Vitrectomy-Macular Pucker

[homecrafter]

Does anyone know if having a bit of lasering done inside the eye for a small hemorrhage during
Vitrectomy/ERM peel surgery increases the chances of scar tissue formation in the future?

Hence, another potential ERM peel. ;-(

Just wondering if the lasering makes things worse.

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

In this "modern" world do airline flights still get canceled because of mechanical problems, are all car  towing services going out of business because automobiles never break down or stall, why did my washer and drying both stop running last month?

You get the idea. Anything mechanical will fail, often at the lease opportune time. The modern medical devices we use are incredibly sophisticated, often the service contracts may cause a physician or hospial $5-15,000 per year.

So yes the equipment we use, in spite of the best of care and maintainence may break down. One time a phaco unit ($50-65,000 apiece) failed and we had to call another hospital put a phaco unit in the ambulance and send it to us. It was a hour delay. There just isn't enough time, money and expertise to have back ups for everything.  Hospital biomedical technicians are some of the smartest and hardest working people in any hospital.    I have been in other countries both "developed" and "developing" our equipment maintanence is the best in the world. Remember that in Missouri alone we have more MRIs and CT scanners than in all of Canada.

JCH MD

[homecrafter]

Thank you once again Dr. Hagan.  
It is nice to get someone on the inside's viewpoint.
Asking my surgeon is one thing, as I'm certain he would minimize it to cover himself...but it is sure nice to hear from you that this is not an unusual or unacceptable behavior on the nurses part.
Do you ever have laser machines break down during surgery ?  I am not "looking for trouble" here, but again my mind just keeps going back to how unprofessional and unacceptable it is to have the laser machine stop working while my eye is hemorrhaging inside...and it taking almost 10 min. to deal with the problem by finally bringing another machine into the room from down the hall and then warming it up.

Would you mind terribly just telling me if this type of thing happens rather frequently ?
The delay could not have done my eye any good with the light on inside there that extra time.
Thank you once again for taking your time to answer these questions.  Both good news or bad news on these subjects help us "non-insiders" understand the process.

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

I have done over 14,000 major eye procedures most under local anesthesia. I've had to deal with many emergencies while in the middle of someone's eye. It can be done. Generally no questions are asked or calls put through during the "crux" of an operation.  The system will come to a halt of surgeons are out for the count to any other business during surgery.  There is a huge shortage of physicians/surgeons and it will only get worse in the coming years. Your problems or complications are not at all likely due to any questions asked him about other patients with emergencies.  Why don't you just talk it over with him, it will make you feel better. There is no deviation from the standard of care.

JCH MD

[homecrafter]

Dear Dr. Hagan,

Just wanted to mention that I tried telling myself to be that empathatic-caring person that I normally am in this situation where my surgeon was interrupted during one of the most detailed/delicate surgeries that can be performed.  
HOWEVER, in this case I'm afraid that I need to be selfish...afterall, it's MY eye and I'm getting one shot at this.  There are many different Doctors she could have contacted for this RD ... the nurse did not know if he happened to have been pulling on the ILM membrane in a really critical spot or not , at the time she changed his focus.   Then, I get a hemorrhage inside and I naturally think it's likely his interruption made him tug too hard or something.   Isn't that what everyone would think?  And, is this fair to me as the one having the surgery ???

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

A retinal detachment is a sight threatening condition and asking the surgeon about it is routine.  Moreover your type of surgery can take several hours. The surgeon is in charge of literally 1000s of patients. Asking questions like this is the rule rather than the exception.

If you were the patient with the RD you would be glad the surgeon took 15 seconds to answer the question and start proceedings to do the next surgery.

JCH MD

[homecrafter]

I actually did ask the surgeon, but he simply said it was from pulling on it.
Still don't know if this type of thing just happens, or if the surgeon was "side-tracked" with the nurse interruption in the middle of surgery and possibly lost concentration for a moment when scraping the ILM layer.
I didn't mention this, but while I was awake and listening a nurse opened the surgical room door and interrupted the surgery with asking my Doctor if he could take an "add-on" patient that day for a RD.  My surgeon took the time to tell her his appt. schedule and said yes.

Really ????   I was surprised that this type of interruption was allowed during the middle of such a delicate surgery.   Any opinions on that ?    

[JodieJ]

I can't answer your question, but your surgeon can.

[homecrafter]

Your the best Jodie !
As much as I try to research these things, sometimes I come up short with answers.
Also, I cannot be on the computer too long after surgery.

Do you know if the hemorrhage during the Vitrectomy ERM / ILM peel surgery is quite common ?  I'm wondering if the vessel started to bleed from normal peeling of the tissue or if perhaps it was tugged on too hard by mistake.

[JodieJ]

Yes, I believe that a very small percentage of people do develop an epitetinal membrane as a consequence of laser treatment.  I did a little online research--one article stated that this occurred in about 2 of 1000 eyes (and did NOT occur in the other 998 eyes.)  Frankly, given all the risks involved in daily living, I don't think that this issue should be a focus for your attention.

[homecrafter]

Thanks Dr. Hagan,
I guess I meant is there more of a chance of developing additional scar tissue, like another layer of ERM over the lasered area, than if there were no lasering done inside.  The laser was used to stop a "hemorrhage" that developed during the peel of either the ERM or the ILM layer.  
Do these hemorrhages happen often during this type of surgery ?  

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

lasering is always do to create scar: that's how it works. It's a controled scar usually to seal holes or tears to destroy some times of tissue.  No scar = no work.

JCH MD