Questions following pars plana vitrectomy

[omfi]

Hi,
I am a 52 year old healthy female, who had a macular pucker diagnosed a few years ago.  It causes a tiny blur in my vision, but nothing overly distressing.  On a recent (4/30/18) routine annual checkup with the retinal specialist, I found out I had a retinal tear and detachment.  I had no symptoms and no idea this had happened.  I've now had the surgery (5/1) and am very, VERY lucky to have recovered almost fully already.  Bubble gone, almost all floaters gone already, and actually see a little better in that eye than I did before!

A few questions, though:

(1)  My retina doctor said that the detachment was unrelated to the pucker--does that sound right?  Do macular puckers increase the likelihood of retinal detachments?  Seems to me like if puckers are coming from vitreous pulling away from the retina that these two things would be related??  The tear, though, was not near the pucker.

(2)  I only began wearing (multifocal) contacts at age 45+ because my vision was 20/20, but then I got old! (Young old, but apparently no one told my eyes that, bc both presbyopia and menopause decided to descend quite early--hey THANKS, body).  I am terrible, truly terrible at getting them out of my eyes, and have had moments of really having to try over and over again to pull them out of my eyes.  Any chance that somehow my abusing my poor eyeballs by trying to drag contacts out of them contributed to any of this?  I really, really love my contacts (except taking them out!) and don't want to do glasses.... but I want my eyes to work longterm even more.... is going back to my pathetic contact removal skills going to harm my post-vitrectomy eye?

(3)  I had one seemingly big floater left after surgery, who I named Fred, because he is so recognizable and is driving me crazy (two little dots of stuff stuck together, and "huge" and black compared with the other floaters--not really huge, or even vision impairing but a giant pain in the butt).  Fred started fading last night, Thank Goodness! but I started getting weird trails and threads (vitreous strands, I am surmising based on Dr. Google) that I've never had before.  Fred is lighter, though.  I think this is just normal and Fred is just dissolving?  Does that sound right??  My retina surgeon says everything is going great, and I don't have an appt w/ him for two more weeks (been seen twice, last time on 5/14--2 weeks post surgery & everything looked great).  I really don't want to bug him about something this seemingly obvious.... Any reason the brand new strands should cause me to call him?

Thanks for any help you guys can offer!

Fred's Mom

[MrPresley]

Fortunately I never had noticeable floaters again in my operative eye after the vitrectomy/ERM peel. There is a tiny dot floater in that eye that appeared following cataract surgery, like a black dot floater except being the opposite like a tiny clear bubble.  There were several of those immediately after the cataract procedure but they disappeared in relatively short order. Now, my other nonoperative eye does have a couple of noticeable floaters, one spider web-like and one black dot. Neither are of Fred proportions though, LOL.

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

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[MaybeOneDay595]

Yeah, I have candida overgrowth.

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

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[omfi]

Thx Mr. Presley--Yeah, the report on Fred is that he is now barely visible... I swear he was a big glop of something that is unwinding itself and reabsorbing with the "strands."  Now Fred is just a faint bubble, and whenever I see him, within about 5 seconds I see a thread or two.  I have no idea if it is a bunch of different floating strands reabsorbing or the same strand just floating around in and out of my field of vision.  

[MrPresley]

Good, and look forward to steady (albeit slow in some cases) improvement in visual acuity. Mine took 9 months+ in my operative eye to settle back essentially to it's former self, and not long after that the developing cataract, as expected, was becoming more of an issue.

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

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

No strandy floaters in the 6-12 weeks post vitreous surgery is not unusualy. What for showers of black dots, flashes of light and loss of field of vision.   Get a little more righteous on your contact lens wear, handling, replacement, etc. Our practice has several lost eyes from bad contact lens practices.

[omfi]

Hi Mr. Presley and Dr. Hagan--Thank you so much for all of your help!  I ordered a removal tool--and to be clear, my "terrible" about my contacts is only wearing them for a week at a time, like they say you can.  I always use clean hands, and always, always replace them at the times that it says to replace them (weekly).  The problem is that the contacts box says that I can sleep in them and wear them 7 days, and the ophthalmologist says that's a terrible idea.  He is great, and I believe him over the box... but they are so hard to get out, I confess that I go with the box over the doc.  Bad idea, I know.  I am hoping to get the removal tool and correct my bad behavior.  Re:  the strandy floaters, they are still here and I am reassured by your answer, Dr. Hagan.... but I swear I cannot see like I should anymore out of the corner of my surgical eye.  Sigh... calling the doc now.  I hate the keep bugging them.  ("Bugging" involves having called them once before bc I had a sharp pain--turned out the be a calcification on the inside of my eyelid that scraped across the incision site).  Since it was all fine, I feel like an idiot calling them again--I hate to be a hysterical patient.  If you tell me I'm OK, then I'd like to leave you alone until my appt three weeks hence.

[omfi]

Thanks so much, both of you--- and yes, you nailed it, Dr. H, I am terrible about wearing my contacts too long and overnight.  In large part bc (A) The box says that it is "OK" though my ophthalmologist laughed at that and said, "Yeah, so they can sell you contacts" and (B) Because it is so impossible to get the damn things out!  I will go read this article and go check out contact lens removal tool.  I've heard of that but never seen one or looked them up.  Not looking to do anything about the floaters as long as the new strands are normal.  Since it's only 3 weeks after surgery, I will just monitor unless something seems abnormal.  You don't sound like it seems abnormal to start seeing strands at 3 weeks when I haven't seen them before?

[MrPresley]

As a caveat I only use daily wear rigid gas permeable (RGP) contacts that are never worn overnight, and have never tried soft contacts, disposables, or extended wear types.  I've worn them for over 40 years without issue thus far, but have always been careful about handling them only with clean hands. Instead of or in addition to the tool if need be, using a few drops of artificial tears right before attempting to remove them may be of benefit. I've always realized superior visual correction from contacts versus glasses, but granted they are much higher maintenance and I have no problem with resorting to my backup glasses instead if I know that I am likely to be in a dusty environment or might not be able to remove them in a timely manner.

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

Macular pucker or epiretinal membranes (ERM) do not, except in the rarest forms, cause RD.  If they did it would start in the macula.   New study out this month shows most people wear contacts improperly and wear them too long and the risk of eye damage is significant.  http://www.dailymail.co.uk/health/article-2639894/How-wearing-contact-lenses-day-DESTROY-eyesight.html    Nothing practical to do about floaters other than let them settle or hope you get use to them.  New laser treatment to break them up. I'm not impressed and do not recommend them to my patients.

[MrPresley]

Consider using a contact lens removal "tool" if you're having difficulties removing them. I doubt having troubles removing them affects your eyes other than maybe the cornea. In my case I didn't start wearing contacts again until over a year and half after having a vitrectomy, which definitely allowed my operative eye time to fully heal, LOL, but also a developing cataract made chasing the correct prescription strength easier using glasses.