Macular pucker and cataract

[gaijin33]

This question was asked some years ago and I am asking again in case things might have changed in the last 5 years. I have been diagnosed with a macular pucker in my left eye.  My vision in that eye has gotten worse but not terribly so ie I have to use readers now whereas before i did not.  I tried drops for a month as advised by my retina specialist.  They did not work.  The doctor recommended surgery to correct the pucker and, at the same time, to do a cataract surgery as the macular surgery tends to accelerate the cataract development and, he says, it would be good just to do both at the same time.  I have not gotten a second opinion....yet.  
I am wondering if i really NEED the surgery. If it is advisable to do both at the same time if I do go ahead with them.
I am worried about the previous response (5 years ago) to this dilemma that suggested edema might result.  Also, that if both are done at the same surgery, the cataract should be done first.  
Would really appreciate any advice, comments.
PS  I am a healthy 70 year old female with no eye or health issues...except for this pucker!

[CBCT]

Hi,
Before you make any decisions, it is important that you have a clear understanding of you diagnosis and recommended procedures.  A good place to start your research is  rooteyedictionary.com   Look at the entries for Epiretinal membrane, Membrane peel, and Macular hole.  You will be better prepared for you next doctor visit.  It is a good idea to bring a well informed friend or family member into the examination room with you.  After the doctor explains his recommendations to you, you should speak about your own understanding of the situation so any confusion or misunderstanding can be clarified.  

You are wise to be concerned about repeated surgeries as it is a legitimate concern.  Be sure to press your surgeon for a discussion of benefit vs. risk.  
As far as glaucoma risk is concerned,  steroids can increase eye pressure and close monitoring is important.  Be sure to discuss this concern.

Please note that I have no medical training.  I am a research librarian who has experienced multiple eye surgeries.  Best wishes!

[Greenbaypat]

I am dealing with needing surgery like this as well, and have been posting my progression with my eyes on another forum on this site...now need laser posterior capsulotomy after ....  However, now a peel has been advised.  I am contemplating my options, but still have obvious concerns and questions.

Defining what I am dealing with at the moment, is even a bit confusing as the terminology used by my 3 doctors has been a bit different.  Tracking, the membrane peel or scrape, macular swelling or hole, and either a steroid type injection or vitrectomy surgery.  Note, I have had RD in both eyes and cataract surgery in both, and YAG in the affected eye already within the last two years.

Perhaps the peal, vitrectomy, and pucker to correct the blurred vision, loss of vision, and swelling / scar removal are all one and the same?

The higher risk you mention, along with the delicateness of it are of concern.  My doctor seemed to downplay this.  So?

I am concerned of adding more trauma to the eye, but fearful of losing vision either way?  Also, he said a steroid injection posed greater risk for the development of glaucoma, but the surgery did not.   Is that not true?

[CBCT]

I assume that the pucker surgery that you refer to is an Epiretial Membrane Peel.  This is VERY delicate business, can result in retinal tears, and should be carefully considered.  How bad is the pucker?  What do you see when you look at an Amsler Grid?  Are lines missing or crooked?  Look at objects with one eye at a time, are the images different sizes?  In my case, the Amsler lines are still straight, but it looks like some of the ink has been scratched away.  My more disturbing symptom is that the image size disparity between my eyes is considerable (13%) which interferes with central vision fusion.  Despite these conditions, I was advised by Dr. Stanley Chang (world renowned retina MD at Columbia University) NOT to have surgery.   Fortunately, I have been able to mange the image disparity problem by placing a small piece of Scotch Satin Tap on the inside of one lens of my glasses.  It blocks central vision in that eye, and I manage quite nicely with peripheral fusion.
If you do elect to have a peel, find a rock star surgeon who has extensive experience with this procedure.  Good luck!

[flossy93]

You might want to use the search function on this website to search on macular pucker and cataract surgery.  There have been several threads where patients discussed their surgeries for these issues and whether they were done together or at different times.  

My personal experience is from my father's case.  He had both a cataract and a macular pucker.  In his case the surgeon did surgery for the cataract first, on its own, for two reasons:

1.  To see how much his vision improved after the cataract surgery, to determine if additional improvement by operating to relieve the macular pucker was worth the risk, or if his vision was good enough with the cataract surgery alone, and

2.  To improve the surgeon's view of the macula by getting rid of the clouding caused by the cataract.  It would have been hard for his surgeon to visualize the macula and the delicate surgery needed to correct the pucker with the cloudiness of the cataract obscuring the retina.

In my father's case he did not need the macular pucker surgery, and decided to live with the slight distortion it causes rather than have an additional procedure.

I believe in some countries it is more common to do both procedures together, where in others it is more common to do them separately.  And of course it depends on your individual surgeon's recommendation/opinion and your personal preference.  

Good luck with your second opinion; hopefully if you have cataract surgery you will get a significant improvement and be able to assess whether the macular pucker surgery is necessary.  

[west98671]

I would get a second or third opinion and make your decision carefully factoring in risk vs. reward, quality of life, etc.  Best of luck.