Vitrectomy surgery

I have been diagnosed with macular pucker following cataract surgery with no noticeable symptoms in left eye, but distortions and 20/40 in previously dominant right eye.  OCT shows worsening over past year.

My cataract surgeon has had two retina surgeons examine me.  Both surgeons were recent fellowship grads.  Both suggest vitrectomy - act like surgery is no big deal.  The older cataract surgeon is not eager to see me proceed.

Left eye appears to have become dominant.

I am a retired dentist who likes to do volunteer dental projects,and visual acuity is important to me.

your advice.

[Sandra M Brown, MD]

Macular pucker in a dominant eye is annoying because the decreased visual acuity is accompanied by a lot of distortion that can be hard to ignore.  You can never truly switch dominance.  Given your ongoing visual needs for volunteer dentistry, the fact that you are OD dominant, and the fact that your vision is only 20/40 you should really consider a macular peeling procedure.  JodieJ had a particularly good experience, don't assume that yours will be so easy, but it is true that (barring complications) the surgery is not particularly painful.  Recovery can be slow as the retinal distortion has to resolve after the membrane is removed, and a keen observer will always notice some mild residual after-effects.  The vote is out on sutureless surgery and I am not sure I would have it myself, I'd have to weigh the pros (no sutures, more comfortable) against the cons (potential leaking hole allowing bacteria into the eye).

[JodieJ]

I have had this surgery, and it is no big deal--if it is performed by an experienced vitreoretinal surgeon using the newer "sutureless" instruments.  Personally speaking, I would not even consider having this surgery done by a resident or a fellow.  Only you can decide whether it's worth having surgery to correct 20/40 vision with distortion.  But I'd urge you to make a decision soon.  Outcomes are better in terms of improved acuity and reduced distortion when surgery is done early (rather than many months or even years after the onset of symptoms.)

There have been recent advances in this type of surgery which your cataract surgeon may not be aware of.  At least in my case, it was totally painless and took about half an hour.  A couple of hours after leaving the OR, I was enjoying a meal at a restaurant and feeling fine.    

[JodieJ]

Actually, I had this surgery twice--my first surgeon unfortunately left small pieces of the epiretinal membrane in my eye (which caused several unpleasant symptoms).  I would very strongly recommend that anyone considering ERM surgery find a specialist who is very experienced with this procedure.  Visual outcome and complications are very much related to the surgeon's skills.  I would highly recommend Dr. Steve Charles in Memphis, who successfully removed the pieces of membrane remaining in my eye after my first vitrectomy.  Dr. Charles uses the modern, sutureless instruments but has never had a patient who suffered a bacterial infection.  Flying back to Chicago the day after surgery was not a problem.