Slow vitrectomy recovery

[ML441]

I am 5 weeks post-op for a Jan. 27th vitrectomy to remove a macular pucker.  My vision is much worse than ever, can't see the big "E" on the eye chart, and have a gray, opaque area in the center of my operated eye when I cover the other one. I did notice the gray area prior to the vitrectomy, after cataract removal on Nov. 11th.  I can see no noticeable improvement in my vision during the 5 weeks, and it is really scaring me that the vision is so much worse..  I carefully took all the drops prescribed after the surgery and followed all directions (did not have to be face-down).  The retinal specialist says the surgery went well and he doesn't know why the vision is so bad (he is worried too).  There is no detachment, edema, leaking blood vessels, infection, or any other known cause.  I have had several other tests including a carotid artery scan, MRI, blood work, OCT's, and fluorescine angiogram.  I also had a YAG laser treatment after the cataract surgery, which was also deemed successful.  All tests are negative.  I have glaucoma (controlled with drops) and macular degeneration.

I found this website, and am anxious to get your response.  Do you think I am going to recover my vision, at least to the pre-surgery level?  Any ideas what is going on?  Should I seek another opinion?  I am getting really worried.  

Many thanks for your help.
Julie

[Michael J Kutryb, MD]

Listen to Jodie J, his words are indeed very wise.  All I can figure is perhaps persistant macular edema, or perhaps macular ischemia or possible some other problem with the optic nerve such as ischemic optic neuropathy.  Of coure, surface problems like superficial keratitis, map dot fingerprint dystrophy or fuch's endothelial dystrophy can also play a negative role.  I would also look into getting a corneal topography and automated visual field test.  A follow up flouresceine angiogram might also be useful.  A good, general ophthalmologist should be able to help to see if treating the corneal surface or other problems might help.  In some of these instances, I find that the membrane peel just didn't help that much but didn't make thngs worse either (if you really look very closely at the old records.)  In the end, cystoid macular edema may be the culprit and I'm a little surprised your retinal specialist has not at least mentioned what he thinks might be the cause.

MJK MD

[JodieJ]

I've had two surgeries to peel a macular pucker, and I can really identify with your anxiety over the long wait to see (literally) improvement.  If your surgeon can't explain your lack of visual recovery, I would certainly seek a second opinion in your place.  I would make all my test results available to the second opinion surgeon.

[JodieJ]

Conventional wisdom suggests that visual acuity should be significantly improved by 3 months post-vitrectomy to peel an epiretinal membrane (aka ERM, macular pucker), although full visual recovery may take 6 months or longer.  This was not the case for me.

My first ERM surgery in 2006 was pretty much a nightmare.  My surgeon used the older vitrectomy instruments that required sutures, and (unfortunately) he left the suturing to a resident.  Around 2 weeks post-op a huge red mound appeared in the white of my eye, with black suture wires and knots polking through.  I was on high doses of steroid drops for several months to treat the inflammation.  By the time my acuity began to improve, I started having symptoms of a fast-developing cataract.  It wasn't until after cataract surgery (8 months post-vitrectomy) that I experienced a major improvement in acuity.  Unfortunately, the larger image size in my affected eye which I first noticed after ERM surgery didn't change.

I saw four top local retinal specialists, who all dismissed my complaints about the symptoms caused by the image size difference between my eyes.  Last year I traveled to Memphis to consult Dr. Steve Charles, who immediately identified my problem--my first surgeon had left pieces of ERM in my eye.  I had surgery the following day to peel the remaining ERM.  One of Dr. Charles' associates told me that it would probably be a couple of months before I'd see an improvement in my image size difference.  After three months had past with no change at all, I was getting a little frantic.  I wrote to a several researchers who had published papers about recovery from visual distortion after ERM surgery.  A British researcher wrote back that she was aware of cases where significant improvement had occurred YEARS after surgery.  During my fifth month post-op, I did experience a period of rapid improvement, although not as much as I had hoped for.

So I think that every case is different.  I'm glad to know that you'll be getting a second opinion.  My experience suggests that even "top" surgeons may vary in terms of their knowledge and skills.  

[ML441]

Thanks so much for your advice.  I am planning on getting a second opinion if there is no progress by the next angiogram in two weeks.  How long did it take you to start seeing improvement in your vision after the vitrectomy?  And why did you have two procedures?  Thanks, Julie

[ML441]

Thank you so much for your response.  Yes, I had corneal topography and visual field tests last week, with no significant changes from previous tests.  I am scheduled for another angiogram in two weeks.  If I see no improvement by that time (which will be 8 weeks post-op), and if there is no diagnosis, I will seek a second opinion.  My retinal specialist actually brought that up last week, even though he doesn't think he 'is missing anything'.  I will also bring up all the 'possibles' you have mentioned, just to make sure all bases are covered.  In looking up the definition of 'cystoid macular edema', I see that it most commonly occurs after cataract surgery....bingo!  That's me.  I can't tell you how grateful I am for your advice.  I'll let you know what happens.
Julie