Macular Pucker How Long to Develop

[MHVC]

Hi
I had a PVD with retinal tears in Sept in my left eye that were treated with a laser.  One was a tuft.  I continue to have flashes when backing up in a car or looking hard to the left.  I am -6. in both eyes.

I've had several follow-ups since then with nothing unusual or new symptoms noted.  Now, at my January follow-up, my doctor said I had macular pucker. She saw a sheen.  My question is over what time period does macular pucker take to develop. How long (months, years) until it is as bad as it gets.  

My vision does not appear to be affected yet.  What is the likelihood it will be?  Is there anyway to prevent the pucker from worsening including any experimental treatment?

[nyssa2oo6]

Hi.
I experienced flashing lights one evening around the first of October.  I went right in to be examined and was told I had a PVD.  The day after that, I suddenly saw a "snake" of blood in my eyeball.  I had developed a retinal tear.  Right back for laser surgery. The first surgery had no bad effects on my retina.  However the quantity of blood released in my eye resulted in a vision-obscuring floater.  Not only could I not see well out, they could not see well in.  At the follow-up appt to evaluate the results, it was decided that there were some other areas of suspicion and so I underwent a second laser treatment.  The worst thing I had to deal with then was the giant black floater and the accompanying motion sickness.  I couldn't  see through it.  All was well for about another couple weeks, then I had another blood vessel rupture.  This third lasering was the most difficult as the tear was so close to the edge of the retina they almost couldn't get to it.  The amount of blood in my eye obscured or scattered the laser so much they explained they had to use higher power to get through it.  Following the third treatment my retina is not undamaged.  I have transparent "black" areas that pop up when I am looking up.  Every blink brings an afterimage of the dendritic pattern of blood vessels on my retina.   I can see my pulse beating.  I  experience an odd and intermittent blind spot that looks like a grey and completely opaque circle that starts in the center of my eye, and in a matter of seconds, steadily expands into an opaque ring limned with fire and then slowly disappears from the center to the edges.  This happens infrequently upon opening my eyes to light after a dark room.  They also told me I  was a "glaucoma suspect", and they took some photos and such for long term evaluation.

Long story longer, I am here reading up on epiretinal film.  On November 10th I noticed a tiny spot on the printed page where letters disappeared as I painstakingly read through my magnifying glass.  It slowly got worse and worse. December 6th I was diagnosed with an epiretinal membrane and as of January 30th I am noticing the now unmistakeable puckering of  my macula.  I wanted to believe this could get better on its own, or at least would not get so profound that I could not train my brain to swap dominance to the other eye.  With the affected eye alone,  I am unable to read anything; I cannot discern expressions on people's faces; cars down the road disappear into a smeary fog; light sources at night are divided: the image from the good eye in sharp focus and a second set of fuzzy headlights.  It has become difficult to get the two images overlaid whether wearing distance lenses or reading lenses - I feel pretty cross-eyed and slightly nauseous most of the day.  Distortion of straight edges is getting worse but not yet profound.  Am I being a "baby" to think I can't live with this the way it is?  Nobody can tell me how much worse it will get and there is no going back after surgery.  Each surgery (unrelated to this) I have had before did serve to "fix" the problem I had.  But each also created problems I didn't have before, and that could not be foreseen.  Ask the experts what they know?  The experts are the surgeons - and aren't surgeons pro-surgery?

So - my answer is that in a period of 4 months following my PVD and retinal tears, the epiretinal membrane I have developed has affected my vision to the point that if both eyes were like this, I would be completely unable to drive, read, watch TV, work, use my phone, my computer, and communicate with others well.  To use my computer I am perpetually squinting one eye shut (undoubtedly not good for the complexion).  I am also a photographer so this loss of my dominant eye is awful - though I am extrememly grateful to have any binocular vision left at all.

The decision I have to make is what to do from here.  I am concerned that my retina has suffered enough insult that further intervention to remove the membrane only serves to aggravate this further.  Like a wet scrap of tissue paper barely clinging to the back of my eyeball...What is the best decision to protect my eye long-term?  What in the world do they put into your eyeball once the vitreous is removed, and what happens to that stuff?  How can it be as optically clear as what you were born with?  Does your body replace it with something else over time?  How long have these surgeries been being done, and does anyone know the eventual outcome after a good number of years?  I am going to need this eye for another 40 years at least.  What I have gotten out of this discussion is that 1. waiting may prove permanently detrimental to the underlying macula  2. I am most likely to need cataract surgery in a short time after the peel  3. its probably better to do everything I can to protect the status of the affected eye in the case this happens to my other eye and 4. it's not likely to get better without intervention.  Any comments are welcome.

[MHVC]

Thank you Dr Oyakawa.

Is there any average time after which the danger of the pucker getting worse is substantially less?  The uncertainty of it is very unnerving.

Thank you

[Ray T Oyakawa, MD]

This may be related to the laser or the tears.  Every case is different.  If vision get worse, treatment is needed.

Dr. O.