Macular Pucker & Myopic Degeneration

[kimicat]

A year ago I was diagnosed with Myopic Degeneration and have been under the care of a retinal specialist since that time.  I had to have one injection of Avastin in each eye over the last year.  I have responded very well to the Avastin without a need for additional shots to date.  At my first appt, I was told by the retinal specialist that I also had a macular pucker in my left eye and would eventually need surgery.  At my last appt, the retinal specialist discussed surgery again for my left eye for the macular pucker.  He indicates that he wants to wait because he is amazed that I have the sight I have in that eye with the pucker.  But, to look at my test results and pictures, the expectation is that my eyesight in that eye should be around 20/100 instead of the 20/25 that it is.  Is there any risk in waiting to have the surgery?  I am 49 years old and have worn contacts for 30+ years and I am not in bifocals yet.  I work full-time and use a computer.  How long of a recovery time would I be looking at to return to work?

[Zen2ster]

Hello again Jodie,

To follow up on my comment a few minutes ago when I reread your earlier comment I noticed you mentioned a loss of stereoacuity. I have been suffering with vertigo for the past 7 months. I have had all the indicated tests:  carotid artery scan, MRI, VNG,  Saccade, Comprehensive Audiomentry. My ENT is now referring me to a Neuro-Opthamologist. Could a loss of stereoacuity be associaated with vertigo?

[John C Hagan III, MD, FACS, FAAO]

strength of glasses lens.   An IOL would not be put in to leave you highly myopic as you are now, so one thick lens one thin lens (aneisometrophia) making glasses hard to wear and often needing to fit one eye with contact lens.

JCH MD

[John C Hagan III, MD, FACS, FAAO]

Macular pucker surgery is surgery you should avoid if possible. It always causes a cataract to develop and grow. That in turn means cataract surgery, that in turn increases the risk of retinal detachment plus creastes a huge difference in the refractive error of the two eyes and trouble using them together.

JCH MD

[JodieJ]

My first ERM surgery was botched.  My surgeon removed the center of my ERM but left the two tails of the membrane in my eye.  The traction from the remaining membrane resulted in a larger size image in my affected eye post-surgery.  I had a second ERM surgery three years later to remove the remaining ERM.  My image size disparity improved by about 50% after my second surgery.  That's  probably about as much improvement as I'll ever get.  One researcher hypothesized that irreversible macular damage occurs about 17 months after ERM formation.  I ended up having cataract surgery within the year for insurance purposes.  (I could have waited--my vision was yellowed but I could still read the 20/20 line.)

My surgical experience wasn't relatively painless--it was TOTALLY painless.  They used IV sedation (Propofol) to administer the local anesthesia, and I was awake during the surgery.  The conversation in the OR concerned to the surgeon's adult daughter's dating experiences.  It was very interesting.  If you do have surgery, I think that you'll find it a lot easier than having an Avastin shot.

[kimicat]

I am sorry about the macular damage your have.  How long did you delay?  How long has it been since your surgery?  Have you experienced the cataract issue?

It is good to hear that your experience was relatively painless.  I hope I have the same when I have it.  I am such a baby when it comes to my eyes.  I have passed out both times I received the Avastin shots.  I think it is the idea more than anything else.

Thanks,
Kim

[JodieJ]

If it looks pretty certain that you will be needing surgery, please don't delay too long.  I experienced some irreversible macular damage due to delayed surgery.

On the positive side, you can anticipate a painless surgical experience and recovery if the newer "sutureless" vitrectomy equipment is used.  I was enjoying a meal at a nice restaurant (wearing an eye patch) less than 2 hours after leaving the OR.  If you don't work with the public or do manual labor, you could probably go back to work the day after surgery if you really wanted to.  My eye was red and swollen the following day (and I definitely wasn't ready for a photo shoot), but I felt fine and had good acuity.  The tech at my surgeon's office said that some (lucky) patients don't even get the redness or swelling.

[kimicat]

My specialist did tell me I have macular swelling in my left eye which has the macular pucker.  So, he does believe I will need the surgery, he is just reluctant to do it now since my vision is so good in that eye.  My next appt is in 2 months unless I have an emergency based on my daily review of the grid.  

What is really surprising is that other than a slight shadow and a slight distortion that remains, my left eye is so much better since my shot in it a month ago.  My right eye is pretty stable.  I do have some distortion on the perimeter from my first episode a year ago which resulted in that shot of Avastin.  My retinal specialist is pleased with my right eye.  Just obvious concerns with my left eye.

thank you for the information.
Kim

[JodieJ]

I agree with Dr. Hagan that a vitrectomy (needed to remove a macular pucker) and cataract surgery do increase your risk of retinal detachment.  In your case, this might be the most important consideration.  However, a recent study suggests that NOT having surgery also involves some risk.  Even when acuity remains relatively stable, there appears to be a progressive wrinkling of the retina, resulting in increasingly distorted vision, a loss of stereoacuity, and ultimately irreversible macular damage.  This is why early surgery for macular pucker (aka epiretinal membrane) is recommended by some retinal specialists.  (I'll be happy to send this article to anyone who provides me with an email address in a personal message.)

Kimicat, given your excellent acuity, I think that you can forget about the future guide dog.  

[kimicat]

Your answer raises another question for me.

My grandmother and my dad have glaucoma.  Based on my poor eyesight and genetics I probably will develop this later in life.  What is my future with degeneration, pucker, glaucoma, and cataracts?  Not to mention retinal detachment possibilities.  

Am I going to need a seeing eye dog in the next 10 years?

[kimicat]

Thank you for the response.  What is refractive error?