so far.
I know I keep saying thank you so hopefully it will not wear off. It really seems like I can communicate better with you and people here other than anywhere else. Please keep up the good work.  
  
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I'll have to find out if I had a macula on or off detachment in the course of having ERM surgery.  I remember he performed some laser repair during the procedure, but I won't see him until I go in for a six-month checkup in late November.
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177275 tn?1511758844
If your reduced vision is due entirely to retina/macula damage from RD and ERM moving your glasses away from  your eye should not make it clearer. If it does it means that a new glasses RX (refraction) should be able to improve your vision. You description would indicate that the glasses lens on the ERM eye could be to strong.  Don't believe that swimming goggles properly fitted would create a problem.  Ask your surgeon though
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The lens that I'm using for my glasses right now are the ones I've been using since the last 6 months (before the detachment) so it seems like my description is going down. Have you ever seen cases where patients become less myopic after vitrectomy surgery? I think I'll ask my retinal specialist next time.
And Dr. Hagan, this morning I started noticing a floater in my top left corner of my operated eye, it is transparent and looks like a floater, but it is not moving. Today is the first day I saw it (I check my eyes every morning). I rushed to the hospital, my RS was not there today but the other doctor took a look at both of my eyes and said it was a vitreous gel (there was no detachment at all) and the gel would resolve on its own later. The doctor was in a rush so I did not have a chance to ask for the risks associated with this vitreous gel. Would you please let me know if this precedes or will increase the risk for or  another detachment? I'm now nearly 3 months post-surgery.
Thank you very much.  



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I'd like to add that the gel is actually moving when I move my eye, but it stays only in the top left corner of my eye.
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