Prognosis after multiple surgeries for retinal detachment

[dansaremm]

On 2/26/09, I was diagnosed with a marginal retinal detachment. The macula was threatened, but not detached. That day, I had a cryopexy procedure with placement of a gas bubble.

On March 25, I had a vitrectomy with placement of a gas bubble due to persistent subretinal fluid.

On May 27th, I had another vitrectomy, again because of persistent subretinal fluid. A drain was made, and a gas bubble was placed. On June 5th, the doctor said I had PVR and needed more surgery.

On June 6th, I lost total vision in my eye. The emergency clinic said the retina was 80% detached, and now involved the retina.

On June 8th, I had another vitrectomy, scleral buckle and placement of C3F8. As of today (July 3rd) I have no vision in the eye except for a very small part at the bottom where I can detect color and large movements. My eye is still very red, and the lid is noticeably droopy.

I am only 38 years old, and had no risk factors for an RD except some myopia as a child (4-5 diopters). The more I read on the internet, the less I am inclined to believe that I will gain vision back. My doctor has been very vague, and just says "I don't know. We'll have to see." The last time I saw him was 3 weeks ago. I thought I would have some improvement by now.

How long does the C3F8 occlude vision? Should I be getting some vision back by now (if it IS going to come back?) What will happen to my eye if it remains blind? Will it always look cosmetically different than my good eye?
I'm so frustrated. Please help!

[Michael J Kutryb, MD]

Wow, nice posting from berrywoo.  I imagine that your prognosis is very guarded.  Your surgeon knows the most but from what you have reported I really can't foresee what your vision might be someday.  I just want to remain vague since I don't want to dash all your hopes or give you unfounded expectations.  I'm sorry for your troubles, this is all very unfortunate and I have very rarely seen such a bad series of events with a detachment that was initially small enough to treat in the office.  Makes you wonder.

Michael Kutryb, MD

[berrywoo]

The C3F8 will take about 6-8 weeks, maybe more to be completely absorbbed. This depends on how much was injected and also how quickly your body absorbs it. So, at three weeks it's maybe at 50%, your doctor can tell the exact fill.

The droopy lid was probably caused by a combination of the scleral buckling procedure and the lid speculum used during all the surgeries. It can be fixed after all the retinal problems stabilizes.

The redness will go away with time. It may take up to a month for the redness to completely disappear.

The vision with a macula off detachment will probably not be that great. And you will more than likely experience some distortion in your vision as a result. Your final visual acuity is dependent on many factors, but one thing is certain, it will take time for the vision to recover.

However, you're in a risky time period right now. The PVR if it has not regressed can cause another detachment and this activity begins to be more noticeable at around 3-6 weeks post-op (sometimes sooner).

When the eye has completely healed from the retinal surgeries than you can began to address the cosmetic aspects if you wish.

Also, note that lens removal will be necessary sooner than you'd normally expect due to cataract formation from vitreoretinal surgery.

Hope this was helpful.

[berrywoo]

Oh, one more thing. With the gas bubble at 50% or more it will be hard to see anything out of the eye. The bubble has to get below 50%, probably closer to 30%, before you can see decently. However, with the macula effected, it's hard to know how well you'll be able to see even at that point.