Macular Pucker surgery and macular degeneration

I am a healthy 65 year old male with no diabetes, hypertension or overweight condition.  I had a retinal detachment surgery 8 years ago, Viteractomy with scaral buckle.  Last September 2010, I had a 'macular pucker' surgery.  The surgeon commented that the pucker was tough but he was able to remove it successfully.  After the surgery, a black egg shaped opaque spot obstructed the central vision but I could read one word at a time thru a wedge shaped opening at one end of the opaque spot with a vision of 20/50.  Starting May 2011, the small opening started to become blurred and now it is completely closed and I am unable to read or recognize faces with this eye.  I must point out that I was on drops like Pred Forte, Lotamax, accular and combigane as recommended by the doctor for the whole year.  The OCT scans are perfectly normal (validated by another retina specialist also).  The doctor says he has no idea why my vision has deteriorated rather than improve over this one year period. I must also point out that I did stop my drops for about a month when another surgeon suggested that only nature would improve the condition.  This was around June this year.  

My question to you is:  What is happening with my eye?  Will I ever be able to read with this eye?

[Houman Vosoghi, MD]

A central blind spot that has lasted this long and has worsened is usually not a good sign.  Any chance you also have concurrent macular degeneration or other macular problem?  If the problem started immediately after the surgery, there is a chance that the photoreceptors or retinal pigment epithelial layer was damaged as a result of the membrane peel (assuming you didn't have the central blind spot prior to the surgery) but there would be no way to know for sure.  I have seen this happen a couple of times in my career to patients and we could only speculate why if there is no evidence of abnormality on examination and even if the surgery went well.  You may want to get a third opinion from another retina specialist to make sure the anatomy in the macula is truly normal (an IVFA using an injected dye to take photos of your retina would be necessary to be sure).

HV

[Nickgupta]

I like to thank the good Dr. Vosoghi for taking time to responde.  Dr. Vosoghi , I did not have any signs of AMD, wet or dry.  In addition, an IVFA using injected dye was performed by the second surgeon I consulted and there was no sign of leakage.  Also, there was no blind spot before the 'pucker' surgery.  My vision had deteriorated prior to the pucker surgery due to the distortion from the pucker but I could see few words at a time if not the whole line of the text.   I posed the question of damaged photoreceptors to my primary eye surgeon and he did not think so.  But I am beginning to feel that there was damage to the receptors except in the small wedge (angle 20 degrees wide) which enabled me to read one word at a time after the pucker surgery.  But why the wedge has clouded over this period that I cannot read at all?  The surgeon has suggested that I take the anti-VEGF injection to arrest any macular edema.  Any comments please?

[Houman Vosoghi, MD]

I'm not sure.  Macular edema would be evident on the IVFA or OCT exams.  The other possibility that I forgot to mention is possible phototoxicity from the light source during the surgery.  This is rare these days with the filters we have on the lights but still possible.  Should have been seen on the IVFA though.  You need to ask the second doctor if the IVFA was fully normal or if there were any subtle findings other than leakage.  Phototoxicity is more likely if you are concurrently on medication that makes your body/skin etc more sensitive to light exposure.  You could google a list of such medications under medications that cause photosensitivity to see if this was a possibility.  Otherwise, I can't think of any other potential causes other than what I have mentioned in my two posts.

HV