Vitrectomy and Macular Pucker

[Zakuski]

I'd like to get a much clearer idea of how the decision is made to perform vitrectomy or not for age related macular pucker.  A friend of mine just had the surgery and the results seem fairly disastrous. Infection seems to have been ruled out but there are indications of nerve damage or a sclerotic nerve.  How does the surgeon determine whether a pucker is going to progress to a hole?  My friend's post-op vision is decisively worse (double vision, for starters, needed an eye patch and now prism glasses) and the symptoms cannot be associated any longer with the time it takes for stabilization.

[Zakuski]

Thanks Jodi for all your comments and insight.  My friend, L, (lives in NY)
has an appointment on 10/28 with a well known and highly respected specialist in the Columbia-Presbyterian system. This whole thing has made me more than a little nuts;  my research (something I'm pretty good at) thus far  tells me that the recommendation for surgery was highly questionable in her case and is a cautionary tale about what happens when the patient doesn't  or can't come in to the surgical consult pre-armed with her own risk/benefit analysis of a procedure the average layperson knows nothing about anyway.  The consult with the specialist was only recommended  a few weeks ago tho the post op complications set in immediately (surgery was a 5-6 weeks ago).  I'm walking a fine line here- my friend needs not to lose faith in her medical care along with the currently lost stable eyesight; I must communicate with her responsibly.

Is it your impression too that this surgery is recommended too often in the 60 & over demographic (those without pre-existing disease or complications from other vascular illnesses? ) I don't recall that my friend was ever advised per Dr. O's note above, that most puckers do not become holes.  Dr. O: Statistically, on average how many do in this demographic? the puckers that do evolve into holes- typical characteristics or time span?   Z

[JodieJ]

The double vision is probably correctable.  Your friend should consult a strabismus surgeon.  It might also be wise to get another opinion from a retinal specialist.  

[Zakuski]

Thanks to you both for your responses.  You've been very helpful.   It's not at all clear to me that the risk/benefit ratio in my friend's case merited surgery.   There was in fact eye muscle damage as a result of the procedure.  Z

[JodieJ]

Whether or not to have surgery is really up to the patient.  It's a question of whether the benefits of surgery (likelihood of improved vision) outweigh the risks of surgery.  When performed by a highly skilled surgeon, this isn't a particularly risky procedure.

Your friend's double vision and need for prism glasses suggests eye muscle damage related to the local anesthesia injection.

[Ray T Oyakawa, MD]

A surgeon can follow a macular pucker to see if a hole if forming.  Most puckers do not lead to a macular hole.

Any surgery has risks.  Some puckers can be treated with medications drops or injections before doing surgery.

Dr. O.